Dying in an Institution

When considering a memoir as reading choice I tend to wonder why I should care to read someone’s account of his or her life. However, Girl Behind the Door is not primarily Stephanie Dickinson’s story but an unflinching account, as seen through a poet’s eyes and mind, of her mother Florence’s death in a “Memory Care Unit.” This memoir is also, though not in a hectoring way, an indictment against the cold, materialistic attitude our modern American society imposes on many old people, and how little comfort and respect that comes down to for an old person who is dying in an institution.

The environment of Florence’s death is itself dead, an airless facility with artificially homey furnishings set in an Iowa landscape and community blighted by industrial agriculture and no longer recognizable as the home where Dickinson grew up. Though she has lived in the facility for some years, Florence, like the surrounding countryside, is treated like an object. Palliative care consists primarily of drugs—drugs that are intended to make her less trouble to overworked staff but do little to relieve the demented woman’s wrenching terror and physical discomfort until her regimen is switched to the quasi-death morphine provides.

Eschewing strict chronology throughout her memoir, Dickinson begins with her arrival at the “Memory Care Unit” but allows past events that arise as she witnesses her mother’s ordeal to illustrate their history and relationship. The result is a fluid, layered narrative issuing from feelings and memories as she observes her mother’s decline and dying. When Dickinson’s two older brothers join her, one sees the family portrait that results from Dickinson’s blend of past and present and that Florence was a single, hard-working mother who has been unlucky; In terms of marriage and was never easy to live with, but who has earned her three children’s love and loyalty.

The mother-daughter relationship, especially, has seen a great deal of conflict. This was a mother who though critical of all her children favored her sons and expected her daughter to mirror the mother’s perfect, imagined self—a self she seemed to believe could earn redemption and better luck through perfection in appearance and deportment. Florence’s symbiotic demands on her daughter have caused friction and adolescent rebellion against the mother’s model female ideals, which included a style of dress and propriety many young women rejected in the 1970s:

You ingrate, Stephanie; after all I’ve done for you and this is how you act? Wearing those rags to meet your college roommate in…I’ve bought you beautiful clothes. Where are all those wonderful pantsuits?

This exchange will be familiar and even comic to many daughters and mothers. But we learn from Stephanie Dickinson’s unfolding narrative that rebellion against Florence’s expectations prompted flirtations with danger Dickinson barely survived. And though Dickinson matures into a responsible if unconventional woman, she never fulfills her mother’s ideals or seems to her mother successful or even very respectable, an attitude the adult Dickinson has come to accept. It is with this attitude of acceptance that she holds vigil over her mother’s deathbed and tries to intervene on her behalf for more mercifully effective care.

Dickinson’s writing style narrating her mother’s dementia and dying is consistently detailed and gritty:

Florence lies there, twisting and turning. I’ll later learn that this is called terminal restlessness. Her eyes are almost closed and her mouth ajar, as if it has to stay partly open for the groaning to come out.

Some may see betrayal in Dickinson’s unsparing account of her mother’s death and their conflicted relationship. The friction between mother and daughter may in fact have resulted in greater detachment than is common. However one could just as well see Dickinson’s depiction as that of a poet, one for whom words and...