Strange is our situation here on earth.
Each of us comes for a short time, not knowing why,
yet sometimes seeming to a divine purpose.
From the standpoint of daily life,
however, there is one thing we do know:
that we are here for the sake of others.
Lives Now Gone: A Nursing Home Diary
by Dr. Robert Norman
Over the last 25 years I have treated patients at dozens of nursing homes throughout Florida and taken down notes and kept a diary. Over the last few months, the urgency of my diary has been heightened due to the rampage of Covid 19. I have talked to many people that seem to think that just because my nursing home patients are generally an older group of people, they are “ready to go” or not useful. In some cases, they have limited function and communication. But whose right is it to assume they no longer have a place in society?
And the age range of my patients in the last year has been from 20 years old to 106 years old; age alone has never predicted if someone is healthy, sick, or institutionalized. In fact, we all live in that border world, as Shakespeare wrote in As You Like It:
And so from hour to hour we ripe, and ripe,
And then from hour to hour we rot and rot,
And thereby hangs a tale.
As with most challenging jobs, my work in the nursing homes has always been tough and
filled with obstacles. But stories get told, things get done, and people sometimes get better. With Covid-19, the world tilted on its side. The people I hoped to keep seeing were abruptlytaken from themselves, their family and friends, and their caregivers.
I remember when I first met Elizabeth. She was coming back from getting her hair cut. She moved down the hallway slowly, like a delicate ship floating atop the water. She came to rest on her bed, complaining of leg pain and itchiness. With her consent, I examined her legs.
If I closed my eyes, I could see Elizabeth walking down the Pennsylvania country road of her youth to her farmhouse. I could smell the earth of the fall, the cool winds sweeping the trees. I could feel the tenor that once sang through her sinewy body.
I looked at her ancient face. I listened. Across the few feet between us, I sent her a life raft, words to float trust on.
I relied on Elizabeth’s wisdom about her body and made my offering. We came to an agreement about her treatment. She smiled and thanked me, and I got up and carefully moved on.
We had more times to meet. She told me about her daughter Cynthia who called her every day, her husband of 40 years, Floyd, now deceased, and about her other family and friends. Every day she was active with her arts and crafts. Having taught elementary school for more than three decades in Pennsylvania, she provided me with many wonderful stories of her days teaching school.
Elizabeth C. Deceased from Covid 19 March 11, 2020
I had many great talks with Evelyn S, who had deep-set brown eyes and a kind face framed with thick white hair. She was born in Macon, Georgia, in 1918, a daughter of sharecroppers, a sibling to ten.
“I’ve had this rash on my face. My doctor said he wasn’t sure what it was.”
Evelyn had herpes zoster, known as shingles. The left side of her face, including part of her nose, was crusted and irritated from the infection. The left corner of her mouth drooped down, resigned to its current affliction.
I started her on an anti-viral medicine and an oral steroid for pain. I also recommended she see an ophthalmologist to make sure she did not suffer any eye damage.
“I can’t whistle,” she said. “And I love to whistle. My face is all numb. And I just started to open and close my left eye.”
Evelyn gave me a droopy smile, but a smile nonetheless. Given her hardy nature, I had a good feeling she would recover soon. But when Covid 19 entered the nursing home and Evelyn’s life, she took a dramatic turn for the worse. She took the time to call me and let me know she had the virus and was not getting better. “I just wanted to tell you,” she said, her voice raspy and her breathing heavy, “that I thank you for you helping me and I enjoyed our talks.’
Evelyn S. Deceased from Covid 19 March 15, 2020
was one of my chronic psoriasis patients. I greeted him with a smile and a fist bump. “Hello, Ernie.”
“Listen, Doc,” he starts, from his perch on his bed. The only thing missing was a microphone and a bigger audience. “A woman has twins and gives them up for adoption. One of them goes to a family in Egypt and is named Amal. The other goes to a family in Spain and they name him Juan. Years later, Juan sends a picture of himself to his birth mom. Upon receiving the picture, she tells her husband that she wishes she also had a picture of Amal. Her husband tells her, ‘Listen, honey, they are twins. If you’ve seen Juan, you’ve seen Amal!’
“That’s good, Ernie,” I said.
We always had time for his health problems, but he preferred to spend the time telling jokes. I think he had enough to deal with in his life, and by keeping me entertained, he could get “out of himself.” I didn’t complain. I always enjoyed his humor and kindness.
Ernie B Deceased from Covid 19 March 18, 2020
sat down in the chair by her bed, and immediately spouted out words on top of more words, rushed, as if they were venom that needed to be pushed out or she would explode. I looked at her chart. Diabetes, manic depression, hip fracture, and other maladies.
“I was going to this primary-care doctor, and I had just had surgery, and my surgeon told my primary-care doctor to keep close watch on me, that I was borderline diabetic. So he treated me for a whole year with antibiotics and nerve drugs. And so finally I had red spots on my face and itchy spots, and I had sugar in my kidneys, and just about everything in me I think I had sugar in it. And so I went to see him again, and I can’t forget it. I thought, ‘That doctor’s kind of odd. Looks like he’s wanting to shoot me, take me out.’
He said, ‘Does your face stay that red all the time?’
“No. I was just thinking maybe it was because he was a new doctor; it was the first time I had seen him. So he checked me out and all. And I knew he kind of acted funny and all to be a new doctor. So I kept going to him, and I was so sick till I had to be led around the office back and forth. And I kept telling him, ‘I’m going to the bathroom every 45 minutes. I’m not getting any sleep. I’m just dead on my feet.’ And he wrote me a prescription for Xanax and Cipro, an antibiotic, and more diabetic medicine.”
“And you felt better?” I asked.
“So things were still going, but I was blind for more than a year. And I went to this healing service. I was blind the 24th of November, and the 24th of December in ’97, I went to this healing service, and I got my sight back. So all of these things, you know, were still going on.
At the healing service, they just put their hands on my eyes and prayed for me. Well, the preacher put his hands over my eyes, and I went out, and then two people picked me up. And he says, ‘What do you see?’ and he held his thumb up like that (demonstrating). And he says, ‘What do you see?’ And I says, ‘I see your thumb.’ And I went out again, and I was out for about two hours. Anyway, I got my sight back Christmas of ’97, and I was in Wal-Mart with my daughter and she was worried I was going to fall down and I kept telling her, ‘Leave me alone.’ I said, ‘I see that man clear across to the wall over there.’ You know, Wal Mart is a good, wide store, and I see that man stacking dog food over there. I went off by myself. And this was a beautiful store I had all around me; it looked like God had opened up heaven.
But, you know, after being blind for more than a year and seeing everything, all of a sudden, you know…that’s all I can think of to tell you.” She let out her breath, a deflated tire of talk, and was still for a moment. A wonderful, odd moment.
“You’ve had some really remarkable experiences,” I said, feeling like I had been on an out-of-control boat that had just docked, and I had finally stepped off on the shore. “Let’s concentrate on your current problems, and we’ll come up with some answers, OK?”
“Sure, Doctor,” she said. “That sounds good to me.
Along the way she told me about her childhood in Ohio, her former husband, her siblings, her work in a cheese shop in Amish country. “I especially liked the aged cheddar,” she said. I liked her stories, even her run-on sentences, and was looking forward to seeing her again.
Linda C Deceased from Covid 19 March 22, 2020
“I want you to look at my arm,” Larry W. a man of 76, said in a halting, falsetto voice.
“I had a bladder growth and I want to make sure what I have now isn’t cancer.”
“Was the growth in your bladder a cancer?” I asked.
“Yes,” he said. “I had an autopsy done and they took a piece out.”
I smiled. “You mean a cystoscopy. The doctor looked inside your bladder.”
“Right. An autoscopy. Cancer, is that what this is?” He held up his arm.
I looked at his arm. He had what appeared to be a benign growth. “No. It looks completely normal.”
“OK, then,” he said. And he proceeded to tell me about his life and how he felt he would be getting out soon and heading back home, despite his poor prognosis.
I listen to stories, and people who cannot face the truth, who have layered themselves in exasperation, and endlessly I feel the centrifugal pull of pathos of failed dreams and ideals and want to help rescue them. Even if only for moments, tug them away from their frustrating lives. And yet at times they share more joy than I could ever imagine, not in the broad strokes of success but in the small, private lives they lived back in their own homes and even now. As the days slip by in this time of pandemic, stories erupt, some glistening like water over a cold stream’s rocks, and others making a pronounced thud in my consciousness. I find that the stories are a healthy and honest measure of my time.|
Larry W. Deceased from Covid 19 March 23, 2020
was a man in his late 70’s. The kind of guy you would call “a super nice guy.” He had recently suffered a stroke and had loss some movement on the right side of his body. Every time I sat down with Jim, he had a smile on his face. “I have a story to tell you, Doc. I know you like stories.”
“Sure, I do,” I said and sat down and looked him in the eyes.
“Worthy Taylor was a farmer. Now this is a true story that occurred in the 1800’s. Many different men came to work on Worthy Taylor’s farm. One particular man came and worked hard. He slept in the hayloft at night. In time, he got to be quite close to Worthy Taylor’s daughter. They grew very fond of one another. At night, the man would sit and stare out the window and think about Mr. Taylor’s daughter and how much he cared for her. One night, he was looking outside, thinking of her, and to pass the time he carved his initials in the windowsill of the loft. He put her initials nearby and drew an arrow and a heart connecting the two. Anyhow, the man asked Mr. Taylor if he could marry his daughter. ‘I’m in love with her,’ he told Mr. Taylor.
Mr. Taylor looked at him and shook his head. ‘No, no, no, you move around too much. You are just a farm worker. You are not good enough for my daughter.’ The man was devastated and finally, he left.
Forty years later, Mr. Taylor was still farming. The barn where the young man had slept was too small and Mr. Taylor decided to rebuild the barn. Before he tore it down he looked around and checked it out. He looked at the windowsill at the place where the young man had slept. On the windowsill, he saw the young man’s initials there and nearby his name spelled out, carved into the windowsill, James A. Garfield.
Mr. Taylor was in shock. He thought back to the young man from 40 years before. He thought about how he had turned the man down for his daughter’s hand in marriage, therefore denying his daughter being the First Lady of the United States.”
“That’s a great story, Jim,” I told him.
“And it’s all true, Doc, it’s all true. Think about it. Before TV, before all these entertainments that we have now, here was a young man who was destined to be the president of the United States carving his name into the windowsill. Pretty powerful image, isn’t it?” he said.
“Sure is,” I said, “And you wonder how things might have been different if he had married that girl.”
“You never know,” Jim said, “you never know.”
Jim T Deceased from Covid 19 March 26, 2020
had one of the strangest bodies I had ever seen. “I done got hit by a school bus,” she told me. Her left leg was long and dry and the bottom posterior section looked like there was a soft, deflated football in it—a large mass. Her legs were three times the size of what would be expected, and her buttocks and upper thighs were convoluted and twisted. She had two ulcers on her bottom that were pink and appeared to be without any sign of infection. I asked her about them and she stated, “I’ve been fixin’ ‘em, takin’ care with ‘em and I got me a nurse that comes in, too.”
“They look OK to me,” I said, “Looks like you’ve been doing a good job.”
When I examined Martha, I noticed she had a massive amount of tissue redundancy as well as a colostomy. “I’ve had that ever since my accident,” she told me. I noted a few other problems she had and told her I would call in some medicines to help her. Before I left to go back on the road, I looked around her room and we chatted a bit.
“You have a lot of little knick-knacks,” I said.
“I call them ‘Whatnots’,” she said.
As I inspected her shelves, I noticed they were filled with hundreds and hundreds of little figurines, mostly of African-American children and adults in a variety of activities —playing harmonica, dancing, frolicking, whatever. She also had a large collection of cat statuettes and Chinese-Americans. Above her couch was a picture of an African-American Jesus. Near her door were about a dozen dog statuettes.
We talked about her life in that dark room, where she had lived the last ten years.
“Time moves on,” she said.
Martha W Deceased from Covid 19 March 28, 2020
was a 66 year-old with blonde hair, blue-eyes and a lesion on his left chin, and turned out to be a man with quite a personality. He went off in so many directions that it was impossible to lasso him into any one compartment.
In the first two minutes of meeting him, he said he was a hypnotist and could check on my past life if I desired.
I had him sign a surgical consent form and listened to him as he went on and on about his life.
“I wrote 50 hit records. Haven’t been paid for any of them yet,” he said.
He started reciting the lyrics and even sang a couple of tunes that I was supposed to readily recognize. He talked about speaking to a roomful of astrologers and bringing each one of them back to their past lives, as well as other outstanding feats he had accomplished.
I removed the irritated lesion on his chin, which later turned out to be a skin cancer, after he told me he had cut it off himself before, on his own. As I sutured the wound closed, he told me that he had just finished a rough divorce.
“My wife almost got half my ranch. I had 80 horses; many of them worth millions, that have been in the Kentucky Derby, the Preakness and other races. But she walked in on me and caught me floating in the air. I have been meditating for years and have taught myself how to float. Anyhow, she ran out. She was pretty scared. So it cost me a lot of money.”
I finished suturing his chin and told him I would come back to take the sutures out. He looked at me as if I had not listened to anything he had told me
“I don’t need you to come back in for that,” he said with a sly smile on his face. “I’ll hypnotize myself tomorrow and the bleeding will stop and the wound will repair on its own.”
The cancer was gone but his wild stories seemed to stay living in the air. Maybe thoughts and tales can float, I wondered. Who knows?
Bob F Deceased from Covid 19 April 1, 2020
was an African American native of Tampa. “I just turned 54 years old when I had fallen at work and broke my hip and become incapacitated. And ended up here in this nursing home.” Her most recent job was cleaning up restrooms along Highway 75 just north of Tampa. She was on a step stool cleaning and lost her balance and tilted back and fell. For years before that she had worked as a housekeeper at Macy’s and then at a Holiday Inn and a Days Inn and along the way she had nine children and 32 grandchildren and was divorced. When I asked her what she liked to do, she said, “Mostly sewing. I make pillows and clothes for my grandchildren.” If she had not fallen, she probably would not have been here, surrounded by others with a deadly virus.
Sylvia L Deceased from Covid 19 April 3, 2020
said to me, “I made it, I made it, I made it to 60,” the last time I saw her. She wore black horn-rim glasses, had a nose ring and purple hair. Her diabetes had progressed to the point of her becoming more and more disabled and she developed ulcers on her feet and lower legs. “I’m going bald in the front.” she said. “My dad is 81 years old and he said he wants to do some kind of will thing to take care of me. I really don’t need much. I told him I got an attitude and I’m OK.” She told me she used to like to grow milkweed in her garden so the monarch butterflies would come. “I could hear the birds chirping, look at the puffy clouds, had the seabreeze, there was always a lightning show every night in the summer. I only lived about a mile from the Gulf of Mexico.”
Rebecca G Deceased from Covid 19 April 5, 2020
was 80 years old. “In 1951 I was in Tampa. I was watching channel 38, a black-and-white TV, and only on from 5 to 11 pm. My family decided to take a trip to Washington DC to see all the famous buildings and visit our aunt. So we drove all the way up there in the summer. It was hotter up there than down here. Anyhow, when everybody was wanting to get out to see the buildings, and the kids just wanted to stay home because they had color TV in Washington DC and we didn’t have it here in Tampa.”
He had a tumor on his left arm that I removed and we had many times to talk. He reminded me of the people that I knew when I first started practice from the “greatest generation,” the World War II veterans that had a certain confidence and purpose in their lives and a joy of remembrance for the new things they had experienced.
Howard S Deceased from Covid 19 April 8, 2020
I saw Michael V in a Nursing home in Hernando County.
“I lived here almost all my life,” Michael said. “Moved here when I was a kid. Came from the Bronx.”
“Why did your family go down to this little town?” I asked.
“My parents and I and my two brothers lived in an apartment in Brooklyn. I was surrounded by other apartments. I looked out our windows at an apartment building and that’s all we ever saw. One day, out of one of the windows, we see there’s an advertisement that was put up on a billboard and we could just see the corner of it and it read, “Come on down to sunny Hernando, Florida,” and on it was a beautiful sun and blue waters and a couple of smiling people. We figured there must be a reason why that billboard got put up when it did ‘cause about that time we was in the middle of a horrible winter and we were going crazy and there was nothing to do, nothing to say, except there was that billboard and it showed a picture of a beautiful beach so my father said we’re going to head on down south and we did and I was a young man and my father wanted a change and he’d been working for thirty years in the sanitation department and it was driving him nuts ‘specially in the winters.
Michael V Deceased April 12 Covid 19
was a short wiry 76-year-old. He had given me his cell number and wanted me to visit him in his house in Ramallah on the West Bank. “I will pick you up and show you all around,” he said. “I need to look good for my wife when I go back to Jerusalem and I need these taken off of me.” He pointed to a couple of very irritated lesions on his forehead, which I later removed.
He had told me about his jobs, especially in Gary, Indiana for US Steel. He worked as a crane operator and worked all the jobs, forklifts, machine generators, press operators, for 20 years. “We had 20,000 people working there at one time, then went down to 5000 people and they stopped appreciating us after a while. When I first started it was a good 13 weeks a year vacation and when I quit it was lucky if you got two weeks a year. When I worked a crane, that was tough, 44 steps to the top of the crane, standing up all day, working in the heat. We had to know all the jobs. I worked five or six different jobs. Sometimes 12 to 15 hours a day, no time and a half pay. If somebody didn’t show up I’d get called in and I come in and worked.
“What about family?” I asked.
“I had 12 kids. Seven boys, five girls, the first kid was from a different wife, the rest from one wife. I had to keep working hard to support all of them.”
“How do you end up down here and in this place?” I asked.
“About a year ago I started getting a bad cough. I smoked and I worked in those factories and I’m sure none of that helped. Anyhow I had lung cancer and they cut out part of me, opened me up and removed it and I was never the same after that.”
Mohamed S Deceased April 18 Covid 19
was squirming in his chair when I came to see him, sort of dancing in place. I assumed a few things about what he had going on but I wanted him to fill in the blanks. First, I went through some of the usual protocols and I asked him if he had any allergies.
“I’m allergic to alcohol.”
“Yep. Every time I take it, I break out in handcuffs.” He smiled and twisted snake-like. “I’ve had Parkinson’s for 16 years, also hepatitis C.” He stopped and pointed out a skin cancer that he thought he had on his left ear. “I’ve had lots of these all over.”
“When did you first know you had Parkinson’s?” I asked.
“I had these tremors in my hands, and one hand started to take off and move before the other. And then it kept getting worse. I couldn’t stop shaking. I was shaking all the time. It hurt. The shaking hurt. I dealt with it for a few years every way I could but then I started doing alcohol, cocaine and methamphetamine and it helped. It was really weird. Every time I took methamphetamine, my shaking stopped for about three hours. I finally got on some carbidopa. It helps stop the shaking but the side effects, of course, can be a bastard. There’s bradykinesia, you know, like my left arm gets stiff and painful.” He knocked on the wall and said, “Stiff like this, you know. You can get immune to that drug. I heard they got some kind a new inhaler that stops the shaking. I need to look into that.”
“And your social life?”
“It’s hard to find a woman when I move it around like I am. But I do go on some chat sites.” He looked up at me and asked, “Do you have anything out there in the world that may change what I have?”
“I know there are technology like CRISPR that has worked on diseases like sickle cell and change a person’s genetic structure,” I said.
“Really?” he said. “Where do I sign up?”
I have always loved neurology and psychiatry, both fascinating and filled with myriad possibilities and combinations and at the core of what makes us human in many ways. I never really understood as much about why neurology and psychiatry intoxicated me until I started understanding more about the embryological origins of the nervous system in the ectoderm. I realized that the ectoderm was also the skin and sensory sources and somehow they all evolved together and shared many of the same capacities and burdens of being human.
I wanted to do procedures and do things with my hands and still tease out diagnoses and I found a good balance in dermatology. I love how the skin seems to reflect the inner nature and the chronology of most humans. Although I loved neurology and psychiatry, especially the cornucopia of stories that arise from the enormous complexities of these patients, it seemed almost ornithological.
In a subsequent visit, I asked Frank what he enjoyed doing the most. “I’m an artist,” he said. I asked him more and he said he was a painter but as his disease progressed he had to start changing his technique. He moved around inside the world of fine arts and painting. He showed me some pictures on his cell phone of drawings that he had done. Even though he said he had pivoted and gone away from fine lines to texture I thought his work was truly remarkable.
Frank M Deceased April 21 Covid 19
Many of the nursing homes here in Florida and elsewhere have dozens of Covid 19 patients, and the fatality rate from the disease has been horribly high. I miss each and every one of the people I was privileged to meet and have a role in their care. Each gave me a sense of their humanity and dignity, and I tell their tales to help you understand a part of the treasure that each offered.
Author Bio: Dr. Robert A. Norman is a board-certified dermatologist and family practitioner who has been in practice for over 30 years and holds master’s degrees in both Public Health and Business Administration. He has written 46 books, including THE BLUE MAN AND OTHER STORIES OF THE SKIN (University of California Press, 2014), DISCOVER MAGAZINE’S VITAL SIGNS: True Tales of Medical Mysteries, Obscure Diseases, and Life-Saving Diagnoses (Skyhorse, 2013), and 100 QUESTIONS AND ANSWERS ON AGING SKIN (Jones and Bartlett, 2010). He has also been the editor and contributing writer of ten textbooks on Geriatrics and Geriatric Dermatology and published over 300 articles in various major media publications.
Dr. Norman is a frequent medical volunteer and has participated in more than a dozen medical mission trips to Jamaica, Haiti, Cuba, and Guatemala. Dr. Norman can be reached at: email@example.com