Buy it here: Amazon | Barnes & Noble | PowellsBy 8:20 all eleven residents are sitting at three tables, placemats and silverware set before each, glasses of water or juice or both, cups of coffee for those who want it. Hayes, who is ninety-one, is currently the only man in the neighborhood. In the world of Alzheimer’s, as in the larger word of the elderly, women significantly outnumber men. At Maplewood right now, of thirty-nine residents living in four neighborhoods, only four are men. Hayes is the oldest and has been here the longest.Hayes’s wife of sixty-eight years, Mabel, has specified exactly how he is to be dressed every morning: white cotton undershirt, long-sleeved button-down sport shirt, v-neck sweater on top; underwear, long johns and khakis on bottom. He is unable to help much, so it takes forever to dress him. But I must admit, the guy looks dapper. He is tall and just barely on the scrawny side of lean with a chiseled face, a strong jaw and a becoming wisp of silver hair. If Jeremy Irons lives to be a nonagenarian, he’ll look just like Hayes.Frances, Jasmine and I are sorting through the covered breakfast plates on the cart that was just brought in, checking the dietary log to make sure we give each resident what the log says we should give them. Somehow Frances has this memorized: no eggs for 135, she tells us; cut-ups to 131, finger food for 134. She says this faster than I can find the notations in the book. Jasmine and I exchange another look while Frances’ back is turned. The look is equal parts awe and terror. This isn’t even Frances’ regularly assigned neighborhood. She usually works neighborhood 1. But apparently she’s worked relief here enough to know everything there is to know. I want to admire her competence, but instead I am intimidated. I’d dislike her if she weren’t so likable.Meanwhile, from over at one of the small dining room tables, Hayes starts yelling.“Help me, help me, somebody help me.”We all look over at the same time to make sure nothing is wrong. Hayes is sitting up straight in his wheelchair. He’s got a glass of milk in his hand.“Help me, help me,” he yells again. As Frances and Jasmine hand out the plates, I go over to see what’s up with Hayes. He doesn’t seem to need help, and when I ask him what he needs, he doesn’t know. I stand next to him and rub his back, the only thing I can think to do. That quiets him down. When I leave a minute later to get his plate, he starts yelling again. I hurry back.“I’m Hayes,” Hayes says when I walk up to him.“Hello,” I say. “I’m Lauren.” He looks up at me.“Moron?” he says.“No,” I say, taken aback for a moment, then laughing. “LAW-REN,” I say my name loud and clear, articulating the syllables carefully.“MORE-ON?” he says again, also articulating, also loud and clear.Is he doing this on purpose? I start to say my name again but think better of it.“How do you do, Hayes?” I ask.“I do as I please,” he replies.I laugh so hard that Frances comes over to see if I’m okay. Who knew that an Alzheimer’s patient – I mean resident – could deliver lines like a Borscht Belt comedian? I’m going to like this Hayes, even if he is a handful.“Rub my back,” he orders me. “I’m itchy. I’m itchy.”The plates are distributed, more coffee (decaf, of course) is poured and plastic juice glasses are refilled. Frances feeds one of the Franceses – the almost centenarian whom I decide to call “Old Frances” from now on – and Jasmine feeds Addie, another small, white-haired woman in a wheelchair. I look from old Frances to Addie and back again trying to find differences in their faces so I can remember who is who. It’s hard. Why is it so hard? All of a sudden, I realize how unaccustomed I am to actually looking at the elderly. All little old white-haired ladies look the same to me. I have to concentrate. I begin to see: Old Frances is smaller and bonier. Addie has big, surprised-looking blue eyes.After breakfast, it’s time to toilet everyone. Part of the personal care the facility promises to provide is toileting the residents every two hours. This can be as blessedly simple as reminding someone that it’s time to go to the bathroom – so called “cueing” (only a few residents are able to function with this minimal help) – or as labor-intensive as lifting a resident out of a wheelchair and holding her up while another RA (wearing gloves) rips off her diaper and assesses and deals with whatever is there. Then the two caregivers steer the resident to the toilet seat, sit her down, turn on the faucet for inspiration and pray for something. Whatever goes in the pot doesn’t go in the diaper, which means an easier change next time. Because each neighborhood has only one caregiver on shift, Frances would normally have to use her walkie-talkie to call for the “Float” – the one part-time extra caregiver who helps wherever needed – to accomplish these two-person assists. But Jasmine and I are here today.We start with Old Frances who would be a two-person assist – that is, she is wheelchair-bound and needs total care – except that she weighs only 90 pounds so one caregiver can handle her alone. When we wheel her into her room, I notice something I had not noticed earlier: a handwritten sign taped to the wall that reads “Hospice patient. DO NOT CALL 9-1-1.” I ask about this. Apparently, Old Frances has pretty much stopped eating, and her family and her doctor think the end is near. Her designation as hospice patient is a kind of death watch. No extraordinary measures will be taken to keep Frances alive. She’ll get what’s called palliative care, only what is needed to keep her comfortable. She is what is known in the world of eldercare as a “DNR” – do not resuscitate. I take a good long look at Old Frances. For an old, shriveled, demented, wheelchair-bound lady, she actually doesn’t look too bad. It’s hard to imagine that she’s near death. But how would I know? Back in those much-vaunted days of extended families when women died in childbirth in their own beds, and children died of scarlet fever in their own beds, and grandma or grandpa, who lived with you, worked until they dropped right in front of you, people knew what death looked like. Not today. I have never seen a dead person, or a dying one.Back out in the common area, Hayes is yelling for help again. Jasmine goes over to him. His arms are crossed over his chest.“Are you cold, Hayes?” she asks. It seems impossible given that he’s wearing three layers of clothing, that it’s a scorching August day and that the neighborhood is kept at hot-house temperatures. “Are you hot”? she asks. He doesn’t answer, doesn’t seem to be paying any attention. “Are you just right?”“Just right on the edge,” says Hayes.When lunch comes, I struggle again to get the right plates to the right people. I check and recheck the dietary list. I stare at Addie, then Old Frances, then back to Addie, still confused. Once I figure out who’s who, I’m still confused. Is the lady I’m calling Old Frances, Frances C or Frances M? I better not confuse them. Their dietary needs are quite different. I went through this just four hours ago at breakfast, but my mind’s a blank. Why can’t I keep this straight? Am I starting to have memory problems? This is, of course, not the first time I’ve had this thought. Every child of a parent with Alzheimer’s secretly fears that there is a bad gene at work, a gene that’s been passed on and lies in wait, ready to switch on the machinery of dementia when the time is right.I know that early-onset Alzheimer’s, a rare disease that hits a person in her fifties, or even forties, has a strong genetic link. But my mother’s disease, coming in her seventies, was of the garden variety, the one that must be caused by something but no one knows what. If genes are implicated, the link is weak. Still, I wonder when my mother first suspected something was going wrong. Was she as young as I am now?After lunch I am allowed a ten-minute break. Most of the other RAs spend their breaks and the thirty unpaid minutes we are allowed for lunch sitting outside, in an area behind the facility hidden by a tall fence, on sticky white plastic chairs where they chain smoke and talk about their no-good boyfriends. I decide to take a pass. I grab my insulated Starbucks mug and get hot water from the kitchen to make a cup of tea. I brought the teabag from home, new fancy green tea I tried last month when my husband and I were at a spa resort. The box of fifteen teabags cost more than I make here in an hour. I sit on a Naugahyde banquette in the atrium massaging my legs and sipping tea.I’m sure I can learn something from this place and these people, but I’m not sure what. I hope I have the strength and the stamina – physical and emotional – to stick around and find out. Right now it’s all I can do to learn the job. I realize sitting here, six hours into my first day of on-the-job training, that I am no longer who I was just yesterday at orientation. I am not a reporter playing a role to get a story. I can’t be. The work is too hard, too all-consuming. Helpless people depend on me. Here at Maplewood I am a caregiver, an RA like the other RAs, with a magnetic name tag clipped to my uniform shirt, with a walkie-talkie and a green half-apron stuffed with latex gloves. My job, for eight hours, is to care for people who can no longer care for themselves, who may no longer be themselves. My job is to be the good daughter.At the end of the shift, sitting in my car in the parking lot, I take a moment to record in my reporter’s notebook what we did, the three of us. This is what one of us will have to do – as in me – when the real work schedule begins next week:11 people woken up, cleaned and dressed5 loads of laundry washed, dried, folded and put in residents’ rooms11 people served breakfast3 people hand fedkitchen cleanedtables wiped and cleaned2 people showered8 people toileted three times11 people served lunch3 people hand fedkitchen cleanedtables wiped and cleanedcarpet sweptgarbage collected from 11 rooms and kitchen, taken out to dumpsterI am glad it takes almost a half hour to drive home, an unheard of commute in this town, because I need every minute of it. For the first fifteen minutes I obsess about the residents. I talk out loud, naming all the names I can remember, mentally going around the perimeter of the neighborhood, room by room, to see if I can match names with numbers: Marianne, 141; Eloise, 140; Hayes, 139. That’s all I can do. I’ll write myself a cheat sheet when I get home, a 3 x 5 file card I can stash in my half-apron next to the trash liners.For the next fifteen minutes I try to ease myself through the transition from Maplewood into the world I know, the world I am comfortable with. It is a world of thoughts and ideas, of talk, of concepts, of books to be read and discussed, films to be seen. Diapers go on babies in my world.The world I have just emerged from is entirely different: small, close, insular, tangible, unpredictable, earthy. This world is a series of disconnected intimate moments. Whatever happens happens when it wants to happen not when you want it to. This world demands something different of you from moment to moment. I think of my life as the “real world” and Maplewood as something else. But maybe I’m wrong.Buy it here: Amazon | Barnes & Noble | Powells