I’ve been treating two women who have suffered and survived with Bipolar Disorder all their lives. Sara, in her mid-seventies, has been struggling with deep depression, trying to find her way out of a depressive swing. She sits very still these days, watching the people in the hallway. From a closet full of colorful matched sets of tops and bottoms, she has chosen a wrinkled beige blouse and maroon sweatpants. Her knee-high hosiery is bunched at her ankles. I miss seeing her with her purse tucked under her arm, reading her latest book by the building entrance downstairs, where she kept an eye on the comings and goings of residents, visitors, and staff. She used to smoke voraciously, the smell of cigarettes emanating from her like Pig Pen’s perpetual cloud of dirt, but she no longer has the energy to make it downstairs to the smoke room. Now she is sitting in the dining room on her floor, half-watching the TV in the far corner of the room, with one eye toward the doorway, where she has a glimpse of the nurses’ station.

I am looking for Sara’s roommate, Kathleen, who is a tiny, but vigorous, 97-year old. When she was 86, she got a poodle to keep her company at home. She keeps a picture of Goldie on the wall in her room, and speaks fondly of the nine years they were able to spend together before she had to go to the nursing home. I hope I have that much faith and enthusiasm for the future when I’m 86.

Kathleen recently lost her 70ish son, her only child, to cancer. She is in mourning, but her natural tendency toward mania keeps her going. On this day I had already spent time with Sara, and when I came over to see Kathleen, the two of them were sitting together in the dining room.

“Hello, Dear,” Kathleen said, grabbing my hand in her iron grip and not letting go for the length of the conversation, “That’s right, it’s Thursday, I’m so glad to see you, Darling.” Kathleen speaks in a singsong voice, calling everyone by endearments. It’s possible it’s a cover-up for not remembering anyone’s name, but it is a charming cover-up. She refers to family members as “my darling cousin Louise” or “my dear Uncle John, I’ll never forget him, what a wonderful man he was.”

Normally I would take Kathleen into her room for a private conversation, but I didn’t do that today. Instead, I began to chat with the two of them, as if we were just regular people, moving the conversation toward their shared fight with depression.

“The trouble with depression,” I said, “is that when you’re in it, it makes you think you’ll never get out of it.”
They nodded with recognition.

Kathleen began talking about the loss of her son James. “I was hoping I’d be the one to go first,” she lamented, “then I wouldn’t have had to deal with the pain of his death.” She sighed, and Sara, who has only one son herself, sighed with her. “But,” Kathleen brightened, the mania allowing for just a moment of sadness, “you have to go on and appreciate the things you do have. It could be worse,” she added, “I could be like one of them.” She nodded in the direction of the row of white-haired women in wheelchairs who had been set up in the dining room and who were clearly oblivious to the world around them. Sara agreed. As depressed as she was feeling, it was better to know what was going on.

I pointed out to Sara that though she was in her mid-seventies, she was like a kid to Kathleen, who was twenty years her senior.
“That’s right, Dear,” said Kathleen, giggling, “you’re like my kid roommate.”
Sara laughed, a rarity these days, and I could sense the good feeling flowing between them.

Sara started commenting on my youth and good looks.
“That’s what I like about working in a nursing home,” I joked, “no matter how old I get, I’m always so young.”
“But,” Sara insisted, “you really do look good.”
“Well,” I said, “I do the best I can with what I’ve got. That’s all we can do.”
“But what if you don’t have anything to work with?,” Sara countered, her depression speaking clearly.
“You just do the best you can with what you’ve got,” I replied steadfastly.
Kathleen said to me, “You know, Dear, that’s very good advice.” She turned to Sara. “She’s very wise. That really is all you can do, Darling.”
The three of us sat and pondered that for a while.

“Kathleen,” I announced, “when I get to be your age, I’ve decided that I’m going to call everyone Darling and Dear just like you. It’s such a friendly way to relate to people.”
Kathleen flushed with pleasure.
I went on, “It’s true. Everyone warms right up to you when you do that.”
Sara concurred.
“But I can’t start doing that now,” I continued, “I’m too young. I have to wait a while.”
Thinking a moment, Sara agreed, “No, you have to be an older person.”
“People would take it the wrong way if I started to do it now,” I added.
“Yes, that’s true,” Kathleen said, “You have to be an old lady in order to do it.”
We sat in silence for a while, contemplating this unique benefit of age.

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