Martha

Several months ago, we printed a story about a homeless friend of mine [“Exile,” Issue 134] to which readers responded with both sympathy and annoyance.

Now comes a story from Andrew Shalit of Somerville, Massachusetts, “about a friend of mine who was, in some ways, similar to your friend in ‘Exile.’ ‘Martha’ is a true story, and it’s my answer to the question you bring up.” He continues:

“The issues, as I see them, are compassion, annoyance, personal responsibility, and true help. Compassion, because we want to love these people fully. Annoyance, because they are sometimes a pain in the butt. Personal responsibility, because we wonder what our responsibility is, but more because these unwanted friends seem unwilling to be responsible for themselves — they ask us to take responsibility for them. True help, because we don’t know how to truly help them. Will indulging them help, or will it just allow them to continue? Will turning a cold shoulder help, or will it only increase their cynicism, helplessness and isolation? And where is the middle, loving ground?

“The conclusion I reached is that we should try to help others, but we should never let anyone give us responsibility for their lives. We all must, at some sublime level, take care of ourselves. If my brother or sister seek to put the burden of their existence on me, then I don’t help by going along. I can help by giving a little friendship, by refusing to hate, by a willingness to sometimes — but not always — talk. I can help by treating them as fully competent, self-responsible human beings. I don’t help by seeing them as sick children. I don’t help by indulging.

“Anyone who thinks we should give more than this either has no long-term experience with such people, or else has truly infinite compassion and patience. I’ve had some experience, and, unfortunately, my virtues are not endless. I cannot give infinitely, though I wish I could. I can only do my best, as I feel you did with your friend in ‘Exile.’ ”

— Ed.

I have nothing else to offer you but my own unhappiness. Please say that it, at least, measures up, that it is a proper sort of unhappiness.

— Walker Percy

Martha is talking to me quickly: she needs another doctor. This one won’t give her the proper medication. She has not been eating well; it is too difficult for her to get out in the snow with her broken foot. Look at her legs, she says, the flesh is like wax. She presses a finger into her calf and it leaves a deep mark which only slowly fades away. She tells me it’s because of her heart condition. The doctors won’t give her enough thyroid or enough anti-depressants. She says she knows more about her condition than they do. They have even told her so on more than one occasion. “Martha, you know more about endocrinology than most internists in Boston.” And yet they will not listen to her self-diagnosis, even when she brings in medical books to back herself up. They will not give her more thyroid, more anti-depressants, or more heart medicine.

Martha has two internists, a gynecologist, a psychopharmacologist, an orthopedic surgeon, and more doctors whose details I can’t remember. She also talks to lawyers occasionally, various members of the ministry (usually Harvard affiliates), and a mass of uncooperative social workers whose names she learns to help her complain about them in a more personal way. These are the people with whom she talks, the ones she asks for medicine, or signatures, or errands, or for simple conversation. In some ways it’s a good thing she is sick and on welfare: her problems give her a community; they give her an outsider’s substitute for friends; they give her a reason to talk to people, when otherwise she would have none.

Martha is talking to me again: she has just been to one of her doctors. She wants to tell me how he wouldn’t listen to her, how he wouldn’t give her more thyroid or more anti-depressants. She wants to describe the ordeal of fasting which precedes a barium enema, how they gave her three times the normal amount of barium, and how barium turns to cement in the intestines if it isn’t expelled within twenty-four hours. She goes on, saying that she has no pubic hair, that she never developed any because of problems with her glands and hormones. She’s upset that they won’t give her a hysterectomy because, though she’s only forty-one and her thin hair is still brown, she’s already sterile, and a hysterectomy would let her stop taking progesterone. She feels that the doctors have intentionally castrated her by cutting down her doses of estrogen. “The hysterectomy wouldn’t have been necessary if they had treated me properly from the start. But, uhh, they wouldn’t pay attention. They wouldn’t listen to me. I knew all along that I needed more estrogen. And the progesterone makes me feel like I’m always getting my period.”

I first met Martha when she was being evicted from her apartment. I was working for a carpenter, taking down a garage at a church. The carpenter and the church offered me my regular pay — five dollars an hour — to help some woman pack. The next day I went to Martha’s apartment with a friend. The place smelled like everything around Martha always does: a combination of decaying flesh, antiseptic, and old cardboard boxes. She talked to us while we went through her drawers and cupboards, her trunks and closets. She was especially concerned with the woman upstairs who listened to all her phone calls. Whenever Martha talked on the phone she could hear the woman drag something heavy across the floor until it was directly overhead. Martha was being evicted because she hadn’t been paying her rent or utilities; $550 a month got to be too much for her when she stopped working. As I left that day, she gave me some trash that she wanted thrown out at my house. It included her unpaid bills from the electric company. She didn’t want them thrown out in front of her apartment, she said, where they could be found by anyone.

Martha has a new apartment now, after a year on church steps, in the basement of a very discourteous woman’s house, several hospital stays, and two weeks with me. She spent all year with twelve heavy suitcases, moving them from place to place by taxi (only Ambassador Brattle — they have station wagons). One of her suitcases was completely filled with vitamins. Another was mostly plastic bags. Most of the weight, though, was from her books, which she never left behind.

In her new apartment the rent and utilities are only $60 a month. But she complains that the project in East Cambridge is a far cry from the nearly suburban Wendell Street of her past. In spite of the bedroom, large living room, bathroom, and kitchen, she doesn’t have space to unpack all her stuff. She is still living out of suitcases, though now in her own place. There are boxes on the floor, covering the dusty red woven rugs from Ecuador. The apartment is just too small, she says. It’s on the ground floor though, which is nice because Martha can’t walk up or down stairs.

I ask her, “Martha, why don’t you apply for disability insurance from the government?” We are talking on the telephone, at night. “Because I’m not totally disabled.” “Do you really think you could work, go to a job every day?” “If I got SSI they would just increase my rent and cut my food stamps and I wouldn’t have any more money than I have now. And, besides, there are other people who need the money a lot more than I do.” If her food stamps were cut, it wouldn’t be the first time; I remember when they went from $87 a month to $37.50. At least now that she has an apartment she can get welfare and food stamps. In Massachusetts you need an address to get them, you need to be a resident of a specific town, and so if you’re homeless — as Martha was for the first year that I knew her — you aren’t eligible. You have to get food and money some other way.

The shades to Martha’s apartment are pulled down. Martha doesn’t like people looking in and she is allergic to the grass which grows so close to her ground floor view. She doesn’t have many visitors, so she likes to talk on the phone as much as possible. When she calls me — a couple of times a week, for about fifteen minutes each time — it’s hard to understand her. She is missing most of her teeth, and she lost her dentures when she left them overnight in the bathroom of a church where she was staying. She talks quickly, and often adds whining sounds and groans between her mumbled words. She explains that her problem with talking is complicated by the doctors who won’t give her enough thyroid. Her under-treated thyroid makes her lose her voice. She asks me to sign an affidavit, saying whether her voice has gotten better or worse over a certain period of time. She says that her thyroid has been cut back, and so her voice is worse. If I sign a statement saying that I noticed, it will help her get more medicine from her doctors.

Even though she knows about the way she talks, I often have to warn her, “Martha, if you want me to understand you, you have to speak more slowly and enunciate. I can get the general mood when you talk this way, so if that’s all that matters, just keep going on.” And she continues as if I hadn’t said anything, “an then I said to Bob, and he, he wount lisen, an, y’now, ewwuhh adrenaline dysfunction ahhh is ah very uuuh dangerous. UewwI could have died. Iaah have all the symptoms, and they ehew didn’t even notice when I wasahhin the hospital. Oh, an’, an’, an’ now they’re uhh, talking about ahh, avicting me because I still have uuuhhhh things in boxes on the floor, and euuyaahba because I can’t carry my ahh, uhhwgarbage cans to the mcurb. Iaah, just don’t have any place to unpack all my books. I ahh needummmuhh, some help putting the shelves up. Jim was here, but he, he didn’t quite finish, and uwweyethen he left town. Iuuh need some place to put my books. Oh, and, an, uhahh the thing with the garbage uhhhisn’t fair, babecause it’s other people thataaah put their uuhhtrash in my garbage cans outside. Iuhh don’t have uhmm that much aahhe trash every week, and I euwcan’t lift the barrels after aahother people fill them up with theireeeh junk.”

When you try to say goodbye to Martha, she immediately rushes into a new, seemingly urgent subject. I mentioned this to her once and she said she knew about it. It was a specific condition, she said, one which psychiatrists have a name for, although she couldn’t remember the name. She said she would call me if she remembered it.

Martha had to stop showering in Mount Auburn Hospital part of the way through her homeless year when they found that she had been stealing books from the medical library. She likes to do medical research, so she can understand her condition and explain it to her doctors and friends. She has told me, for instance, that bound and unbound thyroid are not the same thing. Her internist (Martha calls him “Bobby Baby”) insists on testing her for bound, but she doesn’t metabolize bound thyroid properly. She can only metabolize unbound. But he won’t increase her prescription because her level of bound thyroid is abnormally high. So she has to use old prescriptions and go to various pharmacies to get enough medication. I don’t know where she gets the old prescriptions. Once Bobby Baby made her sign a disclaimer, saying that she was self-medicating and that he couldn’t be held responsible for her condition. She took it as a horrible insult, but I thought it was very nice of him. Others have just refused to keep seeing her.

Martha’s main disease is pan-hypopituitarism, which means that her pituitary gland is nearly dead. The pituitary is the gland which regulates the rest of the body’s glandular system. She also has a diabetic condition. She eats mostly meat and low-salt cheese (grains are too starchy and salt is bad for her heart). Weighing in at 102 pounds, she wants to lose 31 pounds to get down to her comfortable weight of 71. No, she says, she is not anorexic. She recites the symptoms of anorexia, she has read them, she knows them, knows that she is not anorexic. The bones in her hands are visible as we talk. The last time I saw her she told me that she could now see her heart beating from the outside; she could see the auricles and ventricles expand and contract. Still, she says, her clothes are much too tight; it’s disgusting how they don’t fit her anymore. She put on so much weight in the hospital, she says.

Martha is much healthier now than she was when I first met her. That first winter she had double pneumonia, while living in the basement of a Harvard professor’s house. Her hostess thought that a space heater was too great a fire hazard; she wouldn’t let Martha use one. (Martha did, though, surreptitiously heat her room with a toaster oven.) The woman brought Martha to the hospital one day for an appointment and said, “You can’t come back to my house tonight.” She wanted to help Martha get back on her feet again. Martha wasn’t doing much about it on her own.

“In the hospital I blacked out. They told me afterward that my heart stopped. I was on the floor of the bathroom, vomiting and moving my bowels at the same time. It was coming out both ends at once.” Martha sometimes likes it when I don’t take her too seriously. I laugh, am dumbfounded. “That’s a funny image, Martha.” We have talked about near-death experiences, experiences of light and comfort, joy and transcendent knowledge. She is curious, and asks me why she didn’t have one when she was out with her heart attack. Since her conversion to Christianity, Martha has admired the visionary, apocalyptic aspects of life. She would have been honored to have a revelation first-hand. It would have justified her opinions of herself.

I visited her in the hospital a couple of times. When Martha was homeless, the hospital was like a hotel. But she had to be careful: Blue Cross only pays for a certain number of visits each year. I thought it was interesting that she was in a psychiatric ward rather than in some place for her physical problems. They were nice to her there, very matter-of-fact. They didn’t argue because they knew they didn’t have to. Martha was intelligent and powerless, and so they talked to her intelligently, as if she already understood. They knew they didn’t have to convince her of anything. Martha generally didn’t argue with them either, because she did understand; arguing would only have made her helplessness more obvious. And in some ways she liked the company of her nurses and doctors, even if they did interfere with her life. She did, though, take the opportunity of complaining to me when I visited.

Martha does her best to avoid hospitals now, because she has learned that in hospitals she has the greatest chance of being given the wrong medication, the greatest chance of dying. In hospitals she loses all control over what she takes. The doctors even cut off medication that has been prescribed for her by other doctors, things like injections of vitamin B-12. In a hospital she can only take what is currently prescribed, in the quantities currently prescribed. When she checked into the psychiatric ward they took away all her pills, all her vitamins. They took them away and said they wouldn’t give them back when she left. Martha had them all in bottles with the labels soaked off, so there was no telling what they really were. Besides, as a nurse explained to me, even vitamins can be dangerous in the wrong hands. Martha says she is allergic to all antibiotics. She follows Linus Pauling’s advice and takes vitamin C whenever she has an infection. But in the hospital they don’t believe in vitamins. They won’t give her any, and they won’t let her bring her own. She hasn’t told me how they treat her infections.

On the psychiatric ward, Martha took the round red stickers from her meal cards and wore them on her forehead. This was a reference to the book of Revelation, and to Blake’s apocalyptic symbolism. And I looked, and, lo, a Lamb stood on the Mount Sion, and with him an hundred forty and four thousand, having his Father’s name written in their foreheads. Martha was playing with her doctors and nurses, playing crazy for the people who thought she was crazy, showing that she had more perspective than the other crazies on the floor. She was showing that she was intelligent, and that she was religious, and that she wanted to get along with the doctors, have an inside joke with them that the real crazies wouldn’t understand. She wanted to show that she was above their diagnosis.

Because she has a Ph.D. in comparative literature, Martha can also be called “doctor,” and she insists on this title whenever her last name is used. The last time I wanted to send her some money in the mail, she asked me to address the letter to “Dr. Martha Michaelson, Ph.D.” She felt it would get more respect from the mailman that way, that there would be less chance of it being lost.

Any visitor to Martha’s apartment can tell she is educated; it almost overflows with books. Bookshelves block the windows and boxes of books, thesis notes, and old issues of the Times Literary Supplement fill the closets and clutter the floor. Some of the books are apparently quite valuable, some are signed first editions. She wouldn’t sell them when she was homeless. I asked her more than once, “Would you rather be dead with your books than alive and in a home, but without your editions of Blake?” “Yes,” she would always answer, “I’d rather die than sell my Blake. And besides, I couldn’t get what they’re really worth.”

Martha’s great love is for Great Britain. She looks to Blake — with his connections to literature, the apocalypse, and the British Isles — as her patron saint. She bought a casting of his head, a life mask, on her last trip to England. When she decided to become a Christian, she chose the Anglican church. She insists on calling her apartment a “flat,” and she listens to the BBC on a small shortwave radio. If we’re talking on the phone as the hours change, she treats me to the sound of Big Ben ringing from across the Atlantic. “Listen, listen!” she’ll say, and hold the phone up to the speaker of her shortwave.

Martha has told me that she has a lawyer, a will, and an executor. She plans on leaving her books to the British Museum, though she doesn’t say how she’ll get them there. When she talks of ending it all (which isn’t very often, usually just when I’m trying to get off the phone), I remind her that, according to Christianity, suicide is a cardinal sin. Her conversion is convenient in that way. But she argues the point, implying that God would have to make exceptions in cases of extraordinary suffering.

Postscript: Martha recently found a new doctor, one who agreed with her self-diagnoses, and was ready to give her all the medication she thought she needed. She trusted him, and so when he finally suggested she go to the hospital — after her friends had been trying for a month to convince her to do that — she started making plans to go. At sixty-four pounds, even she thought she was underweight. By now, she was having trouble keeping down food. She was also having trouble standing, and getting out of bed, though she could talk all right. I explained to her she wasn’t in shape to be living alone. She needed daily care, and it wasn’t fair for her to ask for it from us, when there were people who were paid to give it to her, and could do a better job of it.

She got help packing from the friend who had helped me pack her up on Wendell Street. Another friend drove her to the hospital. She stopped breathing when he got her there, but they managed to bring her back. He left her in intensive care, thinking she was OK, because she had started talking — or, as he said, complaining. But when he got home, the hospital called to tell him Martha had died.