More tears are shed over answered prayers than unanswered ones....*

"I eat alone now,” she said.

“How did this happen?” I asked.

“I don’t have any friends there.”

Anna is 81 years old now, with a frail body about the same number of pounds as her age, housing a still-sharp brain. Her body, though, has not aged well. She manages to deny the involuntary clacking of her implanted teeth and slow shuffle brought on by Parkinsonism, and talks of the walks she takes to the park near her facility.

“I’ve hiked all over the world,” she proudly told me a year ago when she came as a new patient. She listed the places she and her companion, Paul, had gone in recent years, mostly in the southwestern United States.

Anna grew up an only child in Estonia, a small northern European country bordering Russia, Latvia, and the Baltic Sea. She was orphaned at age 14 when her parents were murdered by the Russians -- mentally I calculated this was about 1938 and made a note to check the Estonian politics of this era. She finished medical school in Germany and immigrated to Canada for training in anesthesiology, practicing for most of her career in Detroit.

I wanted to ask other questions. Were her parents political dissidents? How was she able to go to medical school after being orphaned? What was her life during World War II in northern Europe? Why medical school? Why did she immigrate? I knew she married in Estonia at age 18, but how did it come about that a young, married Estonian woman ended up in medical school in World War II Germany?

She had other concerns at this first appointment, though, and she was not one to look back or look for blame. Several weeks earlier she had a serious suicide attempt and was found unconscious in her room at her retirement community from an overdose of sleeping medication in spite of several months of treatment with antidepressant medication from another physician. She offered little explanation for her attempt other than “I can’t live the way I used to live.”

Anna married and divorced her first husband twice. Her next husband died after a three year marriage while she was on a Fulbright scholarship in Finland. None of these marriages produced children, and like most women in medicine in those years she continued to work as the main focus of her life. I tried to picture what these early years were like for a young woman with no family, holding her own in a politically chaotic world, trying to finish medical training, losing relationships. At that first visit, though, Anna was more focused on her current problem, Paul.

Anna and Paul, close companions now for 17 years, came to San Diego together in 1995 and two years ago moved into a retirement community. I tried to get information on the nature of the relationship, but Anna was not forthcoming, saying only he was a companion. They had separate rooms at the retirement home. “He’s driving me nuts,” she said, and she was wondering whether to end the relationship.

Paul was developing Alzheimer’s dementia and his deteriorating memory was a significant factor in Anna’s unsuccessful suicide attempt. Over the next several months, Anna complained about Paul’s dependency on her (“What should I do about Paul?”) and finally, in some way, the relationship ended. Whether by repeated avoidance or by Paul’s transfer to the “Care Unit” in April was unclear.

“He might end up on the Memory Unit,” she said, referring to the locked unit for dementia residents in their retirement facility. “I didn’t realize how much I relied on him. I miss him.”

We talked about visiting Paul and whether he would still recognize her.

“When do you want to come back?” I asked.

“How about two weeks?”

“You’ve got it,” I answered, even though patients considered stable on their medications would be scheduled at 4 months.

* Truman Capote’s inscription in his last unfinished novel.