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A Vulnerable Place

Does she ever move? I wonder. Does she speak? As if in answer to my thoughts, he goes on: "She gets muscle aches sometimes. She moans." He pauses, then adds: "It's been years since she's spoken. Sometimes she tries to say a name. Every once in a while—very seldom, now—an old family friend will come to visit, and if they talk, I think she pays attention for a little while."

As I turn back to look at her lying in the bed—and note the strange, abbreviated shape under the blankets—I suddenly wonder if she hasn't got any legs. I search my memory for critical details I may have forgotten when I was reading her history: Is she a diabetic? Has she had amputations? But as her son tenderly draws back the covers, I realize that she does have legs after all—slight, emaciated legs curled tightly up against her rounded belly, strictured and useless.

We survey her for a long moment. Her skin is golden brown and smooth, stretched across her gaunt frame. The curved sweep of her pelvic bones is prominent, her legs and arms delicate, her stomach gently protruding. If she were an alien creature, a new kind of being I had never seen before, I would have said that she's beautiful. She has the thin, tender, helpless appearance of an embryo or of a newborn calf not yet able to stand.

She is perfectly clean, here in this place where there is no running water, much less bathtubs or shower stalls. Her skin is unblemished by the sores or pressure ulcers that usually curse the bedridden. She has clearly been exquisitely well cared for.

First we listen to her lungs and her heart; then we prod her belly and her extremities. We hope not to find anything, so we won't have to face the questions that would be raised: Would we treat a pneumonia if she were to develop one? How aggressively do you manage someone in a condition like this? But we don't find anything.

"Technically," the doctor had said to me quietly as we were loading our backpack to come over here, "we should do a Pap smear, a pelvic, and a rectal and draw a bunch of blood. But think about it—we wouldn't treat a cancer if she had one. She's not strong enough to handle surgery, or even radiation or chemo. You have to draw the line somewhere, and I refuse to torture her."

I wonder what will happen when the old woman and her husband die. What happens to a house filled waist-high with stuff that no one needs, in a village of 300 people, hundreds of miles from anywhere? The question of disposal is a serious one in the far reaches of Alaska.

We need to roll her over to examine the rest of her skin. Her son lifts her tenderly, murmuring a soft apology in her ear and setting her down expertly on her other side. She is lying on a pile of diapers, some adult, some child-size; he rearranges them carefully, making sure there are no gaps. The faint smell of urine that I noticed in the entryway is stronger here; he sniffs at one of the diapers, throws it away, and carefully replaces it. Along her hips and buttocks, she bears well-healed scars from several large pressure ulcers. Her skin is perfect now, but she clearly had problems in the past.

He draws a blanket over her after a moment. "It's cold," he says, apologetically but firmly. I shiver paradoxically, feeling uncomfortable in the excessive heat.

The room, I note, glancing around, is as cluttered as the bed. A hanging rack that's braced against one wall is jammed with clothes on hangers—most of them at least 20 years old, I judge from the colors and fabrics. The floor is piled high with more blankets, rolls of paper towels, baskets filled with shoes, bags of clothing. On the wall above the bed hang two crosses, a Madonna, and a depiction of Christ, all of them rendered in faded pastels and soft focus.

When the exam is complete, and it is clear that our patient is not going to open her eyes or respond to us, we retreat to the living room to talk with her son.

I now notice something that I barely had time to absorb on our way in. The house is small, tiny by outside standards but average for Kururak. There is the bedroom, a kitchen just large enough to hold a small table, and a living room with a single small sofa. But the extraordinary thing about the house is that it's packed to a depth of nearly three feet with stuff.

The place isn't dirty—dusty, yes; dust couldn't help but collect in such a setting. But there's no garbage anywhere, and each object was clearly, at some point, deliberately placed in the spot where it sits. Rather than dirty, or messy even, the house is the theoretical extreme of cluttered. Every surface—the sofa, the kitchen chair, the table—is buried in stacks of magazines, clothes, possessions of every description. Not an inch of horizontal space is visible.

There is a narrow, curved passageway in the middle of all this stuff—a channel just wide enough for a person to pass through. It reminds me of the rivers we flew over on our way to Kururak this morning, weaving canals cut by water seeking a route across the tundra. The whole house feels evolved, carved out by time rather than by a conscious hand.

The doctor and the health aide sit on the sofa, after clearing off enough space for themselves. I perch on the edge of a chair piled high with old People magazines. The son stands, facing the three of us, shoulders erect, like a man before a firing squad. I offer him my seat; he shakes his head. Uncertain, I shift to sit on the floor instead. He remains standing.

The doctor reassures him about the exam, saying that nothing looks new or alarming. Then she goes on to discuss treatment options for urinary tract infections—UTIs. The old woman gets terrible UTIs, which are a common problem in the elderly. Her son catheterizes her every day. He has a single plastic catheter that he cleans and reuses; disposable replacements have been ordered again and again, but they never come. Often her urine is thick and white with pus.

She's been tried on many different

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