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It had been 10 canicule aback her aftermost appointment to see him, the longest they’d been afar in 63 years of marriage. He had Parkinson’s disease, which fabricated it absurd for him to allocution on the phone. She’d alleged the nursing agents for circadian updates, and they said her bedmate seemed quiet, and he was accident his appetite.

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“Why is it still so bad out here?” Marlene asked. Her anxiety skidded on the ice, and she captivated her arm about her daughter’s accept as they abashed afterpiece to the car.

“Maybe it would be easier in a few hours, already the sun warms up,” said her daughter, Deb Kennedy, 51.

“No. I’m at the end of my braiding already,” Marlene said. “Poor Earl’s apparently apprehensive if we larboard him alone bottomward there.”

In the aboriginal months afterwards her husband’s fall, Marlene had helped Earl Kennedy move into a nursing home three account from their abode in Burst Bow, a boondocks of 3,000, abutting abundant that she could appointment him alert a day. But afresh that nursing home went broke and bankrupt in May, one of added than 260 rural nursing accessories above the country to shut bottomward for banking affidavit in the accomplished three years, sending addition ancestors on a atrocious chase for the basal medical affliction that is dematerialization from rural America.

Marlene approved to get Earl into the alone added nursing home in Burst Bow, but that adeptness had managed to breach bread-and-butter in allotment by attached the cardinal of association on Medicaid, as Earl was, because the federal affairs pays nursing homes in Nebraska about $40 below per day than the amount of accouterment care. The nursing homes in Ainsworth and Minden had already closed, and the one amid abutting to a atom elevator in Callaway was active a cat-and-mouse list. The best advantage Marlene could acquisition was a aggregate allowance in the boondocks of Cozad, added than 50 afar abroad bottomward alien two-lane roads, and Marlene had been authoritative the cruise aback and alternating several times anniversary anniversary anytime since.

This time, Deb had offered to drive her, and they rode abroad from the single-story abode breadth Marlene and Earl had aloft four children, and afresh accomplished the grocery abundance breadth he had abounding shelves for 47 years. They connected above the feedlots on the outskirts of town, abutting with beasts accoutrement the hillsides. The alley narrowed through a bewilderment of cornfields. Arctic snow crunched below the tires and wind exhausted adjoin the windows as they collection for afar afterwards seeing addition car.

“There’s a dip advancing up here,” Marlene told her daughter, as the alley climbed over a arctic creek.

“Where? I don’t see it.”

“Believe me. It’s there,” she said. “I’ve done this abundant to know.”

She and Earl had rarely catholic alfresco of Nebraska, and they’d never been on an airplane. Abounding of their trips calm in contempo years had been medical trips, the ascent amount of a activity spent in rural America, which in the accomplished decade has absent at atomic 250 maternology wards, 115 hospitals, 3,500 primary affliction doctors, 2,000 medical specialists and hundreds of nursing homes. Marlene and Earl had catholic calm to Lincoln for a affection operation, Kearney for an ankle, Grand Island for a hip, Omaha for corneal transplants, and afresh assuredly to Cozad in the aback of a nursing home carriage van for what Marlene feared would be Earl’s final trip. He was about 88, and he could no best airing or eat solid foods. Marlene had already paid for their adjoining cemetery plots in Burst Bow, breadth Earl had spent his absolute developed life, but there was no abode larboard in boondocks breadth he could alive cautiously until he died.

Deb slowed to canyon a tractor. Marlene coiled to the disciplinarian and afresh stared out the window, breadth rolling hills went on for miles. The prairie was alone except for hay bales and a few pieces of agriculture accessories larboard out in the snow.

“You all right?” Deb asked. “You assume quiet.”

“This drive consistently feels long,” Marlene said. “You absorb your accomplished activity angry up appropriate abutting to somebody, and afresh you don’t get to be there for the hardest parts. It doesn’t assume natural.”

“You didn’t accept a choice,” Deb said.

“No, but that doesn’t stop me from annoying about him,” Marlene said, because that was what she’d been accomplishing for abundant of the accomplished anniversary and a bisected as she waited for the acclimate to improve. She’d afraid that Earl’s bed was apprenticed too abutting to the window on subfreezing nights, and that the khakis she’d bought for him to abrasion weren’t blubbery enough, and that he was accident too abundant weight to accumulate himself warm, and that if he wasn’t balmy he wouldn’t be able to sleep. She’d afraid about what he adeptness be accomplishing if he wasn’t sleeping, aback his apparition fabricated it difficult for him to apprehend or watch TV or do abundant of annihilation except move aback and alternating from his bed to his wheelchair, in which case 10 canicule adeptness accept acquainted to him like forever. She’d afraid he acquainted abashed by her absence, or upset, or scared, or alike abandoned.

“I’d be with him every day if I could,” Marlene said. “He knows that, right?”

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“Of course. He knows we all appetite to be there,” Deb said. She collection by a ample atom elevator and angry into the boondocks of Cozad, parking in advanced of a baby nursing home. She opened the commuter aperture and accomplished bottomward to advice her mother out of the car. “I bet you’ll feel bigger already you get a adventitious to appointment with him,” she said.

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“I don’t like actuality a visitor,” Marlene said. “I’m not a company to him.”

They absolved bottomward a tiled alley with beaming lighting to a baby allowance with an American banderole taped beside the door. Marlene stepped into the advanced bisected of the room, which for the accomplished 15 years had belonged to Earl’s new roommate, Oscar. He coiled from his wheelchair, and afresh Marlene pulled aback a blind to acknowledge the aback bisected of the room, breadth Earl was in the aforementioned position as she’d aftermost apparent him, 10 canicule earlier. He sat in his wheelchair with his anatomy angled over to the right, cutting a baseball cap on his arch and a kerchief to assure his shirt. He faced a TV that wasn’t on and a window with a appearance of snow-covered recycling bins. Marlene put her duke on his accept and leaned bottomward to kiss his forehead.

“I absent you, Earl,” she said. “I absent you so bad I couldn’t angle it.”

He smiled at her and nodded. He accomplished over to his bed and best up a anniversary agenda he’d accustomed from one of their great-grandchildren. He’d apparent it to Marlene on her aftermost visit, and now he handed it to her again.

“Isn’t that something,” she said, abrading his back, affairs over a armchair until it was apprenticed appropriate up adjoin his. She set the agenda bottomward and adequate her arch adjoin his shoulder.

“I absent you, Earl,” she said again. “Did you absence me?”

“Well,” he said. His aperture approved to anatomy added words, but they wouldn’t come. He’d been alive with a accent therapist to action aback the beforehand of Parkinson’s and advance his adeptness to eat, absorb and speak, but afresh Marlene anticipation he had beneath acceptable canicule than bad. She leaned in and approved to apprehend his lips, animated at him, cat-and-mouse for him to allocution as she rubbed his shoulders. His apperception was still sharp, and some canicule his sentences came added calmly as time went along. She believed the affectionate and admiring affair to do was to breach accommodating and delay through the silence, until afterwards a few moments of watching Earl struggle, she absitively the kinder affair was to breach it.

“I capital to appear aloof about every day, but this acclimate had added ideas,” she told him. “You absent me, though, Earl. Didn’t you?”

“Well,” he said again. He smiled and accomplished over to blanket his arm about her shoulder.

“Yeah, I knew it,” she said. “You absent me. And what all did I absence here?”

“Well, the usual,” he said, alpha to acquisition his voice. He acicular out adjoin the account agenda that was acquaint on the wall: a citizen amusing hour at 8 a.m., three pureed commons in the cafeteria anniversary day, bingo on Wednesdays and Fridays, Bible abstraction on Tuesdays, “Wheel of Fortune” in the association allowance anniversary night. Bristles association had died in the accomplished few weeks, and anniversary time the nursing agents had fabricated up the bed with a red rose and a archetype of the aforementioned composition on the pillow: “I am home in heaven, baby ones; Oh so blessed and so bright!”

“I accept you didn’t absence much,” Earl said. “Life in a blow home. We rest.”

Marlene laughed. “You never were abundant of a complainer,” she said.

“No,” he said. “I assumption not.”

They sat calm captivation easily as Marlene straightened Earl’s hat and smoothed the wrinkles out of his khakis. Sometimes during their visits, she took him into the cafeteria to comedy lath amateur or apprehend to him aloud from Philippians, but they spent best of their time calm in silence.

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“I like sitting with you like this,” Earl said.

His bisected of the allowance was about ample abundant to fit a bed, a chair, and a drop of mementos. There were photos on the coffer of his friends, his grandchildren, and his great-grandchildren, abounding of whom lived abreast Burst Bow and were too far abroad from Cozad to accomplish approved visits. There was a adoration book from the country abbey breadth he’d met Marlene in 1954, and a few awards from the grocery abundance breadth he’d started out authoritative $60 a anniversary and afresh backward on for about bristles decades.

“A activity lived right,” apprehend one of those agent plaques, which the abundance had accustomed to him to admire his retirement at age 76, and Earl believed that acknowledgment to be true. He’d aloft four acknowledged children, accomplished Sunday school, formed at the abundance six canicule anniversary week, and appear home best afternoons to eat cafeteria with Marlene. Their ancestors had never becoming added than $35,000 in a year, but somehow they had managed to accelerate the accouchement to college, breach out of debt, pay off their house, and alike body up some accumulation — best of which had vanished in below than two years to pay for Earl’s nursing affliction in Burst Bow.

After that he was affected to await on Medicaid, which meant that like best rural Nebraskans, he was abased on a nursing arrangement that was annoyed and drop the atomic association above the plains. Some of his accompany from the home in Burst Bow had concluded up in Omaha, Wyoming or North Dakota, and Earl had been abashed out of a boondocks breadth he knew about everybody to a abode breadth he knew about nobody, and breadth the one connected was Marlene.

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“It’s accepting to be that time,” she said, as she looked out the window. They’d been sitting calm for a few hours. The sun biconcave bottomward adjoin the cornfields, and the wind best up and started whipping snow off the ground. Anon it would be dusk, aback the anchorage started to refreeze and deer began to bound above the prairie.

“You should go,” Earl said. “I’m okay.”

“Another minute,” she said. She captivated his hand, and she anticipation she could feel it alpha to shake. She’d noticed that sometimes his Parkinson’s affection seemed to aggravate at the end of their visits. “I’ll be aback soon,” she said. “The acclimate advancing up looks appealing good.”

“When you can,” he said. “I’ll be all right.”

“Soon,” she said again.

“Well,” he said. He patted her arm. He approved to say article more, but his easily were afraid harder now, and the words weren’t coming. Marlene leaned in and waited, watching his lips. “I’m okay,” he said again. “It’s okay,” he said, until assuredly Marlene awkward his hand, affected herself up, and started walking out adjoin the car.

Earl watched out the window as the sky angry dark. His allowance was quiet, but in the alley he could apprehend the sounds of oxygen machines and beeping anxiety lights. Nurses wheeled association into the cafeteria for bingo, and the aliment agents able buttery potatoes for dinner.

By all appearances, the nursing home was a abode of accepted and stability, but in actuality it was adverse the aforementioned banking pressures that had shut bottomward 31 nursing homes in Nebraska in the accomplished several years. A few months before, it had appear aural canicule of actuality the 32nd, afterwards declining to accommodated amount and authoritative affairs to alteration all 65 residents. The adeptness had been rescued out of defalcation at the aftermost moment by a new buying accumulation from New York, and now the agents was aggravating advice the nursing home save money about it could.

Lately, one action complex authoritative trips to the shuttered nursing home in Burst Bow to deliver whatever food were larboard inside.

“I’ll be aback in a few hours,” said Kiley Goff, the arch ambassador in Cozad, as she larboard a agents affair and absolved out to her barter to accomplish her fourth cruise to Burst Bow in the accomplished month. Her administration had purchased the architecture there, accustomed her a key and accustomed her to booty whatever she bare for the nursing home in Cozad, which angry out to be about everything. Their adeptness was about 70 years old, and some of the apartment still had hand-crank medical beds. For one of her trips to Burst Bow, she’d busy a U-Haul and assassin teenagers on the bounded aerial academy angry aggregation to advice her amount it with a dozen electric beds, a few couches, a washer and dryer, board doors, a bathtub, a fireplace, coffer art and hundreds of pounds of linens.

This time she was acquisitive to acquisition baptize pitchers, dishware and anniversary decorations. “Any little affair we acquisition is article we don’t accept to buy,” she said.

She was a accomplished accent pathologist who had afresh switched to management, and she’d spent the accomplished year acquirements the difficult algebraic of nursing home finances. The Medicaid agreement amount in Nebraska and best added states had backward about collapsed for the accomplished several years, alike as medical costs rose by added than 20 percent. Her nursing home in Cozad accustomed $152 per day for anniversary Medicaid resident, far abbreviate of the $200-per-day amount of accouterment care. To accomplish up for that loss, nursing homes about answerable abundant college ante for bodies advantageous with their own money, a action that formed in burghal areas breadth about bisected of association could allow to pay out of pocket. But in rural Nebraska, alone 35 percent of nursing home association had money to pay for their own care, and in Cozad, it was below than 20 percent.

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The aftereffect was that burghal nursing homes had been able to abide about abiding alike as affliction abolished from disproportionately older, poorer and rural areas of the country, breadth an aged citizenry that was projected to bifold in admeasurement over the abutting 20 years would accept beneath places to go.

Goff collection by the feedlots on the bend of Burst Bow, chock-full at the railroad advance for a casual atramentous train, and afresh anchored at a low-slung architecture above from a accouterments store. Snow accumulated adjoin the aperture and a aged medical van sat out front. She pushed accessible the advanced aperture and ablaze streamed into the building. She could see bottomward a continued hallway, breadth medical lights flashed red adjoin the walls and a burst blaze anxiety kept activity off.

The nursing home had emptied out aural aloof a few weeks in May already the closing was announced, as 46 association and 65 agents associates accolade for places to go, but aggregate abroad had remained inside. There were wheelchairs in the advanced lobby, Bibles larboard accessible in the chapel, and artificial Easter eggs broadcast in the hall. Goff affective an alone artificial bin from the advanced closet and started walking through the facility, aperture closets and drawers to accessory for anniversary decorations she could use in Cozad.

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She begin a blimp Santa and some anniversary lights in a closet. She went through the concrete analysis room, the adorableness parlor, and afresh into the defended anamnesis affliction wing. “A Safe and Blessed Consistently Home,” apprehend a affected adornment abreast the access to what had already been the breadth for association with Alzheimer’s or dementia, who tended to advance on consistency, and who had aback been uprooted to places all over Nebraska afterwards compassionate breadth or why.

Goff begin a baby Christmas timberline in a closet and a amalgamation of unopened tablecloths in the cafeteria. Her buzz rang, and she set bottomward her bin to answer.

It was one of her agents associates in Cozad, absent to apperceive aback she’d be back. “I’m about done,” she said. “It consistently feels awe-inspiring in here.”

She apprenticed the buzz to her ear, agitated the bin of decorations out to her truck, and bound the nursing home’s advanced door.

“There’s still so abundant acceptable being crumbling abroad in here,” she told her employee. “We’ll charge to appear aback with the trailer.”

A three-minute drive away, in a abode at the centermost of Burst Bow, Marlene was allocation through her own belongings, aggravating to abridge the adventure of her aftermost 63 years with Earl, aloof in case. She capital to aces out photos for his burial program. She capital to be able with a eulogy. She bare to anxiety their coffer and about-face all of their collective accounts into her name.

“You’re acute to adapt early,” a broker was cogent her now, on the phone. “This way you can do some of it together.”

“Actually, he’s not here,” she said. “It’s aloof me.”

The walls of her active allowance were busy with photos of the grandchildren whom Marlene sometimes acquainted accusable visiting afterwards Earl, and mementos from the abbey she didn’t like accessory afterwards him, and plaques from the grocery abundance breadth she still sometimes accepted to see him aback she shopped. One account showed Earl at his retirement celebration, aback some above co-workers came aback from out of accompaniment and the abundance offered chargeless block to the absolute town. A few hundred bodies had appear through the abundance that day to say goodbye. “A baby boondocks turns out to abutment one of its own,” apprehend one bounded account adventure about that day, but on this day, Marlene was cerebration about the things Burst Bow could no best support, and the bankrupt nursing home, and all of the bodies Earl was no best able to see. Aside from their family, she anticipation he’d had two visitors in the accomplished six months.

She angry on the TV to analysis the acclimate report. She put her affection medication into her purse. She inched bottomward the driveway and into their 20-year-old car.

Earl had usually been the one who collection during their marriage, but Marlene had put 14,000 afar on the car in the accomplished several months. She collection out of Burst Bow and accomplished the feedlots on the bend of town. She angry through the cornfields. She went over the arctic creek. She slowed for the dip. She coiled to a tractor. She went by the atom elevator. She looked out the advanced windshield at the rolling prairie and counted off the continued miles, until she was anchored in advanced of the nursing home and walking into Earl’s room.

She saw him attractive out the window and cat-and-mouse in his chair, breadth she’d larboard him a few canicule beforehand and would anon accept to leave him again.

“I’m here,” she said, putting her arm on his shoulder. “I’ll breach for as continued as I can.”

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