How did she know? I’m a nurse, I work with the elderly on a regular basis, but how did my wife know so much more than I did about this?
A few weeks ago, Adi’s grandfather said something monumental, though I didn’t realize it at the time. He wanted to visit the cemetery where his wife of 70 years was buried. I was well aware that in the years since 2016 when she died, he found the thought of visiting her too sad, and this would be the first time he would take the emotional journey to finally see her. Great, I thought. He’s finally ready, enough time has passed, this is important. But then Adi said something that caught me completely off-guard. “I am preparing myself for the reality that after he goes to the cemetery, he will have a sharp decline and die soon.” I was confused. Why would that be? He was 99 years old, but amazingly, he was mostly independent. The whole point of him not going for years was that it made things too sad, the time passing had allowed him to feel like he could handle it, so I didn’t forsee any sort of decline. I’m familiar with Broken Heart Syndrome, which is really Stress Cardiomyopathy, but it doesn’t usually happen, right? That’s the stuff of sad romance novels. But a granddaughter’s intuition is far more powerful than whatever knowledge this nurse could have predicted, because she was right.
The visit was good, Adi sang the songs her Grandma Nette “Bubbles” loved to hear, and her Grandpa shed tears while smiling and watching me keep Natalia – one of 6 great-grandchildren – distracted on the side. Natalia was named after Nette, whose Hebrew/Yiddish name was Nacha; and whenever Mal would see Natalia he would smile and say “Nachala” because she was his Nacha. Buried next to his wife was his only sibling, Julia. On the other side of his wife an empty spot for him one day. When we got home he was tired, as expected. This was Thursday, July 23. The next day he was exhausted. I told Adi that was normal after his first outing in 4 months, and the emotions it stirred up. She said, “I hope you’re right”. The following morning, Shabbat, July 25, Adi’s mother Dale showed up at 9am to catch us before our weekly social distance walk with friends, to tell us an important update. Her father – Adi’s Grandpa Mal – had said he will need a nurse to help him from now on, that he was not able to dress himself anymore.
Let us pause and go back in time for a moment, and understand the significance of this 99 year old man, making a common request for assistance…
Malvin Ross was born and raised with his older sister Julia in Detroit, Michigan. As a teenager he met Nette, the love of his life, who also grew up in Michigan. During those teenage years he played many sports including baseball, tennis and gymnastics. In fact he was awarded a college baseball scholarship, but those plans changed when America joined the 2nd World War. Mal enlisted, and lied to his parents that he was drafted, and spent the years of the war in India and China as a part of the historic Flying Tigers.
When he returned home after the war, he and Nette began the start of a 70 year marriage, with a love that you could feel by being in their presence.
He worked as a valet at the famous Friars Club, meeting and getting tipped by a laundry list of celebrities of yesteryear. He considered going back to school, as the war had prevented that; in fact he was highly interested in veterinary school, but decided instead to begin earning money for his family which was just beginning.
He opened a pet supply store, which he ran every day until retirement at age 65. Because it was in Brentwood, his clientele included huge stars for decades; in fact looking through his rolodex you might think he was a Hollywood agent. He loved to talk about who was nice, who was pretty, and who was cheap and a bad tipper!
He and Nette raised their 2 daughters Dale and Teri in the Mar Vista area, and spent their retirement with weekly visits to Norms and square dancing. He loved his cactus garden, something I can even remember seeing him on his hands and knees tending to when I met him in his 90s. He also loved watching the Dodgers, and frequently went to games with his sister Julia and her husband Phil. Any time I would see him he would bring up the Dodgers and complain about their lack of winning the World Series since 1988. He would continue to worship Nette, who he called Bubbles, and frequently told people, “I don’t deserve her”. He was always as proud as could be when it came to his grandkids and great-grandkids.
So this man I have briefly described, a WWII veteran, a proud man who needed to be strong-armed by his family to move out of his 3-story townhouse when he and Nette were each in their 90s, and stairs were already an intimidating hazard. This is a man who did not want to move out of his elderly living facility when COVID19 started, even though they were recommending everyone who had a family they could live with do so for safety reasons – but he did not want to be a burden on anyone else. This is a man who I needed to convince with great efforts to allow me – the nurse husband of his granddaughter – to shower him 3 times a week. “I’m fine, I don’t need the help, you’re just gonna hurt your bad back” were frequent things I would hear throughout the process. Each time I finished he would tell me, “You’re getting faster and better at this each time”, so that although he would object to the help, he wanted me to always know he appreciated it. I would let him dress himself as often as I thought he could handle it, because I wanted him to feel as independent as possible, but I would also help when it seemed difficult. The balancing act of maintaining his pride while still keeping him safe was one that we were each practicing on a daily basis. Providing dignity and a sense of autonomy to someone while keeping them healthy and safe is not always as simple as you would hope. I have to do this on a regular basis at work by telling people of sound mind that they cannot get up without assistance or an alarm will sound on their bed. Some accept it, and some find it extremely condescending, which sadly, it may very well need to be.
This same proud man, on Saturday morning July 25, was bringing up the need to have a nurse on a regular basis. This was newsworthy. Adi looked at me with a knowing glance, since it had been less than 48 hours since the cemetery visit. We went on our walk. A few hours later, we returned to find Adi’s parents Dale and Mark sitting on the front lawn steps waiting for us. Grandpa Mal had fallen an hour after this conversation, and been taken by Dale’s sister Teri to the hospital. Adi cried, and said to me, “I knew it”. I had nothing more to say, so I hugged her. The test results were good, there was nothing fractured or sprained in this 99 year old veteran. Just a bad bruise on his left side. He was back home, telling us how surprised and relieved he was that nothing was broken. “I was positive that it was much worse, and that I’d be staying at the hospital for the rest of my life, I’m so lucky” he told me. The steep decline continued. I was used to showering him 3 times a week, but he had been relatively easy to get around the house, and required no heavy lifting. I had been helping a family member, not a patient. Now he had transitioned to something I was more sadly familiar with, a man who needed all of the help. Getting up, down, dressing, undressing, eating, bathroom needs, his life had shifted in the way that all of us should be so lucky as to not happen until age 99. Many days were spent sleeping 23 of the 24 hours. Some days he could help walk and follow directions, other days I had to haul him at the expense of my bad back. Caregivers were being arranged, but the process was much slower due to the pandemic. Adi’s father is highly immunocompromised, so the plan was to bring Grandpa Mal to Adi’s Aunt Teri and Uncle Todd, where someone could work. But still COVID testing and caregiver availability meant August 12th would be the date. That’s when he could move and finally get that assistance. Because what I failed to mention is that each and every day that Adi’s father and I would change him, he would ask me when a stranger could start. His pride was still there, and if he needed help it should at least come from a paid employee. It pained him to see his son-in-law and grandson-in-law doing the heavy lifting. So Wednesday, Aug. 12 was drilled into his head, that’s when it would happen.
But things took even more of a turn for the worse a week ago. Early in August, his confusion and weakness became so challenging that I didn’t think my experience alone would be enough; we needed help sooner. My friend from work found us a caregiver who could start as soon as a new COVID-19 test cleared him. Friday evening the results were in. Great. An ambulance was arranged for Shabbat morning Aug. 8. That morning as I got him cleaned and dressed with Adi’s father, and he looked away as usual hating that we were the ones doing it; we told him it would be the last time with us. He would be going to his daughter Teri where a paid professional was waiting to help him. “Oh good!” he immediately said. Such relief was evident. They arrived to pick him up, I said goodbye with Natalia, his Nachala. Unbeknownst to me, Adi got a photo of this moment, of which I’m grateful. Although this is not that photo, just a few weeks earlier, this shot gives you a sense of the joy his Nachala still brought him on a daily basis.
The next few days he was taken care of well, and got to spend invaluable time with his daughter Teri, son-in-law Todd, and granddaughters Samantha and Mikki, but he was mostly sleeping, and far less alert. The hospice doctor saw him in person for the first time on Aug. 11, and gave the bad news that he was likely to only live another 2-4 weeks. That night, at 3:15am on Aug. 12, the same day we had previously told him that he was moving, Malvin Ross died in his sleep. The hospice doctor explained that he may have had small strokes months ago, which led to the decline. Given the information that his sharp decline occurred immediately after visiting the cemetery for the first time, the doctor said that any form of stress can create a decline if someone has had strokes or narrowing of arteries. “PTSD can have life-threatening results in much of the elderly as a result” he told us. This may or may not have been the cause, but one thing I know is that my wife – the non-medical professional – could see all of this most clearly. Her grandfather had been pressured to move from his home for safety reasons. He had then in March been pressured to move in with all of us for safety reasons. His visit to his wife at the cemetery was a choice he could make for himself…and when he left her grave that day, his decision was made up. He was ready to make his final move.
