Society

The Long Goodbye

When the end of life comes later in life, the consequences are often unexpected—and often painful

From the March 2011 magazine
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Photograph by Joanne Ratajczak

Early may, 2010. Henry,* eighty-six, sits in his hot pink living room, dressed in his usual, immaculate checked shirt and tie. Piles of books cover almost every surface, and the art on the walls ranges from a fragile thirteenth-century Persian bowl to a nail “painting” by the late David Partridge. A charcoal portrait of the psychoanalyst Melanie Klein broods over the dining table, across from a pine cupboard full of Greek and Roman bowls and other ancient ceramics.

The nineteenth-century workman’s cottage in Toronto’s Cabbagetown is full to bursting with the habits and enthusiasms of two long lives, but next to the couch a wheelchair stands empty. It belongs to Henry’s wife, Anne,* who is also eighty-six. A distinguished biographer, she is paralyzed on the left side from a stroke she suffered nine years ago, and relies on Henry for everything from picking up her dropped reading glasses to help using the bathroom. Because he needs some respite, he has arranged for her to stay in a nearby long-term care centre for two weeks.

Today, after his first night alone, Henry feels ambivalent. “It certainly concentrates the mind, to do this separation thing,” he muses, thinking about all the interruptions he faces in his normal day. “On the other hand, I miss her terribly. It just feels wrong to be in this empty house without hearing ’Henry! Henry!’”

* Henry and Anne’s names have been changed.

A year ago, at eighty-five, Henry retired, reluctantly, as executive director of Abbeyfield Canada, an organization that maintains group homes for old people. Since his wife’s stroke, he has also been engaged in a Sisyphean struggle to continue living in their house. Henry fought the good fight on two separate battlefields, working to provide homelike environments for people who can no longer live independently while labouring to keep Anne in the place she loves more than almost anything. He continues to serve as a volunteer for the local Abbeyfield chapter, and today he’s thinking aloud about a scheme that would combine elder care centres with daycares for children. “I wonder,” he says in his plummy English accent, “who could do something about that…”

Twenty minutes’ walk from their house, Anne lies in her bed in the Rekai Centre, wearing a flowered silk nightgown with a deep V-neck and a matching bed jacket. She’s spending her two weeks here reading, watching television, and receiving visitors, with a sharp ear out for spicy gossip and an eye for stylish clothes. Of a recent guest’s attire, she says, “I really lusted after that little white leather jacket she wore yesterday.” The same woman brought her a welcome gift, a sub-rosa pickle jar filled with brandy.

One of the words that describes Anne is “indomitable.” When Henry left her in this bare-walled beige space—a sad contrast with the intensely coloured rooms of her house—she told him, with her characteristic drama, “I’ll never forgive you.” But within a day of her admission, he reported, “she really was marvellous, really was lovely today,” happy for him that he was taking advantage of her absence to embark on an epic bus trip to visit his family on Long Island.

Another word for Anne is “avid.” She knows exactly what she wants from life: “Interest. I still have enormous curiosity. I still want to meet new, interesting people and see interesting places and read interesting books.” Her most pressing desire these days is to visit the Prado museum in Madrid: it contains some of her favourite paintings, and she’s never been there. As she sees it, money is the main impediment to travelling as much as she wants. “Money’s so important,” she says. “I think back on my life and think, how could I have managed my finances better? It’s nice to have money when you’re young, but boy, you need it when you’re old.” She still receives royalties, she adds (the most recent from Serbia, for The Secret Ring, her book about Freud and his circle), and she claims the cheques could partially finance a trip to Madrid.

She’s so intent on what she wants that she assumes others have enlisted themselves in her current campaign. When I visit, she asks me, “Are you making any progress? ” With what? I ask, wondering if she is referring to my work. “With getting Henry to see that we can do the trip to Madrid,” she answers, as if this is self-evident.

Henry and Anne are two of the faces of old age, a stage of life that was once rare but is becoming more common. In 1900, a Canadian man could expect to live forty-seven years, and a woman fifty. By 2005, the average life expectancy for a man was seventy-eight, and that of a woman 82.7. Not only are senior citizens living longer; they make up an increasingly large segment of the population. By 2021, Canadians over sixty-five will outnumber children. In 2041, one in every four Canadians—9.2 million—will be a senior citizen. A growing number will live to be what gerontologists call the old-old (they class people aged sixty-five to seventy-four as young-old, those aged seventy-five to eighty-four as medium-old, and those eighty-five and up as old-old).

This burgeoning population is something new under the sun. The relatively few doctors interested in them are still learning how to care for their aged bodies. Psychiatrists, psychologists, and social workers are still trying to understand their emotional and social needs. And, no doubt because old age is unwelcome and even threatening in our youth-obsessed, quick-fix culture, the not-yet-old are still averting their eyes, denying it will ever happen to them. Old age is a largely unexplored and unmapped country, obscured by prejudice and myth.

But not to those who are making their way through it. Perhaps partly because Henry devoted the past quarter century of his working life to senior citizens’ housing, and partly because he remains an old-school Brit, his attitude to age is brisk and un-euphemistic. As with most people who are successfully negotiating this last stage, old age snuck up on him when he was busy doing other things, and he realized quickly that the graceful thing to do was accept it. “I’m not a different person because I’m old,” he says. Ten or fifteen years ago, if someone offered him a seat on the streetcar, “I would have bridled, because it made me realize I looked older than I thought I was, but now I say thank you.”

Anne, too, has been in many ways unfazed by the simple fact of aging. Beginning with her two strong-willed grandmothers, she has always been drawn to old people. During the years she lived in England, she had several older women friends who impressed her as models for a thriving old age. Like her, they were blessed with an unflagging interest in life; unlike her, they had the use of their arms and legs into their nineties. After refusing for several years to accept that her paralysis was permanent, she seems to have made peace with that on some level. And although she complains that old age is tough—“I mourn for my lost energy, because I had gorgeous energy”—she can’t stop herself from noting good subjects for future biographies. Reading about the American writer Elizabeth Hardwick recently, she thought, “Oh my goodness, that would be an interesting person to write about. Then I said to myself, don’t even think about it. You’re too old to start a book.”

Not every octogenarian has as many projects on the go as Henry does, nor regularly asks family to bring the book featured on the cover of The New York Times Book Review, as Anne does, but Dr. Benoit Mulsant would see them as typical of the “old-old” in several ways. Mulsant is the physician-in-chief at Toronto’s Centre for Addiction and Mental Health, and clinical director of its geriatric mental health program. Octogenarians, he says, are physiological and psychological survivors. They’ve combined good genes with sensible habits of self-preservation. They aren’t substance abusers, who may die from lung cancer and liver disease in their fifties and sixties; nor did they die from stroke, diabetes, cardiovascular disease, or other serious conditions that can fell people in their sixties and seventies. They tend to have married, had children, and been fairly sociable—all indicators for a long and contented life. Many have some disposable income, because, unlike the boomers, they were savers.

One of the myths about old age is that the old are particularly subject to depression, a misconception Mulsant credits to the ageism of our society: we project onto the old our own conviction that old age must be miserable. On the contrary, he contends, his research shows that the old actually have lower rates of depression than the middle-aged. Those over eighty-five probably have an even lower rate than do senior citizens in general. It’s true that misfortunes (like the death of a spouse, a stroke, or a broken hip) can cause a depressive episode in 10 to 20 percent of those affected, but depression in the old is just as treatable, if not more so, than in the middle-aged.

Anxiety and panic disorders, social phobias, obsessive-compulsive disorders, and schizophrenia all tend to decrease with age. “Life is a therapy in itself,” Mulsant says. “If you have been waiting for the sky to fall on your head for fifty years, at some point you realize that it isn’t happening.” He doesn’t claim that all old people are happy and busy. With their siblings, spouses, and friends failing or dead, even those in relatively good circumstances often experience what he calls an existential loneliness. Perhaps above all, he says, the old have a remarkable capacity to adapt. They tend to be stoic, because they were raised in an era that valued a stiff upper lip and a shoulder to the grindstone.

Henry and Anne’s generation, Mulsant adds, is a special one. The upheavals of the twentieth century made significant demands on their stoicism, and probably reinforced it. A person born in the early 1920s was a child when the Depression began, and a teenager at the start of the Second World War. Many of the men fought in the war while the women waited for them to return. They faced all the psychological readjustments of the postwar period, as well as housing shortages and other material deprivations that lasted into the early 1950s. In the 1960s, as they hoped to settle into a comfortable middle age, their teenage and twenty-something children moved into massive rebellion. They were one of the first generations to divorce in substantial numbers, and one of the first where women had a professional life.

Henry knows all that first-hand. Brought up in China, where his Northern Irish father was killed in a Japanese prison during the Second World War, he was sent to Toronto as a university student to escape the war. He joined the Canadian army in 1943, and was posted back to China because he spoke Mandarin. In 1980, after business ventures in China (and years of virtual house arrest under the Communists), Hong Kong, South Africa, and England, he reconnected with Anne, a woman he had dated at the University of Toronto almost forty years earlier. Back then, she was a leggy brunette with a wide smile, studying English literature. Now she was the internationally renowned biographer of, among others, Melanie Klein and the sex researcher Havelock Ellis. She and Henry married, the third time for both, and settled down in Toronto. In 1984, Henry founded Abbeyfield Canada.

Anne’s life, which would have been inconceivable before the twentieth century, has swung between the poles of adventure and domesticity. The adventures included biographies that often broke new ground, as in the frank discussion of the nineteenth-century writer John Addington Symonds’ homosexuality; an academic career, at a time when women professors were rare and often considered bothersome; serious illness, including breast cancer; several important love affairs; and marriages to a naval officer and the one-man band of Canadian culture, Mavor Moore, as well as to Henry.

The domesticity began early, with a childhood conviction that books and houses were the two most precious things she knew. It turned tragic at the age of ten, when her adored family house on Toronto’s Rosedale Heights Drive was repossessed in the Depression. More than seventy-five years later, she can still close her eyes and remember every inch of that house. “When I lost it,” she says, “it coloured my whole life.” A peripatetic and unhappy childhood exacerbated her sense of homelessness: for years, when she had trouble sleeping, rather than counting sheep she tried to remember the forty houses in which she has lived. In 1976, at the end of her marriage to Moore and on the eve of moving to England for some years, she bought a small, semi-detached brick cottage, built in 1870 in the gentrifying district of Cabbagetown. That became her anchor to Toronto and the home she had been missing since childhood. When she returned to Toronto in 1982 with Henry, she painted the wooden trim on the outside bright pink and began cultivating her garden.

I had been aware of Anne’s biographies for years, but we probably first met in the late 1990s. We lived two streets away from each other, and I had been until recently the arts and books editor at the Globe and Mail, so we had friends and acquaintances in common. She and Henry were an indefatigably hospitable couple, giving a garden party every summer in the green sanctuary Anne tended at the back of the house, and countless dinner parties under the autocratic gaze of the Melanie Klein portrait. (I had misunderstood a joke about the drawing early in our friendship, and thought for years that it was Dora Mavor Moore, the doyenne of Canadian theatre and Anne’s formidable former mother-in-law.) With her biographer’s nose keenly pointed in the direction of the latest scuttlebutt, Anne was lavish in her praise and support for other people’s work, and subtle and generous in her matchmaking. She swam almost daily in the pool at the Manulife Centre, and I remember her striding through Cabbagetown’s streets, tall and blond in a trench coat. Her zest for life seemed unquenchable.

So did her determination. After her stroke in 2002, she persisted for years in physiotherapy, turning a deaf ear to her doctors’ verdict that she would never regain the use of her left side. Nor would she accept that a narrow, two-storey cottage with a sole second-floor bathroom was impossible for a wheelchair-bound person to manage. Her struggles to walk, cook, and garden again did not succeed, but she prevailed when it came to the house. Against almost everyone’s advice, she and Henry traded a pantry for a downstairs bathroom, and installed ramps and a chairlift for the stairs. With six hours a week of assistance provided by the Ontario government and about twenty hours of private help—and a great deal of fetching, carrying, and lifting from Henry—they stayed put.

Henry and Anne’s fierce desire to stay in their house is familiar. For many people, the adjustment when this becomes impossible is hard, and half of the seniors who enter long-term care suffer a mild depression during their first year. Sheila Smyth, the program director of the supportive housing facility at Toronto’s Baycrest Centre, agrees that the move to an institution is a “tough hit” that does something to a person’s self-definition. The good news is that living independently at a great age, even with significant handicaps, is becoming easier. Thanks to improved nutrition and exercise and decreased smoking, as well as the strides medicine is making in the prevention and rehabilitation of strokes, heart attacks, and other chronic conditions, old people are healthier than they were a generation ago. That means they can live at home longer, which makes the time they need institutional care correspondingly shorter.

Smyth has noticed that the average age at admission to supportive housing at Baycrest has jumped significantly in the past eight years, from eighty-four in 2002 to 86.5 in 2010. The same phenomenon has been reported, even more dramatically, in other prosperous countries. In Sweden, which spends a greater percentage of its GDP on elder care than any other country, 400,000 seniors lived in homes for the elderly or received municipal home help in 1980. By 2005, that figure had been reduced to 245,000, representing a whopping 40 percent decline.

In Ontario, Henry and Anne benefit from the Aging in Place program, which supports elderly people who want to stay at home, by providing access to caregivers, daycare centres, and doctors who make house calls. But home care, especially when it depends on the frail elderly tending the frail elderly, is always in danger of becoming untenable, sometimes suddenly. In the past, Smyth says, Granny moved in with one of her children when she was widowed in her sixties, still young enough to help out with the grandchildren and the cooking. These days, the cared-for and the caretakers are frequently much older. A current joke with more than a grain of truth goes, “My parents are ruining my seventies!” Henry and Anne are in the same generation, but it’s undeniable that an eighty-six-year-old caring for a handicapped eighty-six-year-old is a precarious balancing act.

When people begin to talk about old age, almost invariably someone will opine that we’ve bought longevity at the cost of misery: our extra years, according to this common assumption, are not good ones. But, at least in terms of their physical well-being, the healthier senior citizens we’re now seeing spend less time in the difficult period between decline and death. This change is called compressed morbidity, and it also decreases their health care expenses. A typical healthy senior costs the health system about $600 a year; and, paradoxically, the older people get, the less they stress the system. That’s because sick people in their sixties and seventies need more expensive tests, surgeries, and acute care than the very elderly in their eighties and nineties, who are typically at home, in assisted living, or in long-term care—all of which cost less than hospitalization.

Henry and Anne are at odds about her wish to travel. They have taken an impressive number of trips since her stroke, including several to Britain, which is rare for a person designated a “full carry-on” by the airlines. (Almost the only full carry-ons who do travel are Paralympic athletes.) But Henry can’t do it anymore. He worries about the expenditure, about pushing the wheelchair over Madrid’s cobbles and hills, about the awkward effort of transferring his wife in and out of cabs. He likens her “yanging on about a trip, a trip, a trip” to a spree at Holt Renfrew, something to remind herself that she’s still here. “She knows very well that we’re beyond it in many respects,” he says, “but she wants to go, to show that she is still around. But how do I deal with it? I don’t know.”

A family member has suggested that the couple consult her longtime analyst to work out some of their differences, and Henry agrees: “What we need is an outside person to say, ’Why are you pushing your caregiver so hard? ’” Anne dislikes these visits, finding them “kind of tattletale-y—he tells a tale on me, and I tell one on him.” Meanwhile, she feels the analyst always takes Henry’s side, but she’s not ruling it out.

If they cannot agree about travel, they are united in their wish to stay in their home. But the house remains challenging and perhaps dangerous, particularly the second-floor change of level between the chairlift and their bed. Henry’s life as a caretaker weighs on him physically and emotionally. The nighttime demands, sometimes fifteen to twenty requests in a single night for the commode or a change of position, are wearing him out. He quotes their friend, the biographer Lady Elizabeth Longford, who, when asked if she ever thought of divorcing her husband, said, “Divorce? Never! Murder? Often.” Henry seconds that: “I never want to separate from her, and I never want to leave, and I love her, but she drives me up the wall when she gets me up in the night.”

He thinks one of the strengths that allowed Anne to break down barriers for women in academic life, and to win the Order of Canada for her biographies, is not serving her well in a disabled old age. “She got there through impatience,” he says admiringly, remembering her as an undergraduate who always went to the library immediately when a term essay was assigned months in advance. But now she’s completely dependent on others. Do you think she admires her kind caregivers? he asks without waiting for the answer. Definitely not; she can be infuriated by the slowness of others. “How do you curb that impatience? It’s horrible for her. How would you like it if you couldn’t move anywhere? ”

Henry realizes their situation is fragile; if he breaks a leg, he says, it’s game over. If Anne dies first, he will go into what he approvingly calls the “forced socialization” of an Abbeyfield home, typically nine seniors with a housekeeper. It’s like a family, he says: “You love some of these people, and you hate some of them, and it’s very important to have a bit of friction going on.” But it wouldn’t work for Anne: aside from the fact that she dislikes communal living, Abbeyfield only takes relatively able-bodied senior citizens.

Late May and June, 2010. A few weeks after Anne returned from respite, we speak on the phone. Things are going very badly, she says. She’s too upset to explain what has happened, but Henry isn’t able to care for her anymore, and she will have to go into long-term care. “Isn’t that awful? ” she says. Then there is silence for a beat, and she continues: “Oh, well.” I thought I heard the beginning of acceptance in those two monosyllables. I was wrong.

After hours of not feeling well, Henry had gone to a drop-in clinic in the neighbourhood, where he was advised to go straight to the hospital. He did—on the streetcar and the subway. At St. Michael’s Hospital, they told him he had had a heart attack. Typical of many in his generation, he had not spent a night in hospital for over seventy years. Now, during a fifteen-day stay, he underwent two angioplasties, and had two pacemakers (one temporary, one permanent) installed.

Dr. John Sloan is a Vancouver GP and the author of A Bitter Pill: How the Medical System Is Failing the Elderly. One of his guiding principles is that the old should be kept out of hospitals whenever possible: they become deconditioned with frightening speed, and are vulnerable to every passing hospital-acquired infection. But Sloan also counsels, “Treat for comfort and function above all, and don’t expect miracles.” For twenty years, his office was in his car. He stashed his instruments and his computer in the back seat, treated old people exclusively, and only made house calls. He got a feel for his patients’ lives from being in their homes, he enjoyed hearing their stories, and he relished the complicated challenges of their frail bodies. Chances are he would agree that Henry’s treatment was sensible, neither extravagant nor overly optimistic.

In A Bitter Pill, Sloan insists that a medical culture such as ours, based on prevention and dramatic rescues, is diametrically opposed to an old person’s needs. A big part of the increase in health care costs, not limited to senior citizens but true of the population at large, is due to expensive new drugs and high-tech investigations and procedures. The oldest seniors already receive relatively few of these tests and procedures, but Sloan would like to see them subjected to even fewer. In particular, medication—the typical fistful of prescriptions that compete unpredictably in a delicate constitution—poses a problem for seniors, because interactions between drugs can cause more problems than the individual ones fix. Sloan says the elderly react to medication more individually than younger people do, and most doctors don’t understand that or monitor it carefully enough. (As a case in point, a geriatrician visited Anne last spring and immediately discontinued four or five of her battery of pills.)

Sloan’s recipe for the old: humane, low-tech care, with no drastic interventions. First and last, listen to them. When it comes to their deaths, he says, “Keep them at home, hold their hands, treat them like people, and let them go their course. That’s what I want when I go: loved ones around me, white lies please, see you later.” It all sounds a bit like Dr. Finlay’s Casebook, the BBC series about an old-fashioned country doctor, and Sloan admits that in some ways he is bucking a whole culture. But he’s optimistic about the future, because in 2011 the oldest boomers will become seniors. “We fix everything as we sweep through it,” he says, speaking as part of that generation. As they have done with every other stage of life, once the boomers arrive somewhere it suddenly becomes fascinating, and they use their demographic heft to make things as pleasant as possible for themselves.

When Sloan says, “fix everything,” he’s hoping for a medical climate that would encourage the kind of un-glitzy, individualistic care he recommends, and discourage the interventional over-treatment he sees everywhere. He thinks that the more old people stay away from specialists, including geriatricians, the better off they will be. But it’s possible that Canada’s shortage of geriatricians is also part of the problem. As well as specializing in caring for the elderly, which is still inadequately understood, they determine policy and direct assisted living and long-term care institutions. Perhaps the cookie-cutter, big box approach to elder health care that Sloan deplores would be less prevalent if we had more doctors who were knowledgeable about old age. Canada has about one-fifth of the geriatricians it needs, and many of those are nearing retirement. In 2007, there were only six in the country under the age of thirty-five. This contrasts with Europe, where geriatrics is second only to cardiology as the most chosen specialty, a discrepancy that suggests a peculiarly North American unease about aging.

Canada’s lack of geriatricians is frequently connected to a fee-for-service system that penalizes doctors whose patients take up more time. Dr. Michael Gordon, the medical program director of palliative care at the Baycrest Centre, disagrees. Geriatricians’ fees in several provinces have increased recently, he says, but the disinclination is more profound than money. Medical students are trained by specialists, many of whom concentrate on organs rather than people, and complain that they rarely get “good outcomes” with the elderly. That disparaging attitude influences their students’ career choices. Most important, Gordon says, to go into geriatrics, “you have to like old people. I’m not convinced that many people do.” Scratch a geriatrician, he adds, and you’ll usually find someone who had a strong relationship with an old person in his or her childhood. In his case, it was a grandmother.

People who age well often seem to possess curiosity and serenity. The first keeps them keen about life, while the latter comes in handy when circumstances are beyond their control. Anne has always been notable for her curiosity; now, it seems, she will also need to call on serenity. She has been worried and distracted since Henry went into hospital. Once when I visit, I find her looking at a scrapbook of a lecture tour she did in France when her biography of Melanie Klein came out in the 1980s. I have never known her to linger on the past, even to this limited extent. Every once in a while, she rallies, or at least the clothes horse in her does. A friend had mentioned that a dress shop Anne did not know was having a sale, and she seemed uninterested. But the next time I visit, she asks if I can go to the sale and buy her something, and she’ll reimburse me.

Things are unravelling fast for the couple. After a confused week of round-the-clock care at home, Anne has to return to the Rekai Centre, to another featureless beige room. Her priorities have shifted radically: in May, she was desperate to travel, and now she just wants to go home. When friends come to visit, she begs them to get her out of here. She finds the staff unhelpful and slow. They find her demanding.

I visit Henry when he is released from the hospital. His colour is good, but he has clearly lost weight, and this is one of the few times I’ve seen him without a tie. (His white shirt, though, is freshly pressed.) He is strikingly weakened, unable to walk from his car to the house with ease. On doctor’s orders, his days of supporting his wife in and out of the wheelchair, the car, and over the landing on their second floor are over. “I did it for eight years,” he says more than once, with an air of finality, but also as if he needs to convince himself that he has paid his dues. It’s clear to him that they will have to leave their house, as twenty-four-hour care would be impossibly expensive.

A few days after Henry returns home, he is ushered into Anne’s room at the Rekai Centre in a wheelchair. According to a visiting friend, their reunion, after their longest separation in many years, is poignant, but she has passed from an initial shocked acceptance, if that is what it was, to resistance. In spite of Henry’s doctor, she insists that if only they can find the money to have their paid helper for more hours, she and Henry could get through the nights alone. She is not ready to say goodbye to the pink house.

Henry begins visiting senior citizens’ residences, some of which would take him as well as Anne. Their favourite, Belmont House, has a waiting list of years. Meanwhile, Anne is locked in a disheartening game of musical chairs. In late June, she is moved from the Rekai Centre to the Heritage Nursing Home, where her room is on the Alzheimer’s floor, because space is limited. Anne, whose memory would shame a thirty-year-old, stays in her room, reading. In July, she is accepted at another long-term facility, Vermont Square, and moves there. It looks like a speeded-up return to the repeated, dreary moves she endured as a child.

October 2010. Henry is sharply aware of what leaving Cabbagetown will mean for him. He talks about losing what he calls the second tier of relationships: the jocular but rewarding chats with the people who work at the neighbourhood post office, the corner store, the liquor store. Now he will lose that secondary level, at least in Cabbagetown, as the primary tier—siblings, friends—dies off. He has graduated from wheelchair to walker, although he complains of lassitude. Maybe, he says, that’s a result of laying down his burden of care. He drives to visit his wife about five times a week, and he and a family member take her out for dinner regularly. As he regained his strength, Henry decided that he was not yet ready for assisted living; he will sell the house and move to one-storey quarters.

Anne’s private sixth-floor room at Vermont Square is big and bright, overlooking a swath of trees that have just begun to change colour. The rates for long-term care facilities in Ontario, set by the Ministry of Health, are uniform: a private room with bath costs $2,166.58 a month. Her family has done their best to make it homelike, bringing in a bookshelf, a pine bedside table from the Cabbagetown house, and some favourite pictures, including the Klein portrait. Photographs of Anne’s parents, a beautiful flapper and a square-faced businessman, hang on the wall. When a friend and I visit, we find her curled over a book. She asks immediately to be transferred from her wheelchair to her bed because she’s uncomfortable, but the aides tell her firmly that she must wait until after lunch. We wheel her to the drab, institutional dining room so she doesn’t have to look longingly at her bed. Other residents—some demented—shuffle, walk, or are wheeled into the room. One man, suffering from Alzheimer’s, regularly emits loud bellows, like a donkey braying. Anne tells us he was a professor. A tall, blond aide with an Eastern European accent shows Anne two plastic-wrapped, pallid lunches: breaded chicken burger or egg salad sandwich. Everything, including the thin paper plates, is white. She chooses the chicken.

“Depressing, isn’t it? ” she remarks, meaning the whole situation, not just her lunch.

My friend says, “I won’t lie to you, Anne. It is.”

Although her memory and her judgment of the books she reads insatiably are as sharp as ever, she asks over and over, “When will they put me in bed? ” We tell her, after lunch. “Why am I here? ” she asks, as if she has never been told. When she hears the familiar explanation—Henry can’t care for you anymore, and you can’t afford twenty-four-hour care—she nods sadly, more or less resigned. Then she returns to the present: “When will they put me in
bed? ”

Thinking about Henry and Anne, it’s hard not to wonder what they might have done differently. Anne thinks she should have figured out how to save enough money so they could have afforded full-time care at home: “There’s nothing so important as money,” she repeats. Many of their friends wish she and Henry had moved to a facility years ago, ideally a place that offered graduated stages of care and where they could be together. On the other hand, after Anne’s stroke they had eight more years in the house they love, and they feel they struck the right bargain with fate.

I also ask myself what I could do to avoid ending up in Vermont Square. Save money, or club with friends to pay for a house (called the Feminary by one friend, as we expect to outlive the men) and the necessary services? Move nearly 5,000 kilometres away, to live near or with a daughter and her family? Now in my mid-sixties, I delude myself, with increasingly less conviction, that these decisions are still in the future.

For almost thirty years, Anne’s pink house was her refuge, the place that did the most to heal her homelessness and anchored her to Toronto. She began and ended her 1999 autobiography, Elusive Subject, by writing about her sense of exile, and the cottage that brought her “the reassuring familiarity of home.” Under its roof, she produced four books, hundreds of lectures and articles, and countless dinner parties. The contrast between the house, crammed with her omnivorous personality, and the room she lives in now is painful. But she has survived so much adversity that it is hard, even now, to think of her as defeated. She writes in Elusive Subject about her favourite French verb, se débrouiller—“to cope or manage.” During a particularly difficult time, it became a touchstone: “One mislays a husband,” she writes, “one screws up one’s life; like a muddled Robinson Crusoe, ‘on se débrouille.’” One copes. That is the resilience she may yet regain, to help her make sense of the rest of her life.

Katherine Ashenburg wrote The Dirt on Clean: An Unsanitized History. Her 2011 Walrus feature, “The Long Goodbye,” earned a gold National Magazine Award.

Joanne Ratajczak is completing a book-length project documenting contemporary Poland. Her work was exhibited at Slideluck Potshow Montreal in 2009.

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