Dear Marion,

After finishing my last letter, I spent a few hours reading in
Micha's novel, which raises in my mind various considerations
and questions that I had intended to broach. But first things first.
  
> My inclination is to try and encourage Margrit
> to enter Guilford sooner rather than later.
> I suppose she will resist.
> But what do you think about that? 

For Margrit Guilford is only a talking point.
I don't believe she wants to go there.
I don't believe she will be happy there.
I believe she will be unhappier in Guilford
than she is in Belmont. But I may be wrong.
Intermittently, she complainss loudly about
being unhappy here, but much of the time she
appears quite content and comfortable.

> Just now it's hard to imagine her
> staying in Belmont for a long time. 

I have no difficulty imagining her staying in Belmont.
She is very ambivalent. Her discovery of the edema of
her legs, and especially her gratuitous inquiry of her surgeon
about the safety of her resuming her previous life style
suggests to me that she is whistling in the dark and that
she is asking for an excuse to stay here. - remember that
she had her checks imprinted with "174 School Street, Belmont"

> But if, somehow, she were willing to stay,
> wouldn't that be really difficult for you and Margaret?
Her presence obviously requires some adjustment of our
habits, but I believe such an adjustment to be spiritually
very beneficial, both for Margaret and myself. It would also
be very efficient economically and assuming Margrit lived
another 10 years, would add half a million dollars to the
family capital.

> While on the telephone today to the administration lady at Guilford,
> I asked briefly about how they decide if a resident
> should move to a level providing greater care. 
> She replied, in a pleasant, conversational way,
> that basically this can be done only pursuant to doctor's orders,
> although often it is the staff who first notices
> that a resident is in need of more care. 

Under these circumstances the "doctors orders" would unavoidably
be influenced by the economic interests of the institution, on
whom the doctor is dependent for his livelihood.

> She urged me to look through the packet of printed materials she is sending,
> which includes her name and phone number.
> Then I should call her for further information as needed. 
> I'll be happy to do that.
> (I said I was making inquiries for a friend, naming no names.)

> Interpolating from a conversation with Margrit in September,
> I think she must be on the waiting list at Guilford. 
> The administration lady told me that the length of time
> you need to be on the waiting list varies
> according to which variety of accommodation you're waiting for. 
> I understood Margrit to say that they had offered her a place
> but she turned it down because she wasn't ready to go yet.

Until Margrit starts saving for the entrance fee, makes provisions
for borrowing it, or asks me to provide her with the funds, I can't
assume that she is serious about going there.

> I was pleasantly surprised to learn from Margrit that,
> after she went shopping with you yesterday
> and you had dropped her at Belmont Center,
> she bought a New York Times,
> went to a restaurant there and ate Miso soup and something else,
> then took the bus home on her own,
> and was having no great trouble walking home from the bus stop
> when one of your neighbors offered her a ride. 
> As you've undoubtedly heard, they got into a longer conversation,
> and your neighbor (a Jewish woman who knows Margaret somewhat)
> invited Margrit over for coffee today. I suppose she went. 

As I understand it, Margrit made the acquaintance of a fellow customer
at Starbucks and persuaded the lady to give her a ride home. 
Margrit told Margaret about the invitation as being some other day.
Today Margrit asked me to take her to the supermarket and to
Belmont Center on the way home, but declined the visit to Belmont
Center because she had forgotten she was going to rake leaves.
If there was an invitation to coffee, she had presumably forgotten
about that also.

> Sounds promising in regard to Margrit feeling more independent
> and in her element (thankyou for facilitating),
> yet she was still focused on leaving. 
> She was planning to ask her surgeon (?)
> (the person she had the appointment with a few weeks ago)
> whether it was reasonable for her to resume her normal life now,
> including driving, and mentioning the ankle swelling.

Margrit would never make such an inquiry unless she felt
unable to resume "her normal life". The surgeon hasn't seen
her for three weeks and would be able to give only a perfunctory
answer. It's unlikely that she was even able to get through to
him.

> To my surprise, as of yesterday Margrit was still leaving open
> the possibility of joining the cruise on December 12th.
> I expressed doubt that she was recovered enough and strong enough
> to undertake a cruise so soon,
> but she felt ready as long as the surgeon OK'd it. 
> "I'm resilient" she said. 
> In case she does decide to go,
> we talked about the possibility of her flying to Fort Lauderdale
> direct from Boston, thus postponing the trip to Konnarock.

> Regarding the arrangements in Konnarock,
> Margrit told me she would pay the guy to drive her to Detroit. 
> She mentioned paying for his return plane ticket;
> I'm not sure what further compensation she had in mind, if any. 
> I suppose the guy is competent to say no if he doesn't want to do it. 
> Isn't that so?  Or is there some reason I should ask Margrit
> not to go through with the arrangement?

What I know of the arrangement seems impractical to the point
of being impossible.  Margrit declines to stay at the Bed and
Breakfast 500 feet from the house.
She plans to stay at another Bed and Breakfast 10 or 15 miles away,
presumably communting with the car she is in process of packing.
She must have help opening and closing the garage door, carrying
her baggage down two flights of stairs. The house will be cold.
(Today it was also dark, because a windstorm had interrupted
the electricity.) The toilets are not functioning because the
water has been turned off and drained. So far as I know, as
of today, she still has diarrhea. I can't predict whether next
week her diarrhea will be better, worse, or unchanged.
On all previous trips, Margrit has used the right front seat
for placement of luggage. In order to have space for herself
and her driver, she will need to leave a substantial portion
of her belongings behind. On the other hand, she needs a driver
in order to get her car back to Detroit. And it's Margrit's 
managing in Detroit even more than her managing in Konnarock
that I worry about. But if she doesn't get back to Detroit
with her car, she has no place to go but Belmont. I don't
know what to say.

> I will try and stay in frequent communication with Margrit
> in this unsettled period to prompt her to think through
> the details and the consequences of her proposed undertakings,
> which she is a little slow to do.

> I just received your latest letter.  Thankyou. 
> I'm relieved that you're feeling a little more relaxed
> about this situation with Margrit. 
> (I hope that hasn't changed too much from reading the paragraphs above.)

> I'm going to ask you for some financial clarification,
> since you want me to discuss this subject with Margrit. 
> Yet I sense that I am about to tread on tender territory and,
> in truth, this is none of my business, so feel free to ignore my question.

> You say that Margrit has a pre-tax income of about $60,000 per year
> from which she should cover all her expenses. 
> Moreover, she would need to borrow the $23,000 entrance fee
> and pay it off over time. 
> Though I am completely ignorant on the subject,
> I presume you are administrating, for Margrit's benefit,
> half (or perhaps 1/3) of the inheritance left by your parents. 
> Couldn't the $23,000 come out of her inheritance? 
> Or is it more economical in the bigger picture
> for her to borrow the money and pay it off from her income? 
> (I assume that Margrit's income is the sum of Social Security +
> her pension from Windsor + income from her inheritance.)  
> In any case, the $23,000 won't be a big problem.

It's more economical in the bigger picture for her to borrow the $23000.
More on this topic when next we talk by phone.

> Since you are currently back-stopping
> Margrit's potential medical and pharmaceutical expenses
> beyond Medicare A and B, do you prefer her
> to buy supplemental insurance ASAP,
> or not until she changes her living situation,
> for example by moving to Guilford?

It's more economical for her _not_ to have the insurance,
I suspect, but don't know, that Guilford would expect her
to have such insurance. Certainly, if she were at Guilford,
it would no longer be possible for Klemens and myself to
look after her as we have been doing.

> I think it's good when you can feel somewhat relaxed
> about this complicated transitional period with Margrit. 
> You can't assume responsibility for creating
> a perfect situation for her,
> or for providing her 100% protection against disaster. 
> She won't allow it.  You would have to totally overpower her,
> which would probably make her desperately unhappy for the duration,
> so it doesn't seem worth it. 
> It's great when you find ways
> to facilitate the aspects of what she wants to do
> that seem at least marginally OK to you.

> As far as advising her,
> or at least laying out some considerations
> that she ought to think about,
> perhaps you should send her email
> (so that she doesn't interrupt you,
> and isn't pushed to react to you
> on the spur of the moment.)

Since she automatically rejects whatever I say -
two years ago, when she was driving one of my cars,
when I told her the other drivers have the right of way,
she accelerated into a traffic circle, almost causing
a serious accident. Just two days ago, after she asked
me to listen in on a conversation with the Scotia Bank, 
she made a scene in the telephone conversation when I
tried to eluciadate a matter which she had misunderstood.
I consider it hopeless to try to talk to her, - except
when she is very sick. Then she's totally cooperative.

> I realize, and Margrit does too,
> that she is not in a healthy frame of mind right now,
> that she is stressed and more forgetful than usual.
> Generally, she's not quite herself. 
> She's a little slow in realizing the ramifications of things. 
> Her social judgement is not as keen as it has seemed in the past.
> Illness and surgery and stress
> can promote these kinds of impairments I think,
> so it seems possible that Margrit will improve,
> at least somewhat, over time.

It is imprudent to make plans on the assumption that she
will improve.

> Let me know if you think the cruise
> should be an absolute NO in my conversations with Margrit,
> or just a NOT-A-GOOD-CHOICE.

That's a matter of your discretion. The risk is that the
diarrhea might become much more severe, not likely, but
possible. Medical care on cruise ships is notoriously
precarious. She might get terribly sick - and die. Not
likely at all, but not iompossible.

Then there's the public health issue: There
is no recognized quarantine for clostridium difficile
diarrhea. Nonetheless an outbreak on a cruise ship could
make national headlines, - a latter day Typhoid Mary.
If only for professional reasons, Klemens and I feel
we must go on record affirmatively advising against
the deliberate exposure of other cruise passengers
to this risk. I would be interested in the reaction of
your local infectious disease specialist.

Thanks very very much for your help.
Jochen