Sharmila Voorakkara
The Bodies of Strangers: Reflections on Home
“Suffering ceases to be suffering at the moment it finds a meaning.”—Viktor Frankl
I. PHQ-9
I am the question-asker. The interrogator.
For about eight months, I was tasked with visiting various patient rooms at a small skilled nursing facility (a “sniff,” in common parlance) to ask strangers a set of questions—correction—to carry out a highly developed, randomized and standardized instrument of assessment—and so divine the shape and size of their despair.
The PHQ-9 is designed to record a person’s self-report of the frequency of symptoms indicative of depression. Melancholy. I liked to think of myself as a surveyor, an explorer sent off to chart the wilderness, to unearth the weird creature of despair up from the sightless depths and fix its dimensions. How big? How wide around? What was its shape?
At no time did I ever not feel that I was an unbelievable intrusion on a stranger at the worst point in his or her life. Nor did I ever understand how such a sophisticated instrument was so naive as to believe that anyone was actually going to tell it the truth.
* * *
II. Inflatable Green Booties
The first time I saw a stranger dying, he wanted to get out of his hospital bed for a drink and a smoke. His legs were as big as tree trunks; there were mottled red black splotches where blood spread in shadows beneath his skin. And his skin was stretched out like vinyl, awful Barbie skin.
His feet were swaddled in green booties that inflated and deflated periodically: sucking in, sighing out, breathing, beneath the hiss of oxygen through the tubing he kept pulling out of his nose.
“Fuck this,” he said. “I’m going outside for a smoke.”
According to the nurses, the man had been trying (and failing) to get out of bed for some time by the time I got there. I now know that there is a recognizable name for the phase of dying this man had entered—terminal agitation. The Cleveland Clinic describes it as “ . . . a set of signs and behaviors that occur in the days leading up to death. A person nearing the end of life may twitch, squirm or fidget constantly.”
It’s the soul trying to throw, bat, or otherwise finagle its way out of the theatre, which is fully on fire.
He hoisted his way up to his elbows, jerked one leg off the bed (green, inflatable bootie and all), then his elbows gave way and his top half flopped back onto the pillows.
“Jesus fucking Christ,” he grunted, his face was a darkened purple.
He closed his eyes. He huffed and puffed and coughed from a cellar deep inside of him.
I have no idea what to do. How to help—what help even means at a time like this. I push the nurse call button; I look at the doorway for anyone to appear in it and in the meantime, I ask him the most pointless question anyone has ever asked anyone at a time like this:
Can I get you anything?
Yeah, you can get me the hell out of here, he said.
I hadn’t been at my job for more than a week. I was relatively new to the process of dying. Though I had experienced my parents’ deaths, separately, years before, and I’d had an ex-husband die, suddenly, unexpectedly, and young, none of that helped me to understand—to place—to compute—what I was seeing here.
It shocked me to watch him scuttle across the surface of each painful minute while his body had its way with him: He’d drag himself up, half out of bed as though he were dragging himself out of his body and all the things it was telling him at that moment. Up, up and out he would hoist himself—and if he managed to get that far (however briefly), his body would eventually drag him back into it like a relentless tide.
I felt my own lungs squeeze.
I’d forgotten all about my clipboard loaded with the PHQ 9—the questions I was sent there to ask, then required to log as a pre-condition of corporate or insurance so that the Home could get paid. There was no way I was going to ask him any of them.
Thinking is a pretty higher order process, and I don’t know that I was thinking anything at that moment, except, Where the fuck is the morphine? No one should have to go through this consciously.
Soon, he’d be gone. Just gone. Whatever climbed up and down inside of his skin over the course of his life, whatever thoughts he’d ever thought, all of those things would be gone right along with him.
Maybe he was a good man, maybe he wasn’t. I didn’t know him. It didn’t matter. As I would learn from other bodies, other strangers, there comes a moment when none of it matters.
It was a job I wanted to quit many, many times before I did—for existential reasons. There was nothing—no bedtime story, no buffer, no lie I could tell myself to soften the truth of whatever it is the body eventually does to everyone.
In the end, what got me was how alone he was inside of his body. Only animals know that depth of loneliness.
We can all stop lying to each other in a place like this.
* * *
III. How It Is
I became a social worker out of necessity, out of a jerk reflex to survive madness, grief, and homelessness in my early forties. Nearly every day that I arrive at any place of employment where I wear a badge and carry a clipboard, I recognize the astounding feat of this. It is a miracle that I survived to be this person with a job and a badge and a car—simple yet powerful objects that speak to “normal” life.
We are all survivors.
Until, one day, we aren’t.
* * *
IV. Better
In the house I grew up in, I wasn’t allowed to have feelings, and even if I did have them, I didn’t want them. I didn’t realize this until relatively recently. I certainly didn’t realize it as a child. One day, at the age of fifty, I looked up and realized that my entire life had been barely functional—or rather—functional if you set the bar for functional really, really low.
Feelings were frightening. They were terrifying creatures that hijacked your body and bumped around in the turbulence inside of you. A feeling could break you, so I learned, over years and years, how to not feel anything.
I was a Child Protection social worker for seven years and I never cried. Now I cry all the time. My therapist says that’s how I know I’m getting better: it hurts to be alive.
* * *
V. Snappy Comebacks to Stupid Questions: The Alfred E. Newman Story
When I was a CPS social worker, I used to foist myself, unbidden, into homes and pry into lives inside of them.
I wasn’t welcome. As a social worker, I’ve learned that entering the lives of strangers—whether from across a doorway, desk, or at a bedside, requires iron in one’s spirit. Almost always, the social worker is greeted with hostility, which even the social worker can usually understand.
As a social worker in a skilled nursing facility—I entered rooms which contained the bodies of strangers. The body is another kind of home. Maybe our truest one.
“Hi,” I’d say, trying to establish rapport in the first few moments of forced intimacy with a stranger. I will have tried to gather some understanding of the diagnoses, the reasons, that this person is here, in this particular place. But all of the random specificities of a chart will never really prepare you for the person in total.
Here, the woman was in all kinds of pieces—body and soul. She was shards of taillight, busted into cherry-red teeth. The minute I entered her room, I could feel things breaking.
“I’m going to ask you a couple questions,” I said. “To determine your mental status. You know, your memory, your understanding of things.”
She was in some sort of restraining contraption to keep her from moving from the neck down. The only part of her that she could move was her face.
“Mental status?” she reared up in her binding. “I wish I was goddamn demented,” she said. “But I’m not. I’d be better off demented, then I wouldn’t have to feel all this shit. I was fine! Fine! Not two days ago!” she said. “I was a goddamn guinea pig in their experimental surgery. Look at me!”
I have this form. Oh God. “Over the past two weeks, have you experienced little pleasure or interest in doing things?”
A hitch of silence followed. The room waited for her to upload an answer. Whatever it turned out to be, I was sure, would be entirely appropriate.
“What the fuck do you think?”
* * *
VI. The Real World and Its Unbearable Fiction
Home enters you. Becomes a skin on your skin. You can’t rub it off, scrape it off, scour it off. It’s there. Just there and it’s there no matter what other things the world shouts at you.
My backwards commute is dotted with billboards: Buy buy buy! Buy anything, buy everything: Cars, A/C units, get a lawyer to get compensation for your wounds. Commerce is the antidote to death.
But there is no cure. I’ve seen inside the crystal ball—Old Age, Sickness, and Death wait like three wise men in a snow globe. And now that I know this, I can’t un-know it.
I live at the intersection where anything can happen to anyone. I live in a city in which the hologram of technology is held out like a promised land, a city where the streets are lined with milk and honey and dollar bills, and life everlasting, where old men can maintain erections for hours. No one grows old or just plain breaks down in this hologram-techno-Disney-delusion.
There is a man face down on the sidewalk surrounded by a burble of pigeons. Towering above them, a billboard advertises the next, best, greatest evolutionary advance in the quest to make humans completely unnecessary for life on Earth: AI for Code Review.
The motherboard of this world is demented. Its thoughts are rogue proliferations—meaningless ideas, more and more useless applications that will make some of the worst people in the world a ton of money, and will not change what happens to all of us in the end.
* * *
VII. 8am on Any Random Tuesday
This thing called work confounds me. It has confounded me ever since I got my first job at sixteen. All these years later, I still can’t shake the feeling that I’m walking into a tomb, or serving a sentence.
I get out of my car and do my best to stuff everything that I am, everything I feel, into a thimble-sized container just behind my warm, wet heart. Every morning, the same dull mordant sits heavy in my solar plexus, as I approach the side entrance to the Home.
I punch a few numbers into a keypad. The door sighs and parts its lips, and I enter the long preamble to the Home—the service entrance hallway. Pallets stacked with industrial cafeteria food, processed meats, freight loads of Sysco paper products, file folders, notebooks, copy paper and latex gloves line the way past the laundry and the kitchen to a door marked Employee Lounge.
The lounge is decidedly un-lounge-like. It contains a wall of lockers, a refrigerator and a small table where sometimes people eat and look out a window whose view opens onto the parking lot. The walls are papered with posters about “Good Time Clock Hygiene” and handwashing in fifty languages which no one at the Home speaks: Swahili, Punjabi, Hungarian. Just beneath the employee suicide crisis line poster (only in English) and bathed in the buzzing mushroom cloud of fluorescent light is the central artifact of the Employee Lounge: the punch clock.
I press the tip of my index finger to a little glass square of a sensor. Familiar with the unique map of loops and whorls of my fingertip, my name, identification number and employee classification all appear on a small screen alongside a green checkmark. Registered.
“Thank you,” says the machine.
I hit the green Enter button and my shift at the end times begins.
* * *
VIII. Time and Death
Without one, you don’t have the other.
I’ve hated clocks since as long as I’ve been aware of things, and that was pretty early on. Smug little overlords, I never met one I didn’t want to rip from the wall and eviscerate.
Down down down, tick tick tick, the little miner chips and chips away at the hour as though it might one day reach a cold, glittering center—but it never gets there in the end.
* * *
IX. Orientation
“What day is it?”
“What year is it?”
“What month is it?”
I stand by bed after bed, and watch the answers disintegrate behind the test taker’s eyes. “What day is it . . .” the test taker might repeat, voice trailing off into the far corner of the room, the question becoming more and more faint until both the respondent and myself are convinced it really doesn’t matter.
Many of the residents are in various states of dementia—a dimension which confounds time. A couple seconds, a few billion years. It really doesn’t matter. Everything is equal: was, is.
Each morning, I greet Mrs. E., a long-term resident. Her white hair stands on end, and the rest of her is dressed in a baggy cardigan and skirt. She mistakes this place for her childhood boarding school and though I have met with her numerous times over the past eight months, though I have introduced myself at least a thousand times, she asks, “And what’s your name?”
Each morning I re-introduce myself. “So pleased to meet you,” she says and extends her hand which I take in mine.
The clock, petty, mean-minded warden that it is, is completely futile. A lot of these people have been having the same one long day since 1972. Every morning I am someone new. A stranger in the lives of strangers.
* * *
X. Here
Sclerosis of the liver.
Forty-nine.
Widower.
In and out of sleep.
Sometimes, you come across a face that looks out of place in the age it actually is. His face was so clear and pale I could nearly see the boy he once was.
He drifted in and out—answering, not answering. I was a mumble of shadow in his line of vision.
He got the highest score you can get on the PHQ9. He knocked that score right out of the park.
No plan. No means. No intention. He just wishes he was dead.
By the time I met him, I’d done that job long enough to know that this is a fairly reasonable thought. Everyone who came to the Home wished for the same thing. However, it also presented a certain degree of liability. I’d have to tell someone. A licensed someone. I wasn’t sure what that someone would do, but I needed to tell someone, in part because I didn’t know the first thing to say besides: “We have a psychology service available. All I’d need is your signature, giving your consent.”
“What exactly am I consenting to? “
“You’re giving them permission to talk to you—if you want, that is. You don’t have to talk to them, but they can’t talk to you at all unless you give them consent. It’s like a door you can open if you need it.”
I read him the feathery, fine print, too.
“I don’t want to sign anything.”
“You don’t have to. But I’m going to ask you again, tomorrow, okay? Your score on the depression scale is really high.”
“I don’t want to be here.” In the context of this place, here is a loaded word.
“What do you mean by ‘here?’” I ask. But he’s drifted out again. This too, is usual for the first day or week of arrival at the Home. No one can stay awake. And then when they do wake up, they can’t believe the body they have awakened in.
The worst thing in the world has happened to you, but you are not allowed to not be part of it.
* * *
XI. Free Parking and a Soundtrack for Clouds
A Dollar General parking lot is a handy piece of nowhere. It offers a good view of the sky, which, as far as I can tell, is about the only thing Texas—the state I live in—is good for. The politics are corrupt and there’s an endless supply of Trump bumper stickers on pick-up trucks, but goddamn, the sky is operatic.
Sometimes I park here after work when I want to float in a place that isn’t here, isn’t there – not work, and not all-the-way home. I seek out in-between places more and more these days, unwilling—or less able—to settle into a clearly defined point on the map, especially because I know that the country I find myself living in is different from the one I’d always believed it to be.
Sergei Rachmaninoff’s “Prelude Opus 23 No. 5 in G Minor” is on my playlist on repeat. I love how this one piece of music climbs the stairs of its heartache, and leaps again and again and never dies. It walks through the ghost of its once happiness. It rails against the walls of its human heart, against the physical laws that bind it to the small being who is its feeling host.
I watch clouds and think of the dementia patients at the Home. They dip in and out of the past. They live there, but everyone from that place is gone. They live in ghost towns. Nine months into 2025, I grieve in the way I believe the patients with dementia grieve. I am lost in a country I once called home.
From where I am, I have a view of a touchless car wash, and power lines that rule the sky which are, by their very nature, chaotic. Never before have I been so sure that we are nothing more than tenuous inhabitants on a rock whizzing through space, kept in orbit by a series of chance negotiations, carried out beyond our control.
* * *
XII. Come, Says the Room
Enter—and be entered—by these strangers whose lives are gathered around the bedside of a woman, whose name you will not remember, though you will remember the way her body arranged itself, patiently, beneath the long, quiet hand of disease.
“I’m going home,” she says, her head sunk into a soft divot in her pillow, cheekbones like high balconies.
“Yes,” I say. “Home,” I nod. I hand her discharge paperwork on a clipboard. I need a signature.
The blinds are rolled up and bright, white summery morning light floods this place. It bounces off the cut glass facets of a flower-filled vase on the nightstand so that they glitter like little teeth. All shadow is chased from hiding here. It is a room stripped of all pretense.
A man and a woman stand by the bedside; the light has undressed them to bewildered children, her children, flown in from lives far away (California, I think I heard them say). Their mother’s belongings are packed into bags and wait patiently on the floor.
I will recognize their faces forever. The man and the woman have only recently arrived in the ancient country of this room. They are newcomers, though I have been here for years.
“Oh, yes,” says the woman on the bed, handing me back the clipboard and the form that now bears her name, which will one day soon lift away from her, then folding her hands on the blanket. “I am going home.”
Oh, I say, the word slotting into my understanding. Home.
Sharmila Voorakkara is a social worker; writing is how she finds a way to live.