Her daughter is worried. Mom is 93. She's been on her own for all but the last month and now, she's not taking well to the nursing home.

"She has a Master's degree," her daughter says. "She was so with it...until the Vicodin incident. Now all she does is cry."

My new patient has no cartilidge left in her hip. The Vicodin was prescribed to help with the pain but, as drugs frequently do, especially pain meds and anesthesia drugs, it made this elderly woman psychotic, paranoid and confused.

Now she lives in the nursing home. And cries.

When I find Emma, she is sitting in the dayroom. A huge screen TV is showing a soap opera. Emma has been wheeled to sit in front of the television, surrounded by other demented patients who cannot move on their own. It is, I think, for my Emma, like being sentenced to Dante's Inferno. A living hell.

"My mother isn't being intellectually stimulated," her daughter told me. "They have bingo. Well, Mom did that with her students. She doesn't want to play it herself. The only other thing is church." The daughter smiles ruefully. "She's Episcopalian. That's not what they have here."

I think of the screaming lay preachers who hop up and down in front of the patients, exhorting them to repent before they burn in hell. No, that's not the Episcopalian way. I'm Episcopalian. I know. Hell, to us, is such a tacky concept. We don't "do" hell.

I approach Emma gently, stoop down beside her wheelchair and smile at her. She is crying. Her face is red and contorted with angst as she sobs into her hand and rubs her bloodshot eyes.

For Emma, a lifetime of memories swirl in a rapid-fire slideshow before her eyes. For a moment she is worried about her son. He's only 13 and he's late for supper. She doesn't know where he is. She shakes her head, impatient with the mind that betrays her. "No he's not. He's 36!" She thinks we're in church. She apologizes for the way they've let things go, but the money for repairs simply isn't there.

I tell her I know her mind feels foggy, that she is having trouble thinking. "I know this is terribly hard for you," I say.

"It's hard for all of us," Emma says. "I feel so sorry for them. They need help too."

I tell her I am trying to help as many as I can.

"We're all in the same boat," she moans. "I never thought it would come to this. I just didn't."

And then she remembers her mother has died. It is as if I've just broken the news to her. A wall of grief hits her and she sobs.

I slip my arm around her thin shoulders and hold her. I think of the Youngest Unnamed One, my son, who has learned about MRSA and nursing homes. "You've got to quit," he told me. "Right now! I don't want you to die!"

I tried to reassure him, but he would have none of it. "You don't touch anybody do you?"

Of course not.

I work with Emma for a good thirty minutes, telling her that I believe we can help her get some of her thinking back. She doesn't believe me, but she smiles bravely, as if what I say helps.

I ask what she thinks would help. She says something that doesn't make sense but her facial expression makes me think she'd like me to offer to help her kill herself.

"I can help, but it may not be exactly what you're thinking I can do."

Emma smiles. "Oh, so you got that one, eh? You're smarter than I gave you credit for," she says.

Then, as if I've passed the test, Emma confides in me. "They told me I was scheduled to die on Friday, but I'm still here."

When Emma is alone, I learn, she hears voices, receives visitors no one else can see, and it terrifies her. "I don't know what to pay attention to."

I tell her I will not let her be killed, that we don't do this, that she shouldn't listen to those voices...But Emma is crying.

When she is calmer I tell her I will return to check on her.

She smiles and thanks me, like a proper old lady remembering her manners.

Then she says, "Take care of yourself, honey. Don't work too hard."

I say I won't.

Emma has one last piece of advice for me.

"And honey?" she murmurs.


"Just don't be a pussy like I am!"

I rock back on my heels, wide-eyed. Did I hear her right? Did she just use the P word?

Emma grins.

"Don't you worry," I say, wondering if she knows just how badly I need to be reminded of this. "I'll be on the case and Emma, I won't be a pussy!"

Emma chuckles.

A moment later I look out at her from the desk in the nurses' station.

Emma is crying.

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