End of Life

It’s 57 degrees in Nice, France, where former Princeton resident and Rutgers sociology professor Cathy Stein Greenblat lives, facing the Mediterranean. The lifelong Francophile lives in the land of her dreams, listening to WBGO Jazz Radio in Newark on iTunes.

While taking a “Europe on $5 a Day” tour in the 1960s, Ms. Greenblat traveled the road from Monaco to Nice and vowed she’d return one day to live. Her other lifelong dream she is fulfilling is becoming a professional photographer. An exhibit of her work, Alive at the End of Life, is on view at Rutgers University’s Douglass Library, 8 Chapel Drive, New Brunswick, through June 8.

Here’s what I wrote about Ms. Greenblat several years ago for an exhibit she had at the Woodrow Wilson School’s Bernstein Gallery, titled Long Term Care for the Dependent Elderly: Lessons from Mexico, The USA and Japan:

In the introduction to the exhibit, Ms. Greenblat groups the images most photographers make of the elderly into two categories: frail, weak, isolated from families and societies that do not provide proper care; and thriving 80-year-olds, looking many years their junior, traveling the world, enjoying an idyllic family life. The intent of this exhibit is to challenge the conventional views and show how three different systems in three different countries care for the dependent elderly.

“These tender photographs… remind us of the shared humanity across the world as we all struggle to face aging and its inevitable challenges with dignity and grace,” writes Bernstein Gallery Curator Kate Somers.

Although Ms. Greenblat had long sought to express sociological situations in a visual way, photographing people with Alzheimer’s disease had not always been at the top of her list. Her grandfather had had undiagnosed Alzheimer’s in the 1960s, and when she went to the nursing home to visit him, then in her 20s, he didn’t recognize her because he remembered her as a little girl. He accused her of being “just another person trying to cheat me out of my hard-earned money,” she writes in Alive With Alzheimer’s (The University of Chicago Press, 2004), a collection of photographs and essays that has been traveling in exhibits throughout Europe, the U.S. and Japan. A former “brilliant, successful trial attorney,” her grandfather now told over and again the same stories about a case he was trying, a Brooklyn Dodgers game he’d attended years ago, as if they had just happened.

That her grandfather was living with Alzheimer’s but not alive with it saddened her to the point where she stopped visiting him. Later, her grandmother and then her mother both lost their lives to the disease – Ms. Greenblat recalls her mother folding the same sheets and towels over and over again. Statistically, she has calculated, her chances for avoiding this disease are not good.

While taking a workshop with photographer Mary Ellen Marks in Oaxaca, Mexico, Ms. Greenblat was assigned to an asilo (old age home). “It went against my desire, and rationally I would have chosen not to,” she says. “But as hard as it is to see, I’ve seen worse, people who may be living at home with a loving family member but receiving no stimulation.”

Indeed, some of her images are hard to look at, such as a group of old men sleeping in wheelchairs looking lost and forgotten; yet, other images restore one’s faith in humanity, such as those with loving caregivers holding the hands of the elderly, dancing and singing to them, bringing new life into their lives.

In fact, Ms. Greenblat felt so empowered by the good treatment she saw patients receiving, she was inspired to go on to other projects, such as Silverado Senior Living, an assisted living community in Escondido, Calif.; and group homes in Kyoto, Japan.

At Silverado, residents are offered close contact with pets, plants and children and opportunities to feel productive, loved and have dignity. There is stimulation not only to help retrieve past memories but to create new ones. Music, too, is an important component of the treatment.

Among the images we see are a caregiver singing to and dancing with an elderly person, both their faces lit with joy; two younger people seen from behind, holding the hands of an elderly man, helping him to walk; a woman with thick glasses and wiry gray hair runs a wrinkled hand along the smooth cheek of a young girl; and an older woman looking positively electrified as her hands dance over a keyboard.

In another series of photos, we see a woman lying in bed with a cat sprawled on top of her, purring contentedly. Ms. Greenblat says this woman, Edith, had just been brought from another institution, where she’d been heavily medicated and bedridden. The next photo shows Edith one month later, not only out of bed but in the stadium of a racetrack with other residents, enjoying the outing.

In the U.S., Ms. Greenblat points out, there are limited public resources for eldercare and many have no health insurance. Family members often try to care for the elderly and that may stretch the limit of their financial and emotional resources. In institutions where decent care is available, patients with dementia are often over medicated and nothing is done to stimulate their brains or hearts.

The Asilo Municipal de Ancianos de Santa Rose in Oaxaca offers a “clean, gentle environment” to 72 residents who have been abandoned or are poor, rejected, ill and isolated. With minimal resources, little can be done to prevent the sense of illness and isolation, according to Ms. Greenblat.

This is especially illustrated in a photograph of a woman in a wheelchair, seen from behind, inside the gates of the institution. Alongside her is a plant, but outside is a whole world, the street awash with sunlight. As she stares longingly at the outside, we feel for her, trapped inside this cage of old age and loneliness. A towel left haphazardly under the gate, halfway inside and halfway out, teases at a possible escape.

Another stark photo shows an elderly man and an elderly woman in a courtyard, facing away from the courtyard and its sunshine, their backs to each other, as they lean on their walkers. They stare into the dark abyss around the courtyard, as if they are the last two people on Earth, yet can’t bear to face one another.

Yet another image shows a man in a chair, hunched over, his tattered straw hat, a knee and part of his shoulder soaking up the sunlight. This meditative study of light is an example of how Ms. Greenblat has developed as an artist, beyond just documenting a situation.

Next we move on to Japan. In these color images of group homes, we see music and other activities and excursions into the community. “The staff/patient ratio was always high and the caregivers exhibited extraordinary sweetness, respect and professionalism,” Ms. Greenblat writes.

She was most impressed with the extensive use of physical touch that research has shown to be effective with people with Alzheimer’s. In contrast to the trapped woman in a wheelchair in Mexico, here we see a woman on a terrace looking out into a garden that is open to her; she can feel the sun on her face, and is part of the world and its beauty.

In another, a caregiver seems to be genuinely enjoying herself as an elderly patient holds onto her hand. In the kitchen of this group home, a steaming bowl of udon soup with brightly colored vegetables tempts the palate of a viewer. No institutional food served here, where one of the “guests” is a former chef and allowed to help in the kitchen. Food is cooked by staff members, and staff and residents all dine together.

This facility not only sparkles with cleanliness, but the floor and furnishings are made of amber-colored wood, giving a sense of warmth that can’t be achieved with linoleum or plastic laminate.

When Ms. Greenblat took her digital camera to Kyoto, she shot in color, fully intending to convert to black and white, but when she looked at the images, she realized “color conveyed the Japan-ness” and kept them in color.

“In many ways, black and white gets you closer to the core, looking at light and shape,” she says. “The history of documentary photography is black and white.” She is studying color printing so she can make an informed choice as to whether to shoot in black and white or color.

Ms. Greenblat’s interest in photography began in the ’70s on a trip to Peru. Her images were shown at the Douglass Library at Rutgers and went on to receive awards. While on sabbatical in London in the ’80s, she joined the London Camera Club and enjoyed getting feedback from other photographers. Upon returning to Princeton, she started the Princeton Camera Club.

In 2001, the lifelong Francophile decided to take early retirement from Rutgers and pursue photography seriously. The first thing she did was to get Lasik surgery to enable her to see better, and then signed up for Mary Ellen Mark’s workshop in Oaxaca.

Her current project is looking at palliative care for the end of life. “Unless someone is hit by a truck, we end up thinking the only alternative is to stay in a totally medicated environment and have doctors direct your life to the end,” she says. “But people die under conditions that are not good for the spirit – cold places, green walls, bad food. There are alternatives, and palliative care is a growing practice in the U.S. and Europe, celebrating life until the last moments with dignity, not lying in a hospital bed with tubes. You should deal with the issues you want to when you die.”

How can we find dedicated caregivers for the 18 million sufferers of Alzheimer’s worldwide? (And that number is expected to double by 2025.) “It starts are the top,” says Ms. Greenblat. “The person who creates and directs has to be responsible for a person-centered model. The best intended caregivers can’t do well if the top administration doesn’t say this is what this is about.”

Ms. Greenblat is an invited speaker to various conferences on eldercare, and often uses these occasions to travel to eldercare facilities. Rather than spend her Thanksgiving and Christmas holidays in warm and comfortable homes, eating large meals, she often uses these opportunities to photograph treatment facilities.

“Friends say it’s a morbid way to spend the holidays, but I find it’s wonderful,” she says. “(To see caregivers) providing people with joy in their last days – it restores my faith in humanity.”

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2 Responses to End of Life

  1. When I first looked at the exhibit, I recoiled from some of the images. Painful memories flooding my being.
    After Cathy’s excellent talk, I felt very differently. I hope more people can look at Alzheimers with more compassionate eyes and that the care patients get in the US will become more humane.

  2. joanna tully says:

    thanks for this, Ilene.

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