Elmo P. Gersten had used his middle initial in correspondence and in legal documents for most of his 91 years. Lately, though, he had begun using it when he spoke as well. “This is Elmo P. Gersten” he would announce into the telephone on the increasingly rare occasions when there was a reason to call anyone. The ‘P’ helped stretch out the name. It needed some stretching. Elmo P. Gersten needed some stretching. Everything he could see needed some stretching. It was all shrinking, contracting, closing in. His list of surviving friends was shrinking almost by the week. His list of living relatives had long since shrunk to nil and evaporated into his failing memory.

Ida Gersten’s lucid moments were shrinking in frequency and duration. The hours between arthritic shuffles down the corridor to the antiseptic bathroom at the Bedside Manor with its stainless steel railing around the toilets and heavy particle board door that latched closed with a sound like a shot – these hours were shrinking. The very horizons of the physical world were shrinking, closing in; once distant and beckoning they were now the distance to the nearest wall, papered with endless images of a fluffy, sunny rural America peopled by apple-cheeked boys with fishing rods all interspersed with special calendars reminding the residents what day of the week it was, what day of the month, what year.

Elmo P. Gersten noticed especially that the number of faces he could recognize in the breakfast line was shrinking. And what’s more, shrinking at a rate faster even than the very short list of people whose names he knew that were still alive. Sometimes he saw them leave never to return, and sometimes it turned out to be a false farewell – they would be brought back in a few hours or days, wheeled into their dorm rooms down the long florescent lit hallways where hard, clashing sounds – hard heeled footfalls, dropped dishes, latched doors, the squealing of rubber on linoleum – would shoot past your ear like pebbles in a wind tunnel, wheeled along by young men with bad skin and beards who dressed in severe, ill fitting dark slacks and blue shirts and shiny jackets covered with patches and who Elmo P. Gersten would have taken for security guards or milk men but for the stethoscopes in their jacket pockets. But always, with never an exception, everyone left once more often than they returned, and the faces he knew in the breakfast line would be fewer. Elmo P. Gersten would keep count on his fingers as he waited in coat and tie for Ida to appear, not fooled for a moment by the replacements that were sent in to fill up the line.

“Everything is shrinking,” he once confided to her. He opened his mouth to add “we come in, but we don’t leave alive” but he kept quiet on that subject lest Ida become needlessly agitated. Ida rocked back and forth softly in her wheelchair and plucked at threads on the shawl that was draped over her shrunken shoulders. Then she looked up at him as if recognizing him for the first time and declared loudly that he had shrunk. A passing orderly, overhearing her, paused to reassure him that his spine was settling and nothing more.

Elmo P. Gersten had succeeded in officially stretching his name back by reinserting the “P” which he had dropped when he retired from the bank. He had entirely failed to persuade the staff at Bedside Manor to refer to him – at least to his face – as “Mr. Gersten” and was forced to endure the familiarities of young girls with blue eyelids who called him Elmo in loud, hearty voices, or even “Now, Elmo…” in even heartier tones. He had, however, after much badgering, persuaded someone at the front desk to make up a new name plate for his room – one that showed his name with the “P” in it. He had to settle for a piece of paper, with the name spelled out in long hand with an orange magic marker and a little orange magic marker flower at the very end, scotch taped over the original name plate. Now he sat patiently at the front desk again, this time to petition for a new name plate for his wife. It should say “Mrs. Elmo P. Gersten.” Neither of them was going to get out alive. Everything was shrinking.

Down the corridor, Nguyen Van Tran, mop in hand, was trying by every conceivable means to cultivate in himself a level of interest in cleanliness and hygiene commensurate with American citizenship. Away from Saigon for almost a year, he was still having trouble grasping the extent of the commitment to antisepsis that was required of him if he was to discharge his duties adequately at this place and hence someday be eligible to be an American. The staff at Bedside Manor had made it known to him that sanitary floors were sometimes all that stood between the elderly and premature death. Sanitary surroundings, they cautioned him on a daily and sometimes hourly basis, were the very foundation of good health care, and eventually this much had become clear in his mind: endless vigilance was the foundation of sanitary surroundings. Because a corridor that looked clean, and smelled clean and as far as Nguyen Van Tran could tell was clean because he had cleaned it himself was, in fact, nothing but a large flat medium for bacterial cultures of the most dangerous kind and required a second going over almost as soon as he had finished the first one.

The staff at Bedside Manor was very nice to him, treating him exactly the same as they treated their paying guests, speaking to him slowly and very loudly. At first, he had spoken back to them very slowly and very loudly, but the supervisor had immediately put her finger to her lips and smiled and said “no need to shout, hon, OK?” He had tried to work out the mysteries of this particular language protocol without success. He had tried speaking to staff in French, to see if the protocol was limited to English, but when he tried it out on the supervisor, she explained to him very, very slowly that he must communicate only in English because Vietnamese was not spoken in this country. Puzzled, he’d tried it again in Latin. “Ennng-glish, Hon, Ennng-glish. Not. Vie-yet-nam-eese.”

And so he elected in the end to concentrate on a single cultural barrier at a time. The cultural barrier of the moment was the bacterial culture that was even now forming a barrier to good health care here in the corridor, and therefore also to his eventual citizenship. He pictured the Statue of Liberty at the far end of the corridor and dedicated this hour to the task of paving a glittering highway of antisepsis to it with sophisticated American germicidal agents. He had witnessed American chemistry erase entire forests on the Mekong Delta and could only imagine what was happening to the bacterial civilizations beneath his mop.

Eventually his mopping took him into the entrance to the room of Mrs. Elmo P. Gersten, as he had been instructed to call her by her husband, who in turn referred to him as Mr. Tran. Almost immediately his mop came to rest against an object lying between the bed and the wall, which object turned out to be Mrs. Elmo P. Gersten herself. The blue flowered hospital gown that Nguyen Van Tran understood to be the native dress of all Americans over 80, had come open in the back and had worked its way up around her neck where it lay bunched up like a bib. Mrs. Elmo P. Gersten was asleep, snoring loudly, a naked fetal bundle on the linoleum.

Nguyen uttered a shocked cry at the indignity of her condition and bent down to scoop her up. He slid one arm under her folded-up knees and the other under her neck. But though she was about the same height as Tran, she carried the extra weight of old age. When he raised her up she began to pivot, as if on a spit, around neck and knee, and then began to buckle at the waist, the buttocks assuming the lowest position possible. Slowly she began to slide out of Tran’s grasp, folding into an ever more acute angle aimed for a rapid return to the linoleum.

Desperate, Tran held her against the side of the bed with his body and attempted to finesse her over the edge and onto the mattress. The minute the cold steel of the bed frame came in contact with her exposed thigh, the watery blue eyes covered with a cloudy gray flew open and she instinctively threw both arms around Tran’s neck in a grip that was surprisingly powerful. She muttered something to Tran about placing all her relatives in a large wooden salad bowl. His own neck bowed by the weight of Mrs. Elmo P. Gersten, but with the load now steadied, Nguyen made a final upward lunge and hoisted her onto the bed. The momentum carried them both well past the edge and onto the middle of the bed where they both collapsed, she on her back with her legs spread wide and Nguyen Van Tran on top of her, for the moment immobilized in her two-handed grip.

Elmo P. Gersten, formerly well-to-do, many times a world traveler and long since used to the sloth of the employed classes, sat patiently at the admitting table, which he perceived as the equivalent of the front desk in a hotel, and waited for the attention of a clerk in the matter of his wife’s new name plate. He had arisen and dressed early, appearing with his best cane at seven in the morning on the unfounded assumption that by selecting a suitably early hour he might increase the chances of his being noticed. By 7:30 he had tired of waiting and decided to take matters into his own hands. He rooted around on the clerk’s side of the front desk until he found paper and pen, and in a not-too-steady hand made out the new name plate. Mrs. Elmo P. Gersten’s identity now assured, he began the long shuffle down the corridor to her room to surprise her with it.

Nguyen’s face was stuffed into the frazzled bun of thin white hair atop Mrs. Elmo P. Gersten. He tried to lift himself off her but was afraid of what might happen if he shifted his weight onto some frail bone. Finally, with a firm jerk of his head, he managed to free himself from her grasp and found himself staring directly into the enraged countenance of Mr. Elmo P. Gersten, who was standing in the doorway, waving a piece of paper aimlessly at his side, his jaws working rapidly behind lips sealed tight in disgust. The old man’s breathing was rapid. In his suit he looked imperious and deeply offended, like a small but very angry god.

Tran’s mind cast about for the proper English phrases to explain himself, but strange little nursing home peccadilloes are not covered in most texts and he ended up being able only to smile consolingly and point with his freed arm to Mrs. Elmo P. Gersten who was absently picking at a seam in of the pockets of his overalls. He looked down at Mrs. Elmo P. Gersten, still terrified that he might crush her, then up again just in time to see the stainless steel bedpan as it wobbled in an uncertain arc from out of the hands of Mr. Elmo P. Gersten, its rim clipping him smack dab between the eyes.

Elmo P. Gersten turned on his heel and went to his room to pack. He was finished here. The others might roll over and play dead, but he wouldn’t. Better to perish on the streets than to live with an unfaithful wife in a shrinking world. He spent a good ten minutes in his closet, selecting a suitable pair of shoes and changing his shirt and straightening his tie. Then he shuffled down the corridor, now inexplicably full of running, shouting staff, and went out the front entrance just as a large orange and white truck with flashing lights was backing into the driveway. Elmo P. Gersten propped the door open for the men who jumped out of the truck and walked quickly past him carrying what looked like fishing tackle boxes.

It was going to be a warm day, he could tell. The sun had already been up for more than an hour, the rain last night had freshened the air and it occurred to Elmo P. Gersten that he might well have a few good years yet left in him. He looked across the parking lot to the street, where he would hail a cab and took a jaunty step off the curb and directly into the path of a station wagon pulling up to the entrance.