Elegy in Gray.

She lay on the bed, seemingly weighed down by the sheet that covered her thin body. The word “frail” had been used with increasing frequency in the past month. It had first surfaced during her last visit to the GP, four weeks ago. She had recently recovered from the latest of a series of respiratory infections, but she had a persistent, annoying cough -- incipient acute bronchitis. The doctor suggested that she might not respond well to extreme lifesaving measures such as chest compressions. Her frailty would make her liable to broken bones. It was further suggested that a Do Not Resuscitate order, antiseptically called a DNR,  be signed. The form was simple, and it went home with her. She showed no interest in it, despite the living will she had drawn up eighteen years earlier.

She was sleeping. Her breathing was regular and silent. It seemed a shame to wake her, but I knew that I must. I stood on the left side of the bed, next to the drip which nourished her and provided antibiotics and a diuretic. I reached beneath the sheet and found her hand. It was warm, almost childlike in size. She didn’t not notice. I spoke a few words. Her eyes blinked open, and I spoke a few more words. There was no recognition.

Her will had been, perhaps, her most distinguishing personality trait. She had faced and overcome more obstacles in her life than any two or three other persons. The story was that she had been born during a late-winter blizzard March 1, 1916 in the aptly-named Stormville. A blue baby, her father had rubbed her with corn liquor and wrapped her in a rough blanket until the doctor could arrive. There was also talk about a cold porch to stimulate her. It was the first of many tests of her strength of will.

She had seven brothers and sisters. She was thirteen when the Great Depression knocked the country to its knees. A picture taken when she was sixteen shows a smiling, pretty girl, sitting on the steps of a house in her hometown. There was no hint of darkness in that sunny photograph. But the darkness was just beyond the door behind her. Her father battled regularly with her elder siblings. Two of her sisters were in open rebellion against his harsh treatment. She stood up for them. In a short time, she would follow them out the door of the family home, into an early marriage. The marriage would end in annulment, over the strong objections of her father.

She moved back home. Her father was an orphan, who had been educated at Girard College, a school for white, male orphans in Philadelphia, established by the will of America’s first millionaire, the financier of the American Revolution, Stephen Girard. One of grandfather’s sisters married well, becoming the second wife of Sebastian S. Kresge, the founder of Kresge Five-and-Dime stores, the rival of Woolworth and W.T. Grant. The corporation is now known as K-Mart and owns the other great 19th Century retail survivor, Sears, Roebuck and Company. A brother moved to Hawaii before the Second World War, establishing his family in the middle of the Pacific. But grandfather lived closer to the land. He farmed. He worked on the roads. He moved the family about, returning to Philadelphia. She met her second husband there. My future father pursued her, the story ran, despite her aversion to him. He dated one of her friends, with the objective of ingratiating himself with my mother. He was very charming in a crowd.

Being pursued was a narrative thread that gradually assumed greater and more frightening prominence in her life, eventually overshadowing everything. She had stories to tell. A mechanic wanted to impress her. As she told it, her car would not start. The mechanic took it into the garage to fix it. He got it running. Then it broke down again. She took it to another mechanic. He found sugar in the carburetor. Her stalker had sugared the gas to be close to her. That she was beautiful lent credence to the stories. She was a Rita Hayworth type. It was entirely believable that men would be knocked off their feet by her.

Married in June, 1941, she and my father would soon be part of the war effort on the home front. He built planes and ships, 4-F because of flat feet. They moved to Baltimore, where he built bombers, then moved back to Philly, where he worked in the Naval Yard as a shipfitter on the Liberty ship assembly line. At last, as the war dragged on, 4-F rejects were called up. He was drafted into Army Corps of Engineers. He was sent to the Pacific Theater, serving in the liberation of the Philippines. She worked as a cashier for a while at Sears on Roosevelt Boulevard. She hated the register, and wanted to tear out the keys. She spent the bleak nights cowering in fear in an apartment on North Broad Street.

After the war, things were alternately brighter and darker, but the progression was always to the darkness. It was four years until they added to the Baby Boom. They decided that Philadelphia was no place to rear a child, and, with the financial help of his mother, they bought some land across the Philadelphia line in still-rural Bucks County. The land was wet, swampy might be a more precise description, and therefore relatively cheap. They built a small house in what passed for the suburbs along the Old Lincoln Highway. Levittown was on the spatial and temporal horizon, only a few years and miles away.

In 1953, they moved again, selling the little house and using the money, as well as another loan from his mother, to build a larger house on a hillside. She was now taking Librium. There was a large wicker basket into which the empty pill bottles were deposited. Her moods were never quite under control. Around 1960, she stopped taking the tranquilizers, saying that she was “nervous” only because of Father. Her stories became increasingly more improbable. After her mother died, she began to smell a strange odor in her bedroom. She was convinced that she was being haunted. One day she reported that she had seen a bright red light rise up from the wooded lot next to our house. To a child, the stories were not all that odd. After all, perfectly reliable people have had ghostly experiences and seen UFOs. She was suspicious of everyone. Yet, being suspicious, she had a gift of perspicuity. She saw through pretensions and false smiles, getting to the unspoken aims. People always wanted something, and she, in her penetrating, corkscrew vision of the world, could “see around all the corners.” Those insights gave her other declarations the tinge of truth. Then the abyss opened. People were sending her obscene messages. Radio and TV news reporters were making direct reference to her. Aircraft contrails that crossed high in the stratosphere formed the “X” that marked the spot. Naturally, she fought back against these enemies. She knew, and she wouldn’t take it. Her will was unbending. While visiting me at college, she went to a lawyer and complained about a local solid citizen, supposedly making a threat against him. The lawyer violated confidence and she was sent to involuntary confinement at a state mental hospital.

These were the last days of the “snake-pits” run by the states, which warehoused mentally ill patients in dreadful squalor, depriving them of basic rights. Being “committed” could lead to a long, sometimes lifelong, often extra-judicial, sentence, in conditions that made the worst prisons seem luxurious. The lawyer’s misconduct provided a legal loophole. A court hearing established that the lawyer’s information was improper, and she was released, although a formal diagnosis of paranoid schizophrenia was made. She refused treatment. She fought through the darkness. We moved again. The darkness followed, the always threatening but familiar forms drawing closer. Her disease had become crafty. It hid itself in company. It was as if the disease were a separate, cunning entity -- a demonic presence would have been the term in earlier centuries, which retreated into the locked corners of her mind from which it watched warily for its moment of escape, its malevolence building until it could no longer be contained. And it was cyclical. There would be long stretches, months perhaps, in which she appeared sweet and caring, but during which the fury was building, at last bursting out of confinement, finding the slightest pretext for wild accusations. Someone might have scratched his nose while standing in line at the supermarket: It was an insult. Someone else might have cut her office in traffic: Flooring the gas, she would set off in chase, heedless of the danger. Then it would subside, usually after some screaming confrontation at home. Finally, it became too much for my father. He simply walked away, hating her. He acknowledged that she was “sick,” but blamed her for it.

We tried a change of scene once again. Briefly, it seemed to work. We met her uncle, the very image of her father, in Hawaii. He was ninety-six and partially paralyzed, cared for by our cousin, his daughter. She was unmarried and completely consumed by his care. His resemblance to his older brother was a shock. When he died a year later, his daughter pined away.

Strangers and new surroundings removed for a time the connection to past persecutions, but only for a time. Strangers had no reason to be involved in the elaborate plot against her,  until the idea of money sprang into the equation. People were being paid to harass. Daily the place became more inimical. The complaints droned on like a constant background roar, rising and falling like the tides, sometimes exploding in outbursts of irrationality. She ran off twice. Only after a day long search was she found the first time. The second time she fled to someone she knew only through correspondence. Getting her back was more complicated. Another move was agreed.

By now, all the people who had been complicit in her original delusion were long dead. But the delusion found new actors, somehow mysteriously moved by dead hands. People were working to thwart her every act. Then the hallucinations began to come in earnest. The Gray People were lurking everywhere in the house. She could smell them. Dirty. They were always talking, whispering. Ghosts? Ghosts would be a relief. But, no, not ghosts. They were touching her. Things disappeared. Things were thrown away, burned, hidden. She knew nothing about all that, only that the Gray People were breaking in and stealing. The yelling began. All day, she screamed vile curses at them. Language that would melt the air was spewed at her tormentors. They were lying. “He’s not going to die.” “Get out.” Stop it.” “Make them stop jabbing me.” Then they would vanish for a time. Other behaviors took their place.

Once, on a cold February night, after 10 o’clock, she dressed herself in summer-weight clothing, all black, and walked out into the rural darkness. It was forty degrees. Frantic searching around outside the house found only emptiness. It was a common enough occurrence, elderly persons wandering off. Sometimes they would be found alive. Often their bodies would be found -- off in the woods, in a ditch along a roadside, behind a clump of live oak. The sheriff’s deputies were called. A helicopter with infrared detection capabilities thundered above, back and forth in the still, crisp air. A sergeant in a patrol car found her after half an hour, about a mile away, walking in the roadway. She was shivering, hypothermic. EMTs were called. They warmed her. What was she doing? Where was she going? “I was walking to town to get a cup of coffee.” Town was almost nine miles away. She was transported to the hospital, and involuntarily committed for observation.

Times had changed. No longer could a person be kept indefinitely confined for being mentally ill. There were limits to the period of observation, after which a judge must rule on any request from police, doctors or family to continue the hospitalization for purposes of treatment. The person must be a danger to himself or others. And even such orders are limited to a set span of weeks, after which another hearing is mandated. And the hospitals are not state-operated, but privately owned and run. Treatment beyond the minimum to stabilize the patient is almost always voluntary. And therein lies the great failure of the system. Scarcely ever do the mentally-ill patients choose to continue taking medication after the forced treatment has ended. The prescriptions are discarded or never refilled. And the illness returns. The cycle begins again. The state has solved its problem by washing its hands of its mentally-ill citizens. The whole responsibility of coping with mental illness falls upon the family. Often, as with my father, the burden becomes insupportable. Families members are forced to make choices of personal survival, choosing between their own survival and that of a loved one least capable of surviving alone.

When she was eighty, pneumonia crept into her. It was hardly noticeable. She hadn’t been eating. She had been taking lots of aspirin. Then she was in hospital. There was some gastric bleeding. She was told that she needed a transfusion, or she could die. She consented. She recovered. But whenever the hospitalization was mentioned, she insisted that she had died.

The hallucinations continued, as did the unpredictable forays into odd behavior. She wasn’t suffering dementia. She remembered everything, everything except what her disease concealed from her. At eighty-four, she climbed up on the roof of the house, from which she was rescued by the fire department. The illness seemed to unnaturally preserve her vitality. She was committed for observation again. Again she was treated and released. Again she refused to take medication.

Now there were people telling what she could and could not eat. She became thinner and her resistance to infection weakened. She became more confused and uncooperative. She developed an infection and was hospitalized. She seemed wasted and almost totally dissociated from reality. This time she was transported to a psychiatric hospital for primary treatment of both the infection and her psychosis. When she was physically well enough, a judge ordered her confined for two weeks, and she consented. After two weeks, the judge offered her a choice, consent to continue the medication or be ordered to take it. Of course, this order depended entirely upon the ability of the family to enforce it, and was essentially a impotent threat, but something had changed. She accepted the medication.

It was not a panacea. The hallucinations became less vivid, less urgent, but they were never entirely banished. She would ask if something were real. The improvement was most noticeable in her behavior, which became less combative. There were still bullheaded insistences, but they came less frequently. It was progress. Progress did not come without cost. There were side effects of the drug, primarily tremors and loss of balance. She slowed down, and the darkness gained ground, taking another shadowy form, this time on the x-rays of chest. Pneumonia, pleurisy, bronchitis successively invaded her lungs. The pattern was all-too common. A tenacious infection would yield only after a succession of antibiotics had been tried. There would be months of health, then a new infection, as tenacious as the previous one, would sap her strength. A new round of antibiotics would quell the infection, only to have it shift from one lung to the other. With each infection, she withdrew further into the gray world of her fears. During her last doctor’s appointment, she was almost mute, her most coherent moment coming when she asked, “Do you have my son’s chart?” Gradually, over three weeks, the bronchitis worsened. She would wake in the morning congested, coughing, unable to clear the mucus from her throat. She sat staring when awake. It was harder and harder to get her to respond. What was going on? “I’m holding on to my life.” Finally, she was choking.

She lay on the bed. There was nothing more for me to do. I had already signed the death warrant, the DNR. The doctors had handed down the death sentence, imposed by Nature: She was dying of old age, the suddenly fashionable term for the collapse of an aging body beneath the onslaught of time upon heart, lungs and brain. I moved to her right side, found her hand under the sheet. The fingers were drawn together, seemed only bones. I bent forward and kissed her on the forehead. Her eyes snapped open, stayed open, filled with recognition. Those brown eyes were clear and shone with happiness. Under the oxygen mask, her lips closed and pursed in a smile and a kiss. I said a few meaningless words. We lingered together. She slowly closed her eyes. There was nothing more for either of us to do.

My mother died early the next morning, December 1, 2010, aged 94. The darkness had won, as it always does.