Speaking an Elderly Body Into a Visible Space

“Senior” Friends

Before I moved to Appalachian Ohio, and ever since I was in the second grade, I have had a special love for elderly people. My second-grade teacher, Ms. Walton, walked our class over to a nursing home located nearby and matched us up with elderly people for whom we would read over the next few months. I was paired with a woman who while not especially old was obese enough that she needed rehabilitation. She smelled of ice tea and seemed to attract ladybugs like I had never seen before. When we were out in the garden, little red dots would swarm her as I stumbled reading aloud, trying to pronounce the syllables, one at a time. I felt this woman’s love for me. She was excited to see me in a way I was not accustomed. In fact, most of the people that my class visited with regularly were excited to see their second-grade reading partners. When I was 7, it made me feel special and influential. I loved that we brought some level of happiness and excitement to people living in this residential home community.

In my memory, this old woman is only remembered as the “ladybug lady” because my mother moved us away from Virginia Beach and back to Detroit after that year. Ever since that first experience, I have maintained some sort of non-familial interpersonal relationship with an elderly person in my community. This feeling of being happy to visit with people who are excited to share my presence increased as I grew older. The older I got, the more cognizant I became of where that joy to see me stemmed from for these elderly people. It was not my nose ring, ambiguously tan skin, and crooked smile that brought them joy, it was a face, on a body, with ears to listen and a mouth to talk that brought them happiness. It was not me specifically, but someone who recognized their existence and tried to honor their personhood.

When I moved to Ohio, I knew being reconnected with elderly people would help me feel more settled, because this time it was me who was craving the connection. I learned about GoodWorks from another graduate student also involved in community engagement. GoodWorks is a local homeless shelter with several service programs. The day I called GoodWorks, I was redirected to a woman with a young voice, Amanda, who told me about all the programs they offered. When she got down the list to “Senior Friends,” I excitedly told her, “that one!” My intentions were both benevolent and selfish—I wanted an abuelita in Athens. Amanda directed me to come in for an interview and to go to the police station for a background check, while she called every reference I gave her (playing phone tag with my best friend, Sabrina, for weeks). And so began my 4-year-long relationship with Joan, memories I share here.

***

Today I meet Joan. From a phone call beforehand, Amanda and I were instructed to go around the house to the back door and knock, so we do. Through the small window in her back door, I can see an elderly woman sitting at her kitchen table, her chair positioned so that she faces the back door. As she comes to the door, I can see she is wearing a faded blue flannel buttoned down with brown slacks and heavy, dingy orthopedic shoes. She lets us in. Joan is a tiny woman. She is no taller than my clavicle bone and has a hump on her back that makes it impossible for her to stand up straight. Her at-rest position is always with the tops of her shoulders pointed toward you, instead of straight up toward the sky. She balances her unsteady steps with a walker around the house, moving like “molasses,” as she likes to say. Her hands resemble claws, they curl over the knuckles but loosely dangling, and her thumb makes more of a right angle than parallel with the rest of her fingers. She probably cannot make a firm fist or give a high five if she wants to. She has no upper front teeth and the ones on her lower jaw are hoary. Her curls still bounce fully and fulgently on the sides of her head. Her skin is more gray than white and wrinkled, although not nearly as wrinkly as you would envision an 82-year-old woman’s face would be. Her crow’s feet are barely disguised by her big pink plastic frames.

She invites us to sit down. Her house smells like vinegar and bleach. A smell I never get use to. Laid out like a circle, one could enter her house through the back door, move through her tiny kitchen, through her dilapidated living room, into her spare bedroom, past her hospital bed and then land back to where you started from.

After only a few minutes, I observe that Joan begins every thought with, “Well . . .” We perform the usual greetings and exchanging of surface-level information: where I’m from, what I do, how long I will be here. I learn that she is 82-years-old, has one child named Tom who lives in The Plains (a nearby town), and a husband in the nursing home “down the road” in Jackson, which is not really down the road. She seems sweet and flashes her toothless smile often and with confidence. She is not like the grandmother I don’t have—she’s white and brittle; my abuela was one of those flashy older Mexican women who always wore bright colors and high heels. But she is old and seems nice enough. Judging from the apparent conditions of her house and her health, I bet she could use an extra friend. And she loves coffee, just as much as I do.

***

Over the years, Joan and I have become close. Not quite as warm and familiar as a grandmother–granddaughter relationship but more that of a friendly visiting nurse capacity. In Nussbaum, Pecchioni, Robinson, and Thompson’s (2000) book, Communication and Aging, they write that in Western society, one of the greatest compliments is to call someone your “friend.” They also recognize the potential for friendships with elderly people to become “complicated.” Joan and my relationship was, at times, admittedly co-dependent and even unhealthy. Rawlins (1995), writing about friendships “later in life,” also recognizes this tension that one person can become uncomfortable when they have to rely heavily on the other member and cannot reciprocate. Joan and my “friendship” was and is unique, not fitting neatly into the literature on friendships with elderly people. At its outset, she was 82 and I was 24—I was not her caretaker per se, but I certainly performed that role at times (Chan, 2011; Roberts et al., 2010). We were not family, but I certainly felt a filial obligation to her.

For instance, in my second year of my doctoral program and the Senior Friend’s program, I was very seriously dating someone. When he came to Athens, it was important for me to get Joan’s approval of him; I really wanted them to connect with one another. So I walked him over to her house, she made us coffee, and served us warm coffee cake. I could tell by her demeanor, the smile she revealed, her calmed voice, and her sweet comments about him, that she liked him, though she never explicitly told me so. After that day, and during the time that we dated, she always made mention of him. But the week we broke up, heartbroken, I told her about it. Her only reply was, “I didn’t like him anyway,” and that was all I needed. We weathered and shared a great deal in 4 years: this breakup, her husband’s death, the ups and downs of graduate school, road trips up to Logan to “go shopping,” many meals out in Kaisler’s Country Kitchen, or in-town at Bob Evans, and ordinary everyday activities like going to the bank or changing light bulbs.

In the days and years that we have known each other, I have witnessed the steady deterioration of her aging, elderly body and her aging, elderly mind.

***

It’s 7:00 a.m. and I am awakened to my phone vibrating my whole bed. I try to ignore it, but it inevitably persists. I don’t even remember pressing the green telephone widget to accept the call but her voice is already in my ear. “Rebecca? Rebeccaaaa?! Are you comin today or not? Are we gonna go to the Dollerr General or not? Don’t upset me here, don’t upset me. It’s cold outside, and it might rain, and I don’t wanna be upset. Are you gonna come? You told me you were gonna come. Are you comin?”

“Yes, Joan, I’m comin. I said I was gonna come and I will. I thought we said 10?”

“Are you gonna come? Don’t upset me now. I don’t like to be upset, now. Well, well . . .? Are you gonna be here at 10? Are you gonna come? I went to Walmart the other day and I hurt my back, and I thought the least you could do is go with me to the Dollerr General and carry in some bleach and vinegar and stuff. It’s heavy. Well, are you going to come or not?”

“Yes, Joan, I’m coming.” As hard as I try to speak with patience, it’s challenging, and my voice is starting to reveal my impatience.

“Well, are you gonna drive? Are you gonna drive or am I? Do you want me to drive? I want to drive. I haven’t drove on lately, I want to drive . . . Oh God, I never get to drive. No one will drive with me anymore. Everyone is too scared to drive with me . . . except you.” She sounds distressed like she might cry, but within the instant, her voice snaps back like the sting of a rubber band and she commands, “Pull in beside me. Pull your car up the driveway, next to my car. I wanna drive. Don’t upset me okay, are you comin?”

I want and need to go back to sleep. It’s Saturday. It’s 7 a.m. At this point, I will say anything to shut her up, “Yes, Joan, I’m comin. I’ll be there at 10.”

“Okay, I’ll be waitin for you. Don’t upset me now. Too many people let me down, don’t you let me down.”

“Okay, I’ll talk to you later.” I hang up before she can nag me anymore.

I pull my duvet covers around my shoulders, tuck my hands underneath the pillow, and go back to sleep for a few more hours.

7:43 a.m. My phone rings again. And again, I do not remember accepting the call. “Rebeccaaa, it’s Joan. Are you comin? Are you gonna come? Because I don’t want to wait around for you all day, if you’re not gonna come. I’ve got things to do. Are you comin?” Her voice starts to break and it’s the all too familiar sniffle. “Oh god, I don’t know what to do. What should I do? Are you gonna come? Don’t keep me waitin now. I don’t want to get upset here.” And just as easily as her voice breaks, her voice comes back together by the end of the thought.

“Joan, I told you I was comin and I’m comin. I will be there at 10.” She calls three more times within the next hour. By the end of the third call, I just get up an hour and half before the alarm and I dress and I drive over to her small red brick house over on Stimson Avenue. As I walk up to the house and get up to the door, I can see through the window that she is sitting at her kitchen table, facing the door, awaiting my arrival.

***

This episode is neither fantastic nor fictional. It was not an every-weekend-occurrence, but the story highlights the moments I witnessed, what I perceived to be, Joan’s struggle with the fragility of her body and the subtle deterioration of her mind. I made sense of these moments in my mind by thinking through philosophers of the body, such as Merleau-Ponty. Merleau-Ponty (1945/1962) speaks of the fundamental interrelatedness of the mind–body connection. He looks beyond the division of the subject and the object to see how sensation informs thought. For him, the body is “my point of view upon the world” (p. 70). One’s bodily existence, he notes, is the “barest raw material of a genuine presence in the world” (p. 165). It is through the body that we are present and aware of our existence, the body dictating that awareness and presence. Consequently, as a body grows old, I reckoned so too does one’s experience of the world. As a body deteriorates, the site in which we perceive and interrelate with the world, the mind deteriorates those experiences. The mind is the site that makes sense of bodily experiences. In summary, as Heidegger (1962) famously says in, Being and Time, we do not have a body but we are bodily.

As Joan’s body moved as “slow as molasses,” and more painfully as she said (this was apparent to me from her inability to carry in her own groceries), I wondered if so too does her mind slow her down from making sense of my agreement to accompany her? Does she dial my number again and again not because I have “let her down” in the past—I always kept our plans—but maybe she called because she cannot trust her memory to recall my agreement to go, nor my record of always appearing whenever she needed help? I wondered if her body might be experiencing the anxiousness of her mind, the inability to decide whether she will go, whether I will come, and is this all performed through her stiff fingers punching the dial pad? Does dialing and redialing my number assuage the mental and physical anxiety she might feel in her mind and in her chest? In that moment (in the early hours of my Saturday morning) and in my unknowing and inexperienced 24-year old mind and body, I was unable to make sense of and reconcile with her incessant phone calls.

I could not possibly imagine what it would be like to live in her body; I agree with Bakhtin that there is no true place of empathy. I can only experience her suffering as it is her suffering (Bakhtin, 1919/1990). This narrative above is my perception of her experience of the world. I can only offer a limited view filtered through my interpretation of her experiences and my mere speculation about those experiences. One cannot fully understand another’s subjective positioning. I cannot “step into her shoes” because they do not fit, and my interpretation of her world and her lived reality still would not and could not be the same as her own. I suspected that when I thought of Joan, my brain activated stereotypes, sometimes seeing our relationship as her dependent on me, and her benefiting more so from our friendship.

Adams-Price and Morse (2009) have attended to this very idea—do such perceptions of elderly people affect their ability to receive care? They hypothesize that young people think of elderly people as only a burden, often incompetent, and unable to receive any real benefit from helping the elderly (Adams-Price & Morse, 2009). And what they find suggests that “dependent older people may be seen as a drain on resources, making those who help them seem particularly generous and selfless” (Adams-Price & Morse, 2009, p. 2979). In moments described like the one above, I do not feel particularly selfless or generous per se; but I just cannot imagine living in her condition, and as Adams-Price and Morse (2009) report, helping others does not eliminate the stereotype. I cannot set aside my own ontological orientation to this world and enter into her reality, one with a mind that’s experienced 82 years and a body that has been the site through which she engaged life in all those years.

At our “Senior Friends Quarterly Meetings,” that Amanda from GoodWorks hosted, other Senior Friend matches happily debriefed with one another about how they had cups of coffee with their seniors, their seniors baked them apple pies, and how they laughed together over fond, “olden-day stories.” I went on an internal (and in safe company, external) diatribe! I changed old socks and light bulbs, “combed down” her hair in the back, helped her change, and washed out her trousers when she had accidents. Sure, we have meaningful exchanges over coffee too, but I was preoccupied with thinking that my Senior Friend cannot afford to buy the ingredients nor produce the strength to whip up an apple pie. I learned from these debriefings that my Senior Friend was by far the oldest, and from the sound of these stories she also might have been the most financially constrained and loneliest. These “extra” chores I did and sad realities I witnessed were not part of the advertisements to coax people into the program—nor was it required in the program—but they simply were Joan’s real needs and my real moral obligation to another human being. I distinctively remember the first time she called me over to change her socks because she had an appointment with a “foot doctor.” Obviously, the ubiquity of stereotypes about the elderly does not hinder Joan’s ability to ask for help as Adams-Price and Morse (2009) suggest, although it may have hindered my ability to give her care.

***

I tell her, “No. I’m sorry, but I hate feet. All feet. Not just yours.”

She replies, “Well, I been wearin’ the same sorcks for days now, the girl from Coolville forgot to change ’em before she left . . . ”

Oh geez. I know the girl from Coolville only comes twice a week and she will not be back, until Tuesday, and that’s not for another 5 days. Oh geez.

I relent with an audible sigh, “Okay, I’ll be there in a few minutes.” On the brief car ride across the neighborhood and on to her street, I am absolutely dreading this experience. Sincerely, I do really hate feet. I once vomited because my slightly older and not so slightly irritating cousin, Rico, wiped his sweaty, moist, bare sole of his foot onto my leg. He was wearing tennis shoes without socks. It was an instantaneous physical reaction.

I pull into her gravel driveway, trying to hype myself up. You can do this, Rebecca; you can do this. It’s just feet. Everyone has them. And she’s old. And if you don’t do this, no one will. You can do this.

I knock on the door, and I can see through the door’s window, that she is sitting at her kitchen table, facing the door, socks in hand, waiting for me.

She motions me to come in, without a greeting or even a hello, she says, “Well, that was kinda quick. I was wonderin if you would warsh my feet before you put some new ones on, I pulled the warsh basin out . . .”

You have got to be kidding me. I agonized before about just simply changing her socks. I was scheming how I could do it without actually placing the flesh of my hands onto the flesh of her feet. But now, she wants me to wash her feet. Suddenly my eyes revert to her hands, and I can only imagine that her toes had similar characteristics as her hands, digits permanently overlapping other digits.

I try not to reveal my panic, “Oh, Joan, you know how I mentioned . . . ” And as soon as I start the sentence, I know I cannot finish it. I am engulfed by resignation and just overall defeat. There is no sense in protest because I know in the end I’ll do it. I have to do it. No one else will, and I cannot allow this old woman to be embarrassed at the doctor’s office, which is her only excuse to leave the house. When you’re this old, you lose your pride involuntarily. You are so vulnerable you have to ask some punk-20-something-year-old-girl from the big city to wash your feet. If she has to feel that, I can do this.

I walk over to the bathroom, grab the pale yellow bucket, bring it back to the kitchen where she is sitting and fill it with lukewarm water. I place it next to her feet. I bend down onto my knees, breathe one last breath of fresh air in through my mouth, and reach down to un-Velcro the two straps across her shoes. I gently pull one shoe off her foot and it hits. The smell invades my nostrils almost immediately. It swirls up and is cloyingly reminiscent of my dread of it. Her feet smell like Cool Ranch Doritos Chips.

I hurry myself with the task. I wipe the bottoms of her feet and the top with soap and a washcloth, moving as fast—without compromising my gentleness—as I can. First, her left foot. It’s a veiny, scaly thing I hold in my hand. And then without hesitation, I move on to the right one. As soon as I switch feet in my hands, Joan chimes in, “Can you get in between the toes, there, a bit?” I look up at her face—her eyes are focused on my hands, washing her feet. I can tell from reading her face that she thinks her request is perfectly reasonable. I look back down at her feet, hoping to mask my horror.

I could feel my mouth salivating the way it always does when I’m about to vomit. My friend, Bryan, calls this the “warm spits.” I cough a bit. No, no, no, no. You may not throw up. Get over yourself. I blink away moisture from my eyes, breathe through my mouth and press on. Her toes are very stiff. The digits do, in fact, resemble her hands and they barely budge. I cannot even fit the thickness of the washcloth between them. She notices my struggle with her toes (not the experience, writ general), and relieves me, “That’s good,” she says. I grab the towel lying next to the basin and towel dry each foot. As I wipe the last one clean, my shame hits me and my shoulders shudder.

Cuffed in my hands are this woman’s feet. It does not require an exceptionally observant human to notice how uncared for these feet are. The skin is dead and ashy, on the bottoms and the tops, the toe nails are long and yellow, splattered with brown spots in the nail bed. No one has cared for these feet in years. I am too embarrassed to ask, but I assume she has never had a pedicure. She has not had her toenails trimmed in awhile or her feet scrubbed with the cheese grater tool that I love, or her nails painted. What took me less than minutes to suffer through, she tells me she has not been able to do herself since she was 23 and first diagnosed with rheumatoid arthritis. Her husband has been gone for 2 years at this point, and he himself would not have been in the physical condition to do this since I first met him. Her feet appear as though they have not been scrubbed, touched, or cared for in a long time.

***

I walked out Joan’s door and when my own feet hit the gravel driveway, I called my tía to debrief, needing to share with someone my traumatic foot experience. I needed someone with whom to share this repulsive, but also very tragic situation. My tía is a religiously conservative (Mexican Catholic, which tends to be an odd blend of Catholicism mixed with overt superstitious-ness) woman, as all the women in my family are. She reminded me of the biblical story, about how Jesus had washed people’s feet and assured me that I was, “just earning my jewels for my crown in heaven . . . ” Being likened to Jesus was too disturbingly sycophantic and outlandish to even begin to console me. I hung up with my tía and sat in my car, parked in my driveway, and tried to make sense of and reflect on this interaction for a while.

Sure, I was grossed-out by feet, her needing me to do things that I had nightmares about, but this experience cemented for me something much graver and much more macro. The experience was layered with meaning; washing Joan’s feet was not about altruism, or some religious hogwash about humbling the self. This experience enlightened me to the tragic reality that confronts elderly working-class women, especially those living in rural communities in Appalachia. Two sociologists, Debra Henderson and Ann Tickamyer, who have worked with the elderly in Appalachian Ohio, note,

For older women in small rural areas, the consequences of poverty are exacerbated when communities do not have the economic and social resources to provide for the necessities of an older population. Older adults are at a disadvantage in that they are on average poorer than those in urban areas, experience more functional impairment, and are less likely to have access to needed health care. (Henderson & Tickamyer, 2008, p. 156-157)

Henderson and Tickamyer explore the intersection of gender, age, and geography to understand, on a more macro-level, the subjective experience I attempt to recreate and re-story on these pages with Joan. I witnessed Joan’s experience of aloneness, and Henderson and Tickamyer permitted me to believe that my observations and deductions of Joan were more typical than one might think. Joan is one of many older women whose lives are complicated by the fact that they are old, lack social capital, and live in a rural geographical space, and thus “fell through the cracks and were ultimately ‘Lost in Appalachia’” (Henderson & Tickamyer, 2008, p. 165). Even so, my encounter with Joan was a subjective experience for me, one that defied my understanding of social theory and moved beyond critical analysis. There was visceral traction in my experience of her lived reality.

“You’re the Only One Who Hasn’t Forgotten About Me”

My invocation of this troubling “show moment” above was done to perform my brush with my lived experience of someone else’s unfavorable existence, the socially abandoned existences (Denzin, 2001, 2002, 2003). I purposely was trying to give you my phenomenological insights into Joan’s body, her life, her experiences.

To cross-examine critical theory with my interpretation of Joan’s experience, I grapple with what such discourses say about the body. Dominant perspectives view the body as having purpose; it has form, it can produce labor, it is docile, malleable; it can grow to be stronger and work harder (Marx, 1867/1909). As far back as 1867 in his tome, Capital, Marx discussed the exploitation of the body as a means to gain capital. For Marx, even legislation that protects the body does so as a means to protect the production and reproduction of labor. Every structure and institution is designed to maintain the body for the sake of reproducing capital. The body is conceived, birthed, lives, deteriorates, and dies for work (Marx, 1867/1909). In sum, bodies hold value insofar as the amount of labor they can produce. Michel Foucault (1977/1995), another prominent thinker on the body, also discusses the body as “active,” “useful,” capable of dominance, growth, or discipline (p. 138). But what happens to bodies when they are no longer useful? What happens when they can no longer produce labor? What about when the body wilts? When muscles become flaccid and weak? When we cannot produce the strength to pump our own gas, turn the key in our ignition, or are toppled over by the weight of a screen door? When we cannot reach our own feet, or lift ourselves up from the ground? When we have outlived our death scripts physically but only with constant struggle? What happens when we are physically present but not physical enough to maneuver the present? The existence of this body, although inevitable for us all, is abandoned, forgotten about, hidden from society.

The working-class elderly woman without a family system in this rural geographical space becomes a body that falls within “zones of social abandonment.” The anthropologist, João Biehl (2005), in his book Vita: Life in a Zone of Social Abandonment, discusses “zones of social abandonment” as places where people who are unwanted or undesirable are left to die, alone on “the end-station on the road of poverty” (p. 2). Although Biehl is speaking about a specific context, those living in a zone called “Vita” in Porto Alegre, Brazil, his concept of “zones of social abandonment” can be extended here to working-class elderly Appalachian women. A “zone of social abandonment” is a place where people without social or economic capital, or families who care, go to die miserable—often slow—deaths. In abstractly describing “zones of social abandonment,” Biehl writes, “it is the place where beings go when they are no longer considered people” (p. 2). These “zones of social abandonment” develop from a culmination of factors—poverty, failing family systems, inadequate medical care—resulting in “a state of abject abandonment” (p. 2). Biehl (2005), speaking about “Vita” as a “zone of social abandonment,” writes, “Disciplinary sites of confinement, including traditionally structured families and institution psychiatry, are breaking apart; the social domain of the state is ever-shrinking; and society increasingly operates through market dynamics” (p. 41). Thus, those who can no longer produce labor or capital become invisible—dispensable. People in “Vita” are already socially dead but just waiting for the disappearance of the body. Biehl’s book tracks the life of one woman, Catarina, who was dropped off and left to die in “Vita.” She is thought to be insane and is paralyzed. Biehl is haunted by this woman and tries to uncover her life to learn more about the conditions of her existence. Through fieldwork, unraveling a cryptic dictionary kept by Catarina, interpreting medical documents, and interviewing Catarina’s biological family and old friends, Biehl investigates how her subjectivities are made, unmade, and remade. His detective work unveils the medicalization of mental illness and old age. Ultimately, the inevitable becomes the real, and Catarina slowly meets her demise in this institutionalized “zone of social abandonment.”

I believe it is not too much interpretive speculation and theoretical transference to suggest that Joan falls within a rural “zone of social abandonment” in the American context. Yet, it is what Kathleen Stewart (1996), an anthropologist working in the field of the Appalachian region, calls “the Other America.” Although the topography is well-known for its beauty, Appalachia is a region of the United States that has been forgotten about and has almost been written out of modern American history. In Caudill’s (1962) controversial (because of its myopic representation) book about the Appalachia region, Night Comes to the Cumberlands: A Biography of a Depressed Era, the author suggests that this abandonment occurred after the bust of the coal mining industry. The bust could not have been predicted, Caudill claims, but happened nonetheless. And when the “big bosses” of the coal mines left, so too did all the investment, “the spick-and-span gave way to the dull and disordered, and the women sat down on the front-porch swings and in chairs before the fireplaces and allowed the victorious enemy to run riot through the towns” (Caudill, 1962, p. 146). Caudill notes that this “vacuity, resignation and passivity” still mark the people of Appalachia today, those who stay in the region despite this invisibility and unavailability of jobs. The region remains in this malaise, says Caudill, as an outcome of the export of all its natural resources and the devastation that resulted. This rural “zone of social abandonment” is structural, as a result of economic colonization, decolonization, and structural rejection. Along with Caudill’s work, Stewart’s (1996) ethnography of coal mining regions in West Virginia, Appalachia stands as a kind of “back talk” to the dominant mythic claims of “American progress.” Here, Appalachia, is only “a space on the side of the road,” not a part of “real” America. It is like a distant cousin forgotten about by the whole family (Stewart, 1996).

During my time with Joan and my research at the Athens’s Historical Society, I learned that Joan’s family traces back to Athens County’s first families—they were “early settlers” in this rural/industrial/socially abandoned zone. She is an elderly body in this Other space that falls between the crevices of two broken down localized social institutions—the family and the state. Joan shared with me her family history; spoke to me about her eight brothers and sisters. And from 4 years of weekly visits to her house, I perceived that none of them feel the familial, moral, or the ethical obligation to take care of their own kin. She is the oldest of nine, with seven below her in the birth order with the youngest of siblings only in their early 60s. I learned that Joan also has a son, who in my non-academic and highly crude opinion I deem unworthy. From what I have seen he does not care for his own mother in any financial, physical, spiritual, or emotional capacity. The “breakdown of the family system” is a commonly asserted narrative about Othered peoples in American culture (Coontz, 1992), but this story is atypical of Appalachia. What is typical of Appalachia is kinship being “as natural as the air you breathe” (Stewart, 1996, p. 191).

Most of my co-participants have a profound and at times oppressive familial identity that insists upon tending to the elderly within their systems. Stewart (1996) writes, “the ideal loyalty to kin has the status of a fixed law writ larger on the Real” (p. 192). Family loyalty is not an idea or a mere feeling, it is an unwritten law. Appalachian scholars Lewis, Johnson, and Askins (1978) have suggested that after the industrial era was over, this area was forgotten—economically and politically; and that as a consequence, kin became, “an integral part of the total operation,” key to survival (Lewis et al., 1978, p. 115). The family in Appalachia is more than a support system—it is a way of life.

But in my experience, Joan is one of the unlucky ones. She is an anomaly in a cultural system that favors extended family ties. Typically, a woman in Joan’s physical condition can turn over all their assets (their homes repossessed and their stocks and other assets liquidated), and be cared for by the state. I learned this through several conversations with social workers. Feeling partially implored by Joan, and lost in my consuming consciousness of her social abandonment in the first year, I sought help and more information about ways to assist Joan. In my judgment, Joan has been failed by her family, and she was and is continuously failed by the state and programs designed to protect and serve elderly populations.

Institutionalized Abandonment

After the first year into our relationship, Amanda (the woman originally in charge of Senior Friends) resigned from her position with GoodWorks, and many months later another woman transitioned into her position. I sought help in the midst of these months, but I lost contact with GoodWorks as they changed leadership. I awaited their call. In the meantime, I called a friend who was a social worker and asked her advice. She told me that she does not know much about gerontology casework, but suggested that I check and find Adult Protective Services in the area. After looking around on the Internet, I called Adult Protective Services but the social worker told me, “They have their rights.” She added all I could do was call in Joan’s license plate number to the Highway Patrol, and they would intervene and take her license away. The social worker mapped out and strategized what would likely happen next: then Joan would become completely immobile and realize that she could no longer maintain her independence, and finally would join Albert (her husband who has since died) in a “nice” nursing home. I told her I thought that was stupid and an impractical solution. Furthermore, I believed that losing her license, without securing her in a residential home, would only induce more dependency on me.

During my hiatus from the guidance of GoodWorks and after the futile phone call with Adult Protective Services, I decided to pursue my relationship with Joan alone. In this time of disconnect from GoodWorks, I had considered calling the Highway Patrol as my only option in helping Joan. Meanwhile, Joan decided that she did not want to be separated from her husband any longer. She told me they had been married for 62 years and that she needed to be present with him. But rather than joining him at the nursing home, she decided she wanted to move Albert home. The events following his return home culminated in a turning point for me; it was then that I became acutely aware of how nuanced both aging and abandonment were and are. I share here an excerpt from my diary-turned-field notes from that day:

Yesterday Albert fell and, of course, he doesn’t have the strength to lift himself off the living room floor. So Joan screamed into the phone receiver for me to get over there quickly. Once I got there, I couldn’t lift him so we had to call “the squad,” as Joan puts it. They were able to lift him and put him back on the bed without being too rough. Albert wasn’t wearing anything underneath his shifty, thin, checkered robe. Seeing an 85-year-old penis, twice . . . in one day, isn’t healthy for anyone. Least of all someone like me, who is already a commitment-phobe. If that’s what I have to look forward to—no thanks, cross my name off the list.

Today, he couldn’t get himself out of bed, and she demands that he sits at the kitchen table with her for meals, but he barely has the strength to move out from the bed. Yesterday, I saw her shove the back of his baldhead, because she said he wasn’t close enough to the table. I can’t leave her, I can’t leave him, I can’t leave her with him. I feel terrible when I do because I know she just wants me to stay, but I can’t stay all the time. I feel empty. I’m not helping anyone. And they aren’t getting younger or healthier, what do I do? What can I do? Spending time with Joan and Albert have been my most hopeless volunteer situation yet . . .

After Albert fell down numerous times and could not summon enough strength to get out of bed, he stopped eating and drinking, and Joan was forced to readmit him to the nursing home in The Plains. During this time, our weekly meetings convened at the nursing home instead of her house. A few weeks later, he died shortly before I arrived. Joan sadly recounted the final moments to me, telling me he was gasping for air and holding her hand. I watched her dry lips kiss her husband’s already cold forehead before the nursing staff asked us to leave. To my knowledge, I was the only other person who came to say goodbye to this man at the home. Now, for the first time in 62 years, she really was all alone. At Albert’s funeral, I met their only son, Tom—and this is the only time I have ever seen him to this day. Joan has since told me it is also the last time she has seen him, although, every now and again, about once a year she will lament that he has called, but only to ask for money. At his father’s funeral, I felt both unexpressed rage for Tom and eventually a gut-level understanding of his behaviors at the same time. During the funeral (only 10 people were in attendance, 2 of whom were Amanda and I), I had to repress the desire to punch Tom in the face for what I believed was an inexcusable abandonment of his parents’ emotional, communicative, and physical needs. This emotional dimension comes with the position we might find ourselves in when we are involved in the lives of our co-participants. Chawla (2006) discusses this tension that might arise:

We might find ourselves in fields of ambiguity—being and becoming insiders, outsiders, or partial insiders—positions invoked and orchestrated by our participants. When I use the word orchestrate, I am suggesting not manipulation but a rhythmic dance and a merry medley created when lifeworlds mingle. In evoking these rhythms, I am acknowledging the power inherent in the locales we make our own. (p. 3)

In my relationship with Joan, I am not clearly outsider and not naïve enough to think of myself as an insider to her world; but our “lifeworlds” certainly do “mingle.” Sometimes, I feel our rhythms are far too dangerously in sync. But after years of negotiating a tumultuous and comprehensively demanding relationship with Joan, I transitioned to a new, more forgiving orientation to Tom’s abandonment. I realized that maybe he had to cut off ties with her to protect his own emotional health and well-being.

***

My relationship with Joan was and is complex. We have weathered 4 years together. I have moved from being frightened by her suicide threats and driving, to being almost completely unfazed. We shared the loss of her husband, my own breakup, excruciatingly vulnerable moments with her accidents and physical needs, long drives out to the greenery of her “home” in Amesville, doctors’ visits, grocery store trips, holiday meals, and a litany of nothing special moments at her kitchen table. Her phone calls filled with unreasonable commands used to shake me, and I would feel compelled to drop whatever I was doing at that moment to respond to them. I once tweeted to God about Joan, “Dear God, if I die because I let this 82-year-old woman drive, ‘cuttin country,’ can I please stop and get a beer before I go to heaven?” But now, I demand to drive or I won’t get in the car with her, or I stop answering her calls when she sounds angry. Beyond those challenging times, we have shared many special moments that still make me smile, like the time my brother, on a short leave from Afghanistan, and I treated Joan to dinner. She was so excited to be “escorted” to dinner with “a real soldier!” she exclaimed. The dinner was not anything special, just to Bob Evans, but it was one of the jovial moments I had shared with her. She continues to inquire about him every time we speak. Over the past 4 years, we have grown together, apart, and back together again. To be honest, I was not sure what form our relationship will take once I moved away—we did not talk about the inevitable.

Institutionalized “Help”

When a new staff member finally moved into Amanda’s position and managed Senior Friends, she arranged for us to meet once again at the Senior Friends Quarterly Meetings. Only this time while the other volunteers sweetly reminiscenced about all the memories they were creating with their elderly other, I finally vented my frustrations to the group. I told them it was asinine that everyone else was eating pie and drinking coffee while I tried to create, establish, negotiate, and maintain boundaries with Joan, all on my own for a year. I warned new Senior Friend matches that they might be paired with a seemingly charming elderly woman, develop an emotional connection with her, and then she might rely on you heavily and when you need help, there might not be anyone at the program there to support you. Following this outburst, I was told by the new manager of the program that after this meet-and-greet, I should not come to the group meetings, but rather, schedule my own individual updates, so as not to scare other and future Senior Friends.

During these one-on-one conference meetings, I shamelessly begged for more organizational help with Joan. I was frustrated that this organization paired me with her to help her, and then left me alone to maneuver a difficult situation with a difficult woman on my own. The new Senior Friends Manager directed me to another local social worker who works for the Visiting Nurses of Appalachia. This social worker confirmed my suspicions. I learned that she previously met Joan 6 years ago while Joan was being reviewed for their home care services. The social worker informed me that during the review, their organization decided that Joan was not physically or emotionally fit to remain in her own home and refused their home care services. The social worker, then boldly declared that in her “professional opinion,” Joan does, in fact, have a personality disorder, which has been ignored and undiagnosed her entire life. I suddenly realized that Joan could very well be the Catarina of Vita—the body that fell through the cracks of the health system (Biehl, 2005).

My fears, as well as fears that Joan has confided in me, were made real. Joan once told me, “I just don’t want them to find me, dead with my pants down, on the latrine.” Her fear of dying in her home alone has been repeated to me often enough for it to become my fear of her end-of-life narrative as well (Chan, 2011). When I shared this with the social worker, she confirmed that it is not only possible, but quite likely, that she will die in her home, alone, without someone discovering her for days. She told me, “If Joan does not have sustained home care, or someone who checks up on her daily, then she probably will die, at home, all alone. She’s probably gonna die lying on top of a mattress full of cash.” This stark imagery vividly imprinted for me a sad memory of her words. This social worker informed me that the undiagnosed personality disorder that Joan has probably prohibits her from trusting and utilizing banks, as well as harmless people like me.

This nightmare narrative, the fear of dying alone—that I believe many people share—might be re-inscribed as reality for my Senior Friend, Joan. The social abandonment of elderly people is evasive and structural. I wonder just how many people with abandoned rural existences are dead long before their bodies are discovered? If you do not have family or friends to check in on you, to find out whether or not you are well/ill/dead, then whose responsibility are you? And those living in rural poverty, “lost in Appalachia,” do they fall even deeper into the crevice of the abandoned, the gap widening with the crumbling of the state (Henderson & Tickamyer, 2008)?

The social worker assigned to Joan’s case gave me two more bits of advice, she (like the social worker at Adult Protective Services) told me that the only thing I could do was, one, call the Highway Patrol and have her license taken away, and two, she emailed me an attachment that merely lists alphabetically eight Medicare-certified home care agencies and three home care aide services with their numbers, and nothing else. That was it. This is all the state and social services have to offer elderly working-class women, just a list of the numbers of home care agencies. Without wealth to secure your stay in a functional and safe nursing home or to obtain good home care, without family to help you go grocery shopping and carry your groceries inside the house, without social programs ensuring your livelihood will stay intact, you are just that—a person without.

The social worker also informed me that with Joan, I should develop an “exit plan” for when I leave. Joan mentioned on more than one occasion that she wanted me to take her with me, and if I was not so sharply aware of my co-dependent tendencies, I think I just may have done so. Instead, I printed out this list of agencies and numbers and posted it on Joan’s refrigerator. I sensed that she knew I had to leave eventually, but she refused to talk about it in any detail, let alone develop an exit plan. Then, Joan hurt her leg, and in the last few days she was especially dependent on me, which I believed heightened her anxiety and her vulnerability and made her increasingly difficult to be around. I thought it was clear that she needed full-time care, but she refused to go into a nursing home and she made it clear to me that she hated “strangers” in her home. At that point, my everyday reality was this—let her sit in her own feces—or go over every morning and night to prepare her for the day or bed.

So, I called Adult Protective services again on April 25, 2012, just before I was to move. The lady on the other line simply said, “Joan Smith? Yes. I’ve heard about her. You think she needs to be in a nursing home? Ok, thanks for calling. Buh-bye.” And that was it. A body named. A body dismissed.

***

Today is moving day, so I walk my sister, her husband, my adorable 4-year-old niece and 5-year-old nephew to Joan’s tiny house. Although she had met my sister before, I am nervous, because I have never brought so many “strangers” into her house at once, and my brother-in-law is Black, and although we have never specifically discussed race, I have heard her use antiquated language such as “coloreds” before. My guts are twisted in my stomach as we walk up the steps of her rickety porch and approach the door. But, as always, there she is at her kitchen table. I can see her through the parted curtains, seemingly waiting for our unannounced arrival. When she pulls back her paint chipped door and locks eyes with my nephew standing in front of me, her smile grows wider than I had ever seen before, allowing her top toothless jaw to be seen. She is so sweet and cheery today; she makes my pervious complaints about her to my sister seem completely unfathomable. Joan tells us, “Well, ya’ll the best guests I’ve had in this house in a long time!” We chat for a long while, and then my sister announces that she, James, and the kids will wait outside for Joan and I to say our goodbyes. My sister asks the kids if “Miss Joan can get a hug goodbye?” My bashful niece does not move or say anything but my nephew speeds over to Joan and awkwardly flings his arms around her neck. Joan laughs and then gets a bit choked up, telling us that she can’t remember the last time she got a hug from a cute little boy, which makes me feel the emotional weight of this present moment even more deeply.

***

Right now, I live about a 5 hour drive away from Joan and I check-in just about every Sunday afternoon. The phone conversations for the past year and a half have been mostly predictable and identical: parts of her body that give her pain, wondering aloud if God has forgotten about her, inquiring about how my brother and my nephew are, and demanding to know when am I coming to see her. There is never any mention of her son, or any other interactions with “strangers” and that the Senior Friends program refuse to pair her with a replacement.

I have been back to Athens twice since I moved, and both times without a phone call in advance, I have caught her at the kitchen table facing the back door. These visits and phone calls challenge me to consider my own role in her abandonment. I pine to know whether or not sharing her story without being physically near her is perpetrating the very social indifference of elderly people that I am writing against? Or does sharing my story of our relationship and my experiences with her constitute a right step in combating the invisibility of elderly working-class women in Appalachia? Moreover, I wonder how many more elderly working-class women in Appalachia share Joan’s existence? I sulk in imagining the number of elderly people who don’t even get—what I have to offer—just a phone call once a week.