Under the Skin

Saturday, December 20

When I first meet my mother-in-law Nora, she is naked and skeletal, with a head-to-toe case of scabies. We don’t know yet about the scabies, but standing in the room at the nursing home, we can tell something’s wrong. Arline, my partner, hasn’t seen her mother in ten years.

An attendant brushes in past us. She had instructed us to wait in the entrance, but Arline’s friend Alma, sensing deception, led us down the front hallway and along a corridor until she found Nora’s room. The attendant waves us out; she will get Nora ready. The room holds a dresser with missing drawers and three single beds; they have dirty bedspreads and no sheets. A small print of a lily hangs near the ceiling on a wall as scarred as Nora’s legs.

The three of us go back down the hallway to the waiting room. It’s dim, the blinds closed against the day. We sit on ornate, dark furniture. Arline’s hands are in her lap, her shoulders sagging. She would run far away from here if she could, but I don’t try to touch her; she isn’t comfortable telegraphing our relationship while in Panama. In our Seattle summer clothes— capri pants and Chaco sandals—we are obvious foreigners, although Arline lived here until she was twenty-four. The staff and more alert residents will know immediately that we are the U.S. relatives, come for the rare visit. They won’t know how rare. We had planned on this trip to swim, go birdwatching, and visit Arline’s old friends, not her 86 year-old mother. But before we left Seattle, Arline’s adult daughter Giselle, who lives near us, asked us to check on her grandmother in her new nursing home.

The attendant wheels Nora into the waiting room. An elderly woman comes through in a bathrobe with a towel around her shoulders. The attendant berates her for taking the towel from the bathroom, and the woman shuffles back. The attendant leaves us alone. Nora’s grey-and-black hair has been brushed into a clip, and she’s wearing a blue nightgown and slippers. Her eyelids droop, open, droop. She scratches her inner elbows. Alma whispers that she’s probably been drugged to sleep. In Spanish Alma says, Arline is here — your daughter, Arline.  Arline is so afraid to see her own mother that she’s asked Alma, her best friend since elementary school, to come with us. Brisk, efficient Alma will know how to manage the situation.

Alma continues to speak softly to Nora, and after awhile Nora’s eyes stay open for more than a few moments. She squints at Arline: Giselle?

No, it’s me, Arline.

Marjean? The older half-sister, who also lives in the States and has had no contact with Nora since her mother gave her up for adoption, when Marjean was a teenager, to an American couple.

No, Arline says. It’s me.

Nora’s eyebrows rise; she doesn’t believe it. Arline asks about the nursing home, if she’s comfortable. Nora shakes her head emphatically no. They’ve stolen her money, she says. They don’t feed her. She would rather die than stay here. Get her out. She scratches her legs.

A tall, well-dressed woman comes into the room, and Nora stops talking. The woman introduces herself as the manager, Felicia. Alma and Felicia have a conversation I don’t understand; the tone is not warm. Soon the three of us are leaving. We step into the long, wide hallway that functions as the home’s lounge. Residents are arrayed along its length. The only light comes from a small window at the end of the grimy room. A few residents notice us; many others sleep, including a tall, gangly man wearing nothing but a diaper.

The attendant lets us out the gated door. Alma unlocks her car and, inside, Arline shakes. We agree that we have to get Nora out of there before we go home. We have seven days.


Sunday, December 21

Arline and I walk through Casco Viejo, the old part of Panama City, half gentrified, half crumbling, a warren of Spanish colonial buildings that open onto views of the sea. We stop for a moment to listen to a man play “Feliz Navidad” on a banjo. Arline is telling me stories, some I’ve heard, some I haven’t, about her mother. How she left Arline as a child alone for hours in their apartment with the bathroom door locked so she couldn’t use it. How she raged, screaming obscenities as she sharpened a cleaver on the concrete balcony wall beyond their front door. How she beat Arline with belts and high heels, threatened her with a hot iron. How over and over again she told Arline that she was a monster of nature, found in a garbage can.


Nora had been smart and charismatic. She worked as a legal secretary and maintained long-time friendships with members of the powerful Arias family. In fact, she had been in the presidential palace during one of the coups that ousted Arnulfo Arias from the presidency. But she was also ruthless; she called the police on people she didn’t like, or sued them, or otherwise made their lives miserable. That’s what she did to Arline’s father, a prominent young doctor, after their brief relationship resulted in a baby. So for the first eleven years of Arline’s life, her father stayed away, terrified of Nora. But what Nora told Arline was this: “Tu padre no te quiere.” Your father doesn’t love you.

The abuse continued throughout Arline’s life. When Arline started college and wanted to go on a trip with her theater group, Nora committed Arline to a psychiatric clinic. It was Alma who helped Arline escape. Her father, who by then braved Nora’s rages to have contact with his daughter, hired a lawyer to keep Arline from returning to the clinic. Arline spent several days in a hospital undergoing tests before she was declared sane. Meanwhile, it was Nora who dosed herself repeatedly on valium: Arline remembers a trip to Colombia, where a seedy doctor didn’t examine Nora but gave her a prescription. Arline assumes that all these years her mother has had an untreated mental illness, one that allows her to both charm and terrify.

I have never fully understood these stories. They are too distant — in time, in space, and from my experience. And Arline seems so emotionally grounded that it’s hard to believe she could have been treated like that. She says the scars are there, but it’s hard for me to see them. Even now, as we wander through the narrow streets of Casco Viejo, it’s hard to feel anything in response to these stories. Arline has parceled them out slowly over the years and always in flat, unembellished sentences. The story of Arline’s childhood that bothers me most is the one about her attempt to take tiny figurines of cats and birds to her first grade class to give as Christmas presents. By the time she gets to school, they have all broken, and no one gives her a present in return. I suppose it’s the failure of my imagination that this story, which could have happened to anyone — which could have happened to me — is more vividly sorrowful than the stories of her mother’s abuse.

Yesterday, after leaving Nora, we went to see Alma’s brother, Fernando, and his partner, Gilberto. They know a lot about the healthcare system in Panama. The evening deepened over the patio as Alma and Arline told what we’d seen, and Fernando thought out loud about what we might do. I understood maybe a tenth of the conversation and surrendered to a semi-alert state. I drank my soda as slowly as possible, not wanting to be offered more. I noticed how the green bulb cast the concrete patio in a sickly color. The air was warm and clammy. While the events of the day were distressing, there was nothing I could do. Alma and her brother would figure things out.

After awhile, Fernando called a doctor he knew, and she agreed to come to the home Monday for an evaluation. He gave us the name of a better nursing home.

In Casco Viejo, Arline and I stop talking about her mother for a moment when we discover a fancy ice cream shop. She has ginger; I try chocolate orange. We sigh, sucking on the tips of the cones to catch the melt. When we take a tub of ice cream to Nora in the afternoon, we find her eating runny hot cereal and drinking tea. Arline suspects the home may be run by religious fundamentalists who don’t believe in coffee; her mother never drank tea. The attendant says Nora can’t keep down anything solid, but Nora, who is more alert today, says that isn’t true. They’re starving her, she says, and indeed her skin looks like tissue paper over her bones.

Now, after ten years with Arline, I have met the main character in her stories. She looks like a fragile, old woman, nothing more.

Panama City view

Monday, December 22

The doctor, in a white smock over blouse and slacks, meets us at the home, and this time Felicia and her staff are ready for us. Nora appears immediately, washed, dressed in a nightgown and robe, and walking with the help of an attendant. In the waiting room, Arline is paralyzed next to me, as if this weren’t her mother approaching but the queen. I nudge her. “Help your mother.” I’m thinking that Felicia and the doctor are expecting a solicitous daughter; they won’t understand Arline’s fear of this old woman. Arline reaches for her mother’s hand. Nora takes it and leans into Arline as she comes into the room. Arline settles her on the couch next to the doctor and retreats.

Felicia hovers at the edge of the waiting room as the doctor listens to Nora’s heart, peers into her eyes and ears, and inspects her skin. The doctor has never seen such a severe case of scabies, a highly contagious rash caused by mites that burrow under the skin. Even her palms and the soles of her feet are infested. Indeed, Nora continues to scratch — arms, ankles, elbow creases — as she endures the examination.

After the doctor leaves, the attendant wheels Nora, tired now, back down the hallway. But she takes her to a different room, one with a single bed.  The attendant leaves for a moment, and I get out the camera. We’ve decided this needs documentation. I snap pictures of Nora on the narrow bed, her knees drawn up and the scabs and scratches visible on her legs. The flash draws two attendants who confront us. What are we doing?

Arline snarls in Spanish: I can’t take pictures of my own mother?

The women leave.

We go back through the dim lounge. A fan pushes greasy air down the length of the room. Other than the bedrooms, there is no place else for the residents to go; they seem to eat in their chairs or at one of the little tables against the wall.  The waiting room, with its heavy, ornate furniture, appears to be off limits to them. They sit in their chairs all day, rocking, staring, scratching. At least the tall man is wearing a nightgown now.

A young, pale woman in a neat skirt and black flats greets us in English near the door. “Are you here to see Nora?”

I nod.

“I can help you,” she says. “If you need anything, let me know.” She isn’t dressed in smocks, like the staff. Could she be a resident? She smiles, as if it’s her job to attend to us. But there’s something missing in her eyes.

“Thank you,” I say. “We’ll let you know.” It occurs to me that we may get Nora out of here, but the rest of these residents are doomed to stay.

In the afternoon, we decide to take Nora something better to eat. At the cafeteria in Riba Smith, an upscale grocery store, we get chicken breast and pureed potatoes in a styrofoam carton. The attendant sits Nora at a small table at the end of the lounge, and we unwrap the cellophane around the plastic fork and knife. We’re wearing surgical gloves now, afraid of contracting scabies. An elderly resident in a long nightgown moves to a chair nearby and watches us.

“Buen provecho,” Arline says to her mother, opening the carton.

Nora digs in with her fingers, furiously pushing bits of chicken and clumps of puree into her mouth. Arline turns away. Nora smears puree over her face. The resident points her finger at her own mouth. I feel terrible for bringing the smell of roasted chicken into the home, but we can’t feed everyone.

Nora suddenly stops. She says something.

“What did she say?” I ask.

Arline can’t look at me. “She said she ate that like an animal.”

Nora pats at her face with the napkin. There is nothing left to share with the other woman.


Tuesday, December 23

Arline and I ring the doorbell of a nursing home in a pleasant neighborhood. The attendant asks us to wait on a couch in the living room. This home is owned by a woman named Lili, a cousin of Arline’s ex-husband. The living room has a television, magazines, and light coming through open curtains. An old man walks through with a cane and says hello.

Arline migrated with her husband and three small children to the Seattle area in the late 1970s when her half-sister Marjean, who had kept in contact through a friend, sponsored them. Over the years, Arline sent her children back one at a time for extended visits with their father’s family. Giselle, the oldest, maintained contact with her grandmother through the mail; Arline had told Giselle little about the abuse. About a year ago, Giselle visited her grandmother in her apartment and found her frail and disoriented. Giselle enlisted her father, who had returned to Panama after he and Arline divorced, to help find a nursing home. He contacted his cousin Lili, who owns several, and although Nora’s small pension wasn’t enough to pay the monthly fee, Giselle and Arline agreed to send the balance every month. But Nora hated it. She stood in the yard screaming that she had been imprisoned. She claimed her money had been stolen. No one wanted to share a room with her.

One day a friend of Nora’s came to take her away. The home had no legal authority to keep her. Several months later, a news station broadcast an image of an old woman found living on the streets; Lili recognized Nora and picked her up from the police station. The friend, it turned out, had cashed Nora’s pension checks and left her to fend for herself. Lili had refused to take Nora back; on short notice, Giselle’s father found the nursing home where Nora is now.

Arline and I have been visiting alternatives to that home for several days. We saw the one Fernando recommended; it was lovely but expensive. This one is nice, too. Lili arrives in the living room and takes us on a tour. Residents sit in several light-filled rooms and patios; most wear regular clothes, not pajamas, and they watch television or chat. Two residents play cards at a dining room table. I feel like I can breathe here; maybe this one will work out.

Lili takes us to the front porch and closes the door behind us. She’s in her mid-forties and wears chunky jewelry and a business suit. When she learns that I don’t speak much Spanish, she switches to English. She is apprehensive about taking Nora again. Arline apologizes and begs her; we have few options and we’re leaving in five days.

I’ve been trying not to worry about the money, but I am worrying. Nora has a pension of four hundred dollars a month. The current home charges a bit more than that, but the nicer homes are, of course, even more expensive. The home Fernando recommended, which I’m calling Hogar Krueger, is $1,000 for a shared room; Lili’s is $750. We will also have to pay for medical treatments, medicines, clothes, and sundries. Panama has a state-run nursing home for the poor, but we don’t expect to like it. I keep running through our budget, wondering how hard it will be to send five or six hundred dollars a month to Panama. Just thinking about it makes me feel guilty.

The only experience Arline and I have had with a dying relative was helping my parents take care of my paternal grandfather. But my parents bore the burden of navigating bureaucracies and finding caretakers, and my grandfather could afford $6,000 a month for a room in a licensed, private home in his last year. If my grandfather had had the equivalent of Nora’s pension, the search for good care would have been much harder. So the challenge in Panama is not only that we’re here for a short time and don’t understand how the system works; we also don’t have the money, and neither does Nora, to get her quickly into a good home.

Lili tells us she needs time to consider. Arline says we are going to the state-run home; we’ll call her later.

In the car, I write our impressions of Lili’s home in the notebook we brought to document our trip — good restaurants, nice hotels — that has become a record of nursing home visits and doctors’ phone numbers. It’s been four days since we discovered Nora’s condition, and while the shock has worn off, a deep uneasiness has settled in. Even if we can find her a new home in the next few days, which isn’t guaranteed, we’ll have to figure out how to care for her from Seattle. We can’t rely on Giselle’s dad, and we can’t expect Alma to take on Nora as if she were her own mother. We’re both college instructors; we can’t just fly to Panama every time there’s an emergency. We’ll figure something out, we keep saying. We keep hoping.


Part 2 of this essay will be published next Tuesday, 4/30/13.




Allison Green is the author of a novel, Half-Moon Scar (St. Martin’s), and essays, stories, and poems that have appeared in publications such as ZYZZYVA, Calyx, and Bellingham Review.

Photos by Allison Green

Under the Skin

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