It’s Friday and I’m ready to rumble.
Ladies and gentlemen! This afternoon in front of Hillview Towers for Senior Residents here in Jersey City, New Jersey, in a raspberry scarf, blue jeans, and practical walking shoes, weighing in at 115 pounds, unfazed by jealous bosses, backstabbing colleagues, or Puerto-Rican-hating sales clerks. The woman who never says never, whose fear of water or traffic circles or germs on public door handles never holds her back. Welcome the one. The only. The legend. La campeona. La Nancy!
The saggy yellow four-door honks twice as it pulls up in front of Hillview Towers. A-1 Taxi Company. Five minutes ahead of the ETA the dispatcher had quoted on the phone. A good sign. The driver and I nod at each other. Middle Eastern, middle-aged, Bluetooth earpiece to receive pick-up addresses from Command Central.
I hold Mami’s arm, help her into the back seat, and climb in after her. I tell the driver we’re going to the Medical Center and to go south on Jersey Avenue to its end, just before Liberty State Park.
“The hospital or 377?”
Another good sign: He knows the difference between the hospital and the doctors’ suites building right behind. This guy has obviously transported other people to medical appointments. Not a job I’d want. The drama potential is too high: aging parents and adult children, ready to combust with anxieties and resentments. Plexiglass alone can’t protect drivers from what can erupt behind them. The taxis should be equipped with fire extinguishers in case the backseats become engulfed in flames. Or maybe boxing helmets. But Mami and I are of the silent-and-still-when-anxious type. I tell the driver that the dispatcher had quoted eight dollars as the fare from Mami’s address to 377 Jersey Avenue.
“Lady, if that’s what he say, that’s what it is. I don’t wanna fight.”
I sit back and exhale. No fight about the address or the route or the fare. I need my energy for what’s coming.
The first face-off of the day was with Mami. I was on high alert when I reached the ninth floor of Hillview Towers and approached my parents’ apartment. Papi had opened the door and hugged me a little longer than usual. Was it gratitude for accompanying Mami to her doctor’s appointment, the one she’d avoided for more than one year? I didn’t ask how Papi had managed to schedule the appointment and gotten Mami to agree to it. Papi and I tag-team it with Mami, and we each need to stay focused on our own action—and are grateful for the hand-off moments.
I was surprised when I saw Mami waiting for me in the living room. She wasn’t in her battle gear: the flowered housedress that states she is dressed to stay home. Instead, she wore her windbreaker and slacks. She was quiet—a little more so than usual. She wasn’t smiling, but she was ready.
Getting Mami to the doctor is always a fight. She’s never had a flu shot. The last time she’s been seen by a gynecologist was when she had me in the early 1970s. She has torn up prescriptions for recommended colonoscopies, bone density scans, and cough medications. She refused to see her doctor for more than one year, but she didn’t put up the fight today. That scares me. I would prefer to have found Mami in her housedress. In that fight, I can anticipate her every move and know how to respond. Today is serious.
Mami’s forgetfulness has been increasing. It’s becoming harder for her to brush it off as normal aging, overstuffed mental files, Papi working her nerves, or her depression and anxiety. We all worry about it. I want to know what “it” is, what kind of fight lies ahead, and what, if anything, we can do to prepare.
I know, both from having observed Mami all my life and my own struggles, that depression shares symptoms with dementia and age-related memory loss: the sadness, hopelessness, and worthlessness. The social withdrawal. The irritability and inability to sleep. Problems with concentration and memory. Throughout my childhood, it was not unusual for the frozen dinner rolls to get soggy on the rack because Mami forgot to turn on the oven. On her black-cloud days, she just didn’t care.
The past year has been different. Mami wonders what is in the oven, where she put the dinner rolls, why the oven is on—and again, what is in the oven, where she put the dinner rolls, and why the oven is on. Mami’s also high anxiety, which makes her heart race and mind fail. In the cab, she asks if I remembered to bring her medical records. Then asks me again. Then again. I answer Mami each time as if it’s the first time she asks.
Our knees touch as we sit in the back of the A-1 Taxi, and we look out our separate windows as the cab drives south along Jersey Avenue toward 377.
* * *
Today is the first time I’ve met Doctor Miami. Mami had said he used to be “¡Tan flaquito!” Being too skinny causes major anxiety for Latina mothers. She had mentioned he gained weight, but Doctor Miami is not the doughy middle-ager I expected.
He is too tan for April in New Jersey. His glossy hair is tousled precisely. His broad chest strains the buttons on his linen shirt, and the tribal tattoos on his pumped-up arms extend past the shirt’s too-short sleeves. The leather choker with a silver clasp, the wide, flat platinum wedding band, and the braided wrist cuff are each modern, but lose their edge worn all at once.
Each of us in the room—Doctor Miami, Mami, and me—is “too” something. Isn’t that part of being Latino? Maybe Doctor Miami is so pumped up to make up for having been a flaquito who got his too-skinny ass kicked all the time. Today in Doctor Miami’s examination room, I present super-competent Nancy, the assured mid-40s woman with the notepad in which I record Mami’s medical notes and history. No one else in the room needs to know Little Nancy still lingers after more than four decades, the kid who used to be so silent people wondered if I spoke English, the girl who needed constant assurance that she was acceptable.
Super-competent Nancy still needs gold stars to prove I’ve moved beyond all the liabilities Mami has spent my life pointing out: my too-nappy hair—growing up, I knew more words in Spanish for bad hair than I knew in the entire language; my too-chunky legs; my too-big ass (Mami had used it as a warning to women within the family: “It’s impossible to buy pants if you have too much ass like Nancy”); my too-nervous manner and too-volatile temper. Little Nancy’s continued presence makes it seem impossible that I am super competent or the champion La Nancy. Champion what? Champion imposter?
Why does any of this matter when the reason we are all in the examination room today is Mami’s too-forgetfulness? She sits on the edge of the exam table and picks at the cuff of her windbreaker’s sleeve. She’s a small woman. Too small for her feet to reach the step at the base of the table. Her arm is too thin for the blood pressure cuff. Mami sits there, focused quietly on her sleeve, except when I tell Doctor Miami she doesn’t always take her antidepressant and anti-anxiety medications as prescribed and ask if this can cause increased forgetfulness. She looks directly at me as I speak. She doesn’t say a word, but I recognize the anger, betrayal, and fear.
My degrees in English literature don’t make me a lot of money, but they allow me to engage in a lot of denial. My tremendous vocabulary allows me to avoid using the words for things-that-shalt-not-be-named. In the examination room, I use the same words that I use in conversations with and about Mami: increased forgetfulness, distracted, unfocused. Doctor Miami is the first to say the unnamed.
“She is showing the signs of early dementia.”
The big wallop. The kind of full-on, right-in-the-face punch that sends lesser beings staggering backward.
Doctor Miami is just giving it to us straight. What did I expect? I asked the questions. Three to be exact: 1. Could he review the side effects of not taking Xanax and Paxil as prescribed (too many Xanax = great chance of passing out; changing Paxil dosage without doctor’s supervision = not a good idea)? 2. Can the antidepressant or antianxiety medications contribute to Mami’s increased forgetfulness? 3. What next steps or tests need to be taken to determine if the forgetfulness is something to address?
I sit with my pad and pen, not taking notes but not passed out on the floor. Mami doesn’t fall to the floor either. She just picks at her sleeve. If I was her, I’d be happy to let someone else step into the ring. Doctor Miami keeps Mami included in the conversation. We all know English, but he punctuates the discussion with well-chosen and timed Spanish phrases, the kinds of idioms that Mami has used throughout my life.
“Yes, depression and anxiety te sacan de quicio”—the Spanish equivalent of “make you feel out of whack.”
Doctor Miami confirms what I’d Googled—depression and anxiety mimic and mask the symptoms of dementia and age-related memory loss—and anticipates my next question: How to tell the difference? Depression causes the concentration and short-term memory problems Mami exhibits. Mami also alters her dosage of Paxil and self-prescribes too many Xanax in cases of extreme distress. Feeling betrayed by her mind can increase Mami’s depression and anxiety and continue the cycle of self-doctoring that further blurs the line between what is and what is not age-related memory loss.
Mami doesn’t agree with the assessment.
“Everything started with those eye drops.”
I bite my tongue. I’ve heard that story so many times. Medical procedures rank high on Mami’s list of anxiety triggers, and her glaucoma surgery nine years prior had knocked her out of quicio. The post-op eye drops had given her headaches, which made her more anxious and in turn, more distracted, etc. Doctor Miami agrees that certain medications can affect depressive states or interact with the medication she had already been taking, but nine years is enough time for the drops to be out of her system. I can’t help but remind them both that I’ve known Mami for the forty-plus years of my life and she’s been depressed and anxious way before the glaucoma surgery. She turns away from me.
Doctor Miami recommends a new antidepressant that’s been found to improve memory and cognitive function. We look at Mami. She looks only at Doctor Miami. He assures her the new medication is similar to Paxil and she is likely to tolerate it well. She sighs. Doctor Miami and I exhale when she says the new medication seems a good idea.
“She’s so cute,” Doctor Miami says as he listens to her breathing with his stethescope.
Mami presents her cute, pixie side in the examination room. How can so much anxiety and despair fit into that little woman who smiles girlishly at the doctor as his beefy hands probe her teeny stomach? I don’t look forward to the not-cute side that will emerge, maybe as soon as the lobby (“How could you tell the doctor I take too many Xanax?!”) or when the bottle of new pills arrives from the pharmacy. (“I am not taking those.”) Mami always keeps me on my toes, ducking and weaving because I never know when ¡fuacata! she’ll get me with a not-cute jab or hook.
Doctor Miami explains he will order further blood tests that will help determine whether the cognitive difficulties are due to something hormonal or an abnormality, such as a thyroid condition. He will see us in three weeks and gives me my to-dos: schedule the three-week follow-up; take Mami to LabQuest for bloodwork; fill the prescriptions; follow the medication transition instructions; observe and note anything that needs to be brought to his attention. Plans and tasks comfort me.
Mami stops picking at her sleeve. She doesn’t look at anyone or anything in particular. I ask if she has questions or wants to go over anything. She says she understood everything. The examination room is bright and organized, but I feel suffocated by words: depression, anxiety, prescriptions, medications, conditions, tests, family history, dementia. Mami remains perched on the edge of the exam table. She’s so quiet. I wonder if she’s already taken flight.
As Mami and I wait for the elevator, we agree we need air and to stretch our legs. We decide to walk back to Hillview Towers. It’s about one and a half miles, but we’re both big on walking and it is a distance we can manage.
* * *
Mami and I walk past the corner. My husband’s ground-floor bachelor pad is now a sweets and ice cream shoppe (the quaint “e” = expensive). Mami declines the offer of ice cream. I would splurge for triple cones for each of us to celebrate the doctor’s visit being over. I had anticipated the worst: that Mami would refuse to go at the last minute or that she would refute anything I said in the examination room or that she would insist I not accompany her into the room so she could be cute to Doctor Miami, get her meds refilled, and be out of there.
The visit had had cute moments: two petite Latina women and Doctor Miami in the examination room, sharing information and Spanglish-isms, reaching that level of confianza where there are no blank looks, just heads nodding si because yes, we all understood. The word had been confronted: dementia. I was grateful that Doctor Miami had put the word out in the open, action-hero-like: “Stand back, damas. El Doctor Miami will handle this for you.”
It’s a relief to feel I’m not alone in finding the possible causes for Mami’s increasing forgetfulness. I had been paralyzed: It’s impossible to take a next step when I don’t understand what I’m confronting. Going forward into the unknown requires faith, and I have very little.
In that and so many ways, Mami and I are similar. She’s never been officially diagnosed as having social anxiety, but that’s what Doctor Berger believes. She’s my doctor, the one I’ve seen since my infant son died eight years ago. Doctor Berger diagnosed my own depression and anxiety, and because so much of therapy involves talking about where you come from and of course, talking about your mother, Doctor Berger feels that Mami likely suffers from social anxiety.
When I was younger, I didn’t have patience for Mami’s behavior. She had seemed irrational. Why didn’t Mami want to take me to the park? Why didn’t she want to attend school events? Why was it my job to stand on tip-toe to peek over counters and speak to store clerks or bank tellers? Mami understands and speaks English. She’s the one who read with me in those first grades, helped me sound out words and practice, practice, practice until we could both repeat from memory the passages assigned to me by the nuns at Most Precious Blood School. She’s also the one not to be messed with if she’s overcharged at Macy’s or ShopRite.
Mami is capable of holding her own in English, in the United States, the place where she’d arrived as a young, single woman decades ago. She’s the one who had worked factory jobs in Puerto Rico and saved for that first plane ticket to leave her own Mami and Papi’s house in el campo to Nueva York for una nueva vida. She’s the one who stepped off the plane with only the Bronx address of an unfamiliar aunt and a utilitarian English vocabulary that included the days of the week and the words for farm animals. It took cojones to do all that in the early 1950s, but when I was younger, I had focused on what Mami didn’t do.
Imagine if Mami had had the benefit of a Doctor Berger? But psychotherapy was not an option in rural Puerto Rico during the Depression years when Mami was growing up. And housewives in New York City public housing just didn’t do talk therapy, ¿sabes? That’s the kind of thing daughters born and raised in the United States do, women whose mothers had to go through a lot of shit, sometimes took jobs cleaning shit, so we could have more opportunities than they ever did—like the option to sit on the couch in Doctor Berger’s Hoboken office to talk about how I want to be bold, not rely on medication, and not be so anxious like my mother.
Yet I’m just like her: small, brown, and high-anxiety. I get my fear of stepping into the unknown from her. I have also chosen to take bold risks in my life. Those times took cojones. I get those from Mami, too. I’ve learned what I do and don’t want to be, and who I am from her example.
We walk along Jersey Avenue and I ask Mami more than once if there is anything about the doctor’s visit that she wants to go over. She says no, she understands everything. I ask if she likes Doctor Miami. She says yes. I don’t ask if she thinks he’s cute or likes to be doted on by a younger guy. Let her savor that alone if she does. I tell her I’m impressed with his knowledge, especially his understanding of her, and his manner and patience. I don’t ask Mami if she’s afraid or nervous. That’s not the ground I want to cover in this one-and-a-half-mile walk. There will be time to cover that ground, and I don’t know how many miles that journey will be.
I look at the small woman beside me, whose gait and forward-leaning, gotta-go posture match mine. I’ve spent my life trying to move ahead and away from her. I never noticed she’s always been right beside me. In my championship moments, I’m most like my mother. Today is just the first round of a long fight. I’m scared about what lies ahead. I’m certain Mami is too. I hope that she’ll remember that neither of us is in the ring alone.
Nancy Méndez-Booth is a writer, and teaches writing and Latinx literature and culture at colleges and universities in New York and New Jersey. Her writing has appeared in print and online, including in Poets & Writers, Latina, Salon, OZY, VIDA: Women in Literary Arts, and on her blog (nancymendezbooth.com/blog), and is forthcoming in the Latina Outsiders: Remaking Latina Identity anthology, to be published in 2019. Nancy has been the recipient of awards and residencies, including the Brundage Charitable Foundation Fellowship to attend a month-long residency at the Vermont Studio Center, the Author & Poet's Scholarship to attend the Martha's Vineyard Institute of Creative Writing, and a month-long residency at Blue Mountain Center. Nancy's writing for the stage recently earned her support from the NJ Women Playwrights Project for the development of her one-woman show about royal aspirations in public housing. Nancy is currently seeking representation and publication of a collection of nonfiction essays and two fiction manuscripts. Nancy has a BA in English from Amherst College, and an MA in English Critical Theory and an MFA in Creative Writing, both from Rutgers-Newark.