SELF-CONTAINED

I didn’t know what it would do, to say out loud that I was tired of listening to the disembodied voices of men insulting and giving me orders, but I knew it would do damage. I’d been so scared of my visions and auditory hallucinations that I never told my parents about them. When I willingly walked through ER doors my senior year of college, I didn’t tell my parents that I would be an inpatient in the psychiatric wing of Lennox Hill Hospital. Out of fear I would disappoint them into heartbreak, I went the eight days there with minimal communication, lying about where I was at any given time as the haze lifted. I knew I needed help, but I did not trust my parents enough to confess that. Somehow, I thought that cracking into pieces would get me in trouble. Three months later they received a statement from my insurance company and I was exposed. My mother, between outrage and terror, insisted that they could have helped me had I told them how I was feeling, and I insisted that I didn’t want to worry them, didn’t want to become a burden, didn’t want to embarrass them. I didn’t know where the shame came from, but it filled my pores and froze my vocal cords.

The help I received my eight days at the hospital was enough to hold me for a few years, but not enough to sustain my erratic mind. My memory was pregnant with falsities, it took too much work to focus my train of thought, everyone else’s reality didn’t seem to match my own. The sunrise over San Juan had been a scoop of rainbow sherbert the morning my parents and I landed in the island. I was moved back home to receive psychiatric treatment for an illness I did not yet know I had. I watched the colors melt into each other from the plane window, my parents still asleep next to me. They told close family that I returned home because I was depressed, finding that to be better received than the full, new-found truth – that I was bipolar. I was used to lying – a symptom of my delusions and mania – but this felt more like going into hiding. My embarrassment was validated. When my abuela – my father’s mother – asked why I was back, my parents told her I needed time to think of what to do next. They feared her age would affect her judgement, that she wouldn’t believe in the validity of mental illness. I disagreed, but worried that abuela would find me weak if she knew the real reason behind my move.

For the three years I lived back home, she and I picked at leaves from the family tree, found words in letter soup and listened to the music of her time, soft and scratchy at the edges. I visited her every Wednesday, and she would repeat the same three stories, emphasizing the same scenes, feeling them the same each time. In one of her memories, she fell from a mango tree after her mother warned that one more climb would award her a few knocks over the head and two rounds of rosary prayer. In another, she talked back to a nun at school, telling her the virgin Mary could go screw herself. She always laughed at her own young wit, “Mamá always gave me such beatings!” her words in bursts of girlish giggles.

Upon my move, I’d been warned that abuela’s senses were coming loose at the hinges. She had received a diagnosis as well: Alzheimer’s. Her memory was faltering and conflating events, sometimes she hallucinated birds or children. It frightened my family, but it was all familiar to me. Leading up to my hospitalization four years prior, I had seen things too.

One Wednesday, about a month into my visits, abuela and I sat side by side on the sofa doing a wordsearch. She looked at me as if suddenly realizing I’d been there the whole time. “Say,” she started, “have you gotten used to being back on the island?”

She hadn’t asked a relevant question since I’d been back. Bewildered and caught, I answered, “It’s been ok. I’m still adjusting.” I was still embarrassed that I’d lost control and had had to be taken in. Having to keep my mental illness silent and secret only isolated me further.

“What happened, were you depressed?” Unsurprisingly, abuela could smell the recovering in me, sage and nervous sweat.

“I was sometimes,” I answered, telling her what my parents’ wouldn’t. “And other times I would be euphoric or really anxious or too excited. I couldn’t control the mood swings.”

She listened to me, her wrinkled brow folding further as she processed my confession. “And ire?” It was uncanny. Like traveling back in time to a familiar woman. I felt seen by her.

“Maybe once or twice, but not usually,”

“I remember ire,” she said, almost fondly. “I was depressed once, too.” She looked out the window, watching the past replay before her. “We were living a few towns over, and a group of thieves had been terrorizing our neighborhood. They broke into our house twice in a matter of months. Then, they broke into our neighbor’s house.” Her inhale, in and out her nose, sucked in her lips. “And they killed the couple who lived there, took everything. All I could do was cry. For weeks, I was incapacitated.” I didn’t have a word to offer. The thieves had stolen the little jewelry my teenaged aunt had accumulated then, they had taken appliances and cufflinks. I imagined abuela as a young mother, resilient against black-veiled intruders and desperate to protect her family. I imagined her on the floor of her bathroom as everyone slept, whispering sobs into her hands, as I had done so many times.  

Grandma bopped her head a little, putting her next thought together. “Well, you’re home now. Take care of yourself and you’ll be back in New York in no time.” She returned to the puzzle book, as did I, afraid that any sudden burst of feeling would startle her back into dementia. She fell asleep a few minutes later. When I returned on Sunday with my father, she’d already forgotten that I’d been there that week.

Abuela had always been open-minded, despite her being of a generation characterized by prejudice of various kinds. In an era when only her brothers were encouraged to attend school, she became the only woman in her family to complete the highest level of education available then — eighth grade. I imagined her in a school yard, the only one in primped curls, the boys in dirtied button-downs. My father had inherited her smarts and open mind, though he failed at inspiring fear in others’ hearts. About a week after arriving at home, my father and I flew back to New York to pack up the rest of my apartment and settle various debts, including one to my landlord, that I had left in my trail of mania. We donated all of my furniture to Goodwill and, on our way back to JFK airport, he put his hand on mine as we rode in the back of a cab without speaking. There was an understanding between us – that we’d gotten rid of my old life, that he knew I was mourning. We barely spoke during our travel. When we arrived back home, I heard my mother ask him how I was. “She’s quiet,” my father answered.

Six months into my visits, abuela’s condition began to gain momentum. Between her nieces and nurses, five women took care of her, delegating days and shifts amongst themselves. They dressed her, combed her hair, cooked her meals and told her what the neighbors were up to. I continued to spend Wednesdays at her house, sitting with her through lunch. Soon, she unlearned how to hold a fork, and I helped feed her. With the erasing of that skill went her ability to hold a pencil. I held the puzzlebook up for the two of us, and searched for every word she could not recognize. I talked to her about the weather in New York, and she tried to match my winter stories with those from the time she lived in Chicago as a young bride. She was losing vocabulary, her nouns and verbs hiding behind images of the things she wanted and escaping her grip. I saw my previous self in her.

At the height of my mania, I was unable to read. Story was elusive, words didn’t come through as related or tied together. To get a sense of cohesion, I had to weave past the neon aura of the objects around me, the imagined movement of the walls. My brain had created a world atop the one I walked on. I sacrificed basic functions to free enough energy to navigate it. My thoughts zipped one way, then another, erratic in their movement and extreme in their assumptions. I had magical powers. All of the men were out to get to me. My teacher could read my thoughts. There was little left of me to speak coherently, and even less to put into reading. Words swirled in my head, my tongue was eager for use, but my brain moved too fast for me to voice anything.

There were words inside of abuela too. When I told her the youngest of the cousins now had a boyfriend, the twitch in her eye gave away her desire to speak. But there was little language left. I slowed the cadence of my speech to accommodate abuela’s descent. Her hearing already a problem, I took to repeating loud, short sentences – a combination of standard questions, “Are you hungry?” and vintage colloquialisms, “No mail today, but no news is good news!” Family members began calling me for updates on abuela, unable to communicate with her directly. I called the nurses when I wanted to know if she’d eaten, or if the cough had gotten any better.

Abuela’s increasing silence pierced me. My family took to speaking about her as if she was already gone. Sometimes, they talked about her quietly in front of her, her barely-there hearing coupled with her barely-there mind kept her oblivious. I knew the feeling well, as my parents had talked to my doctor in front of me the same way, as if I was lost in a fog. I continued to speak to her as if she was the same woman who’d taught me not to get a husband until I had a job. As if she was the same abuela who gifted me fabric and taught me how to sew. I recognized the desperation of being trapped inside your head, the saddened half-hearted gaze. My roommate at Lenox Hill had had the same eyes.

She had arrived on my fourth day as inpatient, her daughter following closely behind her, hands extended with palms facing up, prepared to catch her mother were she to falter. My new roommate, an aged woman with stark black hair, sat on her bed and looked around, wide-eyed and blinking. Whatever drove her to the unit was with her now. The daughter slouched to her mother’s eye level and, with a gentle hand to her wrinkled cheek, said something in what sounded like French. The young Mademoiselle took a short breath and kissed her mother on the forehead. There were no tears, none that I could see. Madame looked up at her daughter, quiet. Mademoiselle left the room, and her mother shifted her weight, continuing to take in her surroundings, floor to ceiling, wall to wall.

“Dinner time!” The warden’s voice boomed down the main hallway of the unit, gaining volume step by step. Madame did not move. I stopped at her side on my way out, extending an open palm as invitation for her to come. Dinner was mandatory, and if she didn’t eat now she might not be able to later. Madame found my eyes right away, her lids flinching in surprise as if she couldn’t believe someone had found her. “Dinner- do you want some?” I spread my fingers open wider. She raised a most fragile hand as high as she could, and I swooped my own under it, holding its weight. I motioned for her other hand and helped her stand. I didn’t know any French, but on the chance that the vocabulary could somehow be conveyed through another Romance language, I locked eyes with her and asked in Italian, “Bene?”

She smiled and responded in a breathy hoarse voice, “Bene.”

On my seventh day as inpatient, I walked into my room to find Madame standing in the middle of it, eyeline shifting erratically, hands ready to brace. “Hello,” I announced as gently as I could. She faced me, mouth agape, prepared to speak.

She waved her hands in front of her pants bringing attention to her pelvic area. “I had…” her voice always barely there. “I had accident.” I looked down at her navy pants and could tell they were wet.

“That’s ok. It happens,” my pitch was purposefully high and decidedly loving. I put out my hand for her to steady herself. “I’ll walk you to the bathroom so you can start to undress and I’ll go get a nurse.”

“No, no,” she exhaled quickly. “If…” her eyes widened to a child’s terrified stare.

“Oh, stop it, you’re not in trouble,” I shoo-ed with my wrist to make light of the whole thing, and she snorted a small laugh. In the bathroom, she lowered her pants, sat on the toilet, and with a nod signaled she was ready. I closed the bathroom door halfway and ran to the nurse’s station to get Madame help. Once changed, the nurse helped Madame to her bed. “The stress tired her out,” she said to me as I sat at my desk. Madame closed her eyes, head atop pillow, body under blanket. I stayed in the room until she awoke so I could help her walk to the dining room for our next meal. The day I left the hospital I was told at 8 AM that I was to leave by noon. I hurriedly packed my bags, had a medication consult and was walked to the door. I had no time to say goodbye to Madame, the doors closed behind me, trapping her inside.

“Lunch?” Abuela’s daytime nurse, Silvia, motioned from the kitchen that food was served. She’d made enough for both, myself and abuela, as the only habit the Alzheimer’s had not claimed was my grandmother’s adamant insistence that you sit and eat something. My father and I purposely arrived after meal time for our visits to avoid having to eat an extra meal at her house.

One Sunday, we pulled up to abuela’s house to find her and Silvia lounging on the porch, my grandmother falling asleep in her chair. She’d been falling asleep often, nodding off while you were talking to her, mid-sentence. It was a new symptom of her disease. She wasn’t forgetting faces yet, but names, places and dates were a jumbled mess.

As my father and I walked up the driveway, our “Hello!” woke her, and focusing her eyes on my father’s face, she exclaimed, “What are you doing here? It’s a miracle!” My father laughed, “Oh, Ma. I was here last Sunday.” We joined her and Silvia on the porch, enjoying the rare summer breeze. The beach hummed a few blocks away. We kept grandma’s attention for a few minutes, but soon her head was flopping backward and forward, falling into a nap. Every once in a while, she would wake. Her eyes would blink themselves wide, look around and then squint into laughter. “I fell asleep!” her wheezing laugh leading to a drained yawn.

A couple of hours into our visit, my father tapped my grandmother on the knee. “Let Silvia give you a bath so you can put pajamas on.” I saw abuela’s shoulders roll back and her posture lengthen.

“I’m not letting Silvia touch me,”alarmed and defiant.

My father helped her stand up and began leading her to the master bedroom. “Don’t worry about that right now, just come with me.” I followed them all into the house and held back in the living room as Silvia continued behind my father. “It’s time for a bath, Silvia’s going to help you.” I heard my grandmother talk back to him, and his muffled bartering. “Fine,” he said loudly, “Tania will do it.”

She will? I breathed in deep and held the air at the base of my throat. My father appeared from the hallway, eyebrows raised in the middle. I let the breath go and headed toward the master bedroom, my father took a seat in the living room.

I gently washed abuela’s skin, loose and soft under my hands. My fingers rinsing her hair, images of her braiding mine bubbled. Her brittle frame sat still in the shower chair as I ran soap along her chest the way she used to rub vapor rub on me when I was sick. She closed her eyes when I scrubbed her back. Her body was a doll’s body, the arm I lifted stayed up until lowered. I held the shower head close to her, the water clearing off suds. She held onto me as I cloaked her in a towel and patted her dry, her fingers clasped to my shoulders. I dressed her carefully, then lay her on her bed, cozy in pajamas. A nap found her mid-sigh.

I watched my grandmother teeter between present and past, Wednesday to Wednesday, for three years. My deepened relationship with her had become known in our family, and, once my move back to New York was certain, every member helped prepare abuela for the day we would separate. My parents, cousins, uncles and the nurses dropped lines about my moving weeks before my departure date. “When Tania leaves…” or “Since Tania is moving…” were common clauses used to implant the impending reality in her foggy head.

She was unable to remember most things, but abuela let tears loose of understanding as my mother started the car at the end of my last visit. My own followed closely behind hers. We pretended not to notice the other was crying, and said our farewell in even breaths, with our faces wet and glistening. Unable to stand from her wheelchair, she raised her arms as high as they would go for a hug. I enveloped her small body, her wispy hair in my nose. I inhaled the ache, and it welled in my eyes. She’d prepared me to leave her.

My mother’s voice shook in its words, I imagined her chin quivering. “We knew she would get upset, but I’d never seen her so betrayed.” For months, my father and his siblings had been debating whether to place their mother in a nursing home. The two youngest, one of which was my father, believed a facility would provide her with needed round-the clock care and immediate access to doctors. The oldest two adamantly refused, the memory of their mother clouding the reality in front of them. Conference calls between the four siblings went on into the night, weekend after weekend, until they finally came to a decision. “She’ll be in one nearby and close to us. Better for everyone,” my father had said to us, more so to himself.

Moving abuela to the elderly care home was only made more difficult by her ebbing in and out of lucidity. In her youth she had been fierce and quick. She relived these memories daily, sometimes asking where her deceased husband was or when mamá was getting home. Reasoning with her was difficult regardless of where her mind was – she was lost in memories or was completely present, demanding explanations and resisting help. She had retained control of her house, her garden, and her money even when her mind started to break off into pieces. My father managed his mother’s finances, but she managed my father. My grandmother, with thin silver hair and fragile frame, always had thick skin and strong character.

When she and my parents arrived at her new room, the beige walls and clinical bedding gave away what was happening. Abuela yelled and cried, tensed up and fought back. “How dare you? You don’t love me!” She refused to sit, her weak legs shuddering at their use, her weathered hands holding on to the back of a chair. She was being committed against her will, but will was all she had left.

I felt her anger as guilt, despite not having had a say in the matter. I knew what it was like to be stripped of freedom and put under surveillance. Unlike her, I had voluntarily walked through ER doors and had asked to be admitted during my senior year of college. Even so, the shift from civilian to inpatient was enough to trigger my instinct to resist. I’d had to steady myself with a wall in the foyer of the unit upon walking in, icy cement reeling me into my new reality. The warden gave me a moment to collect my spilled emotions and then led me on a tour. We headed down a hallway lined with closed birch doors. He opened a door on the right and allowed me to step in. “You’ll be in this room. You’re the far bed,” he pointed to the one closest to the window, a steel mesh screen in front of the glass. He walked out of the room, leaving the door open behind him. I had nothing to unpack. My thoughts thrashed against my skull, I concentrated on the silence.

Abuela, instead, had called on all the noise. It took hours for my parents to calm her down and get her to agree to stay at the facility. As they filled the closet with blouses, pants, shoes, abuela asked how long her stay would be. My father, fist full of hangers, said, “give it a week.” When my parents said goodbye, abuela broke into sobs, her back heaving up and down. “I can’t believe you would do this to me.” Her words were thick with saliva, tied to each other in one cry. My parents had to walk away.

Eventually, abuela settled into the meal times, the medicine, the nurses. I’d known the comfort of monotony, too. The gentle hum of sameness in perpetuity was enough to lull you into submission. Outpatient treatment did the same thing. I have quieted my worries, have hid my troubles from others by way of a medicine routine. This is not to say that my worries and troubles have quieted. Rather, I have kept quiet about them, entrusting the routine to put its hand over my symptoms’ mouths. Often, I accompanied swallowing my medication with an internal plea that it work. The sheer act of taking the medicine was supposed to soothe me, and I felt it overkill to confide my fear in someone when I was already knee-deep in a solution. It’s a toss up whether the medication numbed me or the routine did.

The last time I visited abuela at the nursing home, I put my hand on her knee so she would feel that she’d known me my whole life. She sat in silence, combing through my features. I told her about things in New York, how she was my first stop in my visit to Puerto Rico. She could not ask if I was doing alright, if I had steadied, but I told her I was doing well. Abuela nodded, possibly contemplating my words, possibly still trying to place me.

“What do you see?” I asked as she studied my face. Abuela’s mouth stretched in a gentle smile. She placed her quivering hand atop mine, and said nothing.

Originally from San Juan, Tania Pabón Acosta holds an M.A. in English Literature from the University of Puerto Rico, and an M.F.A. from Sarah Lawrence College. Her work has appeared in Briller Magazine, Gravel, Breadcrumbs Mag, The Acentos Review and Pigeon Pages; is forthcoming in Great River Review, Entropy and The Los Angeles Review; and was chosen for AmpLit Fest’s Emerging Writer Showcase 2018.