"Come on, Cathleen," I urged, gently and patiently but with (I thought) just the barest hint of desperation, as I gripped her arm more tightly and tried to shepherd her up the stairs. "Just a little further. Just a little more. There's only—" I counted very quickly in my head. "Seven more steps. You can do it, can't you? Come on, sweetie. Just a little more."

My sister didn't look herself—or, at least, not the version of herself that she'd looked back when she was herself. With dark hair raggedly cut short, and hanging limply in strings, and paler than ever with huge dark circles under half-shut eyes, and skinnier than a pole, she looked on the verge of death. "I can't go," she said, slurring.

"Come on," I said; "I'm sure you can do it. At any rate, I can't carry you. Come on, honey. Just a little tiny bit more. Here we go, lift your leg—one! That's good. Here's another. Two!"

We had been stopped at the eighth step on the staircase for nearly five minutes. Altogether, it took us around a quarter hour to ascend the whole thing.

We reached the top, and I led her across the upper floor of our home, along scuffed wooden floors, to her bedroom. We had a little routine, her and I: every day, I would ask her to clean her room up, make it tidy. Every day, she would say, "Alright, Lou." And every day, I would come in her room to find that it was just as terrible as before: clothes strewn all over, chair tipped over, bedsheets in disarray, some kind of food or drink inevitably spilled somewhere. Her carpet, once a nice shade of blue, was now a patchwork of stains. And every day, I would sigh before cleaning her room up myself.

I didn't hate Cathleen; I loved her, even when she wouldn't clean her room or when she swore at me or when she refused to eat or when I had to force her into the bath. I loved her dutifully at all times, playing the part of the sister who is more than a sister, she is a friend. But in these latter days, we were practically neither. I lay awake some nights feeling terrible at the boiling resentment I kept locked deep within, resentment at the load that had been unfairly forced on my shoulders: to care for an imbecilic woman who no longer resembled the sister I had grown old with, who no longer resembled anything of Cathleen at all.

In her room, I found what I had expected. Dirty tissues on the floor. A long-sleeved shirt lay haphazardly across the foot of her bed, one shoulder torn badly, probably in one of Cathleen's many rages. (Cathleen could not wear anything but a long-sleeved shirt now, because it prevented her from cutting herself.) On her bedside table, a glass lay overturned, with spots of dark red liquid like blood staining the side of the table where they had flowed, and staining the floor badly where they had landed, in a gory-looking pool. I hoped at least she had drank some of the tomato juice before overturning it. It was such a battle to get her to consume anything these days.

Mercifully, the bed itself was remarkably clean, and well-made, as though she hadn't slept in it last night. For all I knew, she hadn't slept there—sometimes, for whatever reason, she preferred the floor. I tucked her into it, pulling the sheets close around her bony shoulders. She was docile and tired today, with little of the furious energy that tended to characterize her behavior. All day, even as I spoon-fed her breakfast earlier, she had not lashed out at me once, not clipped me on the side of the face, not given me a nasty bruise. In that respect, the day was like heaven.

I said gently as I could manage, "Try to clean your room up when you get up. It's a mess."

"Bitch," muttered Cathleen quietly, then rolled over onto her side and shut her eyes.

I couldn't fight the wave of anger that rolled through me. I was treated with such indignity, such mad vulgarity—and yet I did everything for her. When she was hitting herself in the head with tightly-curled, white-knuckled fists, who was it that gently pulled her hands away? When she couldn't go up the stairs, who coaxed her up one step, then the next, then the next? Who fed her and bathed her and dressed her? I did. And she had the nerve to call me that word?

God forgive me, I'll say an extra rosary tonight, but—sometimes I hated Cathleen. I truly did. I knew none of it was her fault, but I still hated her for it. And sometimes, in my darkest moments, I had thoughts of just picking up and leaving. Leaving the house. Leaving her alone. Leaving her to her own devices, to wander around and bathe her own damn filthy skinny body and make her own damn oatmeal and deal with her own damn problems.

But then I got perspective. I mean, what if it were me? If I were the one who wasn't in control of my own mind and bowels? I had no doubt Cathleen—the old Cathleen—would take care of me however I needed, and would do it with loving selflessness.

As the thing-that-was-once-Cathleen tossed and turned in her bed, restless, I quietly went downstairs and got a wet washcloth and began dabbing at the stain on the floor, penitently, piously, selflessly. I was the model of a good sister, lovingly crafted in God's hands and placed upon the earth to impart the reality of good sisterhood to the rest of the world's inferior sisters.

O

Day 873 of my sentence.

In the mornings, sometimes, I woke up early enough that Cathleen was not a problem—yet. On day 873, my eyes opened and looked over at the clock on my bedside table, red-orange numbers flashing:

6:58

Not long afterward, I was sitting on a little window-seat by a large square window, my arm resting against the cold glass. The seat was uncomfortable and cramped, but it was located in the attic, which was very important: Cathleen could not climb stairs. She could not aggressively intrude into my morning with arms flailing and mouth screaming endless nonsense. Not if I sat in the attic. The attic was safety. If and when she needed me, she would call, and I could choose to insert myself into her life, at my own leisure. That was all I asked.

I sipped on a nice hot mug of tea, steaming my glasses up. I stared out the window into the hazy blue of morning, about as content as humanly possible. For a few peaceful minutes, I watched the sun paint its orange and pink streaks over the horizon beyond the houses outside, and I forgot that there was a Cathleen in my life who needed me.

Of course, she interrupted—she always did. I heard the moaning, beginning as a low, creaking, slow noise that sounded as though it began in the throat of a giant, and shifting into a guttural bellow that made me wince and scowl, and finally into a piercing, squawking howl.

"Louuuuuuu! Louuuuuuuu! LOUUUUUUUU!"

"I'm surprised you even remember my name, you brainless—" I began to mutter to myself, but stopped short of using the word I had intended to whisper.

My tea abandoned on the window-seat to get cold, I rushed down the attic stairs to Cathleen's aid. I entered her room and flicked on the overhead lamp, illuminating the dark hovel-like bedroom in a light that almost seemed perverse when wasted upon such a mess.

There was Cathleen on the floor, rocking back and forth. Her pinched face was oddly expressionless, as usual. She leaned against the bedframe, and her bedsheets were rumpled and twisted, half-pulled off the bed and onto her lap. I noticed a terrible smell—that is, a different terrible smell than usual—and realized with bleak resignation that, somewhere in the room, Cathleen had shit herself. Underneath her bottom, I could see the nice blue carpet was darkened. She had pissed herself as well.

She looked up at me and with that same expressionless face, she cried, "Lou, you slow, useless, ugly piece of—you stupid—how did it take you so long? It took you so long!" Her words continued, but I paid them little attention. Each one was like a sharp knife into my heart, twisting and turning any love I had left into nothing but irritation and resentment, but I had learned to mostly ignore these knives even as they flew into the core of me. I had to remind myself that my sister was not the one speaking the words.

"Come now." I was surprised at myself, at how gentle my voice was, how patient and kind and understanding, even though I was none of those things. "Let's get you up." I went to her and grasped her under the arms, lifting. She rose without protest; she was lighter than a bird's feather. Still, it was awkward, and one of her pointy elbows dug into my stomach. I ignored it. For once, she hadn't hurt me on purpose. At least, I didn't think she had done it on purpose.

Below her on the floor, there was a piss stain, and remnants of what I suspected was feces as well, having soaked through her pyjama bottoms. She had had diarrhea. The stink grew worse and worse until I wrinkled my nose and nearly threw up.

"Ugly," Cathleen called me. No hint of contempt in her voice this time; she was just telling the truth.

"Come along." I hauled her off down the hall and to the bathroom, thinking all the way about how on God's green earth I was going to get those stains out of the carpet. Off came her clothes; I threw her pyjama bottoms straight into the garbage, and her shirt as well, because it was useless without the bottoms. They were nice, strip-patterned peach-colored pyjamas that had been a Christmas gift from me, two years ago, when Cathleen was only just starting to lose herself. They had been quite expensive, too. Wasted money. Wasted time.

I tossed Cathleen into the shower like a sack of potatoes, and got to scrubbing. She was remarkably compliant, this time. Perhaps she didn't like being dirty anymore. I couldn't remember the last time I had been able to get her into the shower. I stayed outside the shower, scrubbing her with rolled-up sleeves, scowling in annoyance whenever the spray of the water splashed me. Off came all the stain, all the rot and grossness. Off came the feces. Off came the grease of months without bathing. I even washed her hair, using my own shampoo. The scent of strawberries filled the room. I used nearly the whole bottle. Finally, I handed her a washcloth and told her to clean her private parts as best she could, then I closed the curtain. I opened it a minute later to find Cathleen still holding the washcloth. Maybe she had washed herself and maybe she hadn't. I had done the best I could, either way.

Out she came, naked as a newborn babe, and scrubbed cleaner than finest church shoes. Her mouth was not so clean. "Bitch!" she called me resentfully as I toweled her dry.

I ignored her. It was my greatest skill. "Come along, let's get you dressed and feed you some breakfast." I took her elbow and led her back down the hall, still dripping a little.

Sometimes I wondered whether Cathleen called me bitch because she really thought I, who cleaned her and dressed her and spit-shined her and fed her, was truly a bitch. Or, perhaps, if she only said the word because her mind was empty and ignorant and she knew little more.

Dressed in a bathrobe and herded downstairs, Cathleen's hair was beginning to dry. She looked quite nice when she was clean, when her hair was no longer stringy. At the least, she looked nicer than she had looked. We sat at the kitchen table together, and my sister picked at a bowl of oatmeal.

"One more bite, sweetie," I encouraged. "Just one more. Yes! That's it. And another. Can you do another? No, you think that's enough? I don't think that's enough. Here—" And I grabbed the spoon, scooped up some oatmeal, and held it insistently to her thin lips. This strategy worked about half the time, in my estimation. Half the time, she would obediently open her lips and submit to yet another spoonful.

This instance was firmly in the other fifty percent. Cathleen slapped the spoon out of my hand. It clattered against the wall, splattering oatmeal onto the floor. Before I could do more than process what had happened in the most basic manner—Spoon on floor. Oatmeal on floor. Need paper towels—Cathleen had started a rampage. Up the bowl of oatmeal went, flying towards the ceiling and landing upside-down on the table—bang! Oatmeal flew everywhere, onto mine and Cathleen's hair and our clothes and onto the walls and the floor. Up Cathleen's dining chair went, flying across the room and breaking—crash, splinter! I ducked with the dexterity of a gymnast and narrowly avoided a second chair—we had three chairs, the third one being set for a potential guest who never ever stopped by—as it flew by my head. Bang, crash, splinter again!

All the while, Cathleen was screeching. "Bitch! I won't eat that slop! You can't make me. You fat, ugly pig! You bitch! Bitch!"

As always, I tuned it out. These types of instances were when calmness seeped through me like a blessing from Mother Mary, and I was bestowed with perfect clarity. I reached out to Cathleen, gently and calmingly, the only thing one could do. "It's all right, dear—you don't have to eat it, not if you don't want to eat it—"

Her skinny fist clipped me across the chin. The blow barely hurt—Cathleen had been much, much stronger a few months ago, before she decided that she did not enjoy eating food. But inside of me, the blow stung—the humiliation of it, the rage of being hit by someone who you nurtured and protected to the best of your ability.

Outwardly, I ignored the hit. I reached out again. "Cathleen, please."

She hit me again. This blow was stronger, harder. My head was knocked to the side; my cheek smarted, and I imagined I was a brilliant shade of red-pink.

Only once had I ever called the police on Cathleen. Just once. That was a few months ago, and it was at a time when I knew for certain that I would not be able to get her back under control. I had fantasized that the very instant the police knocked on our door and walked into the house with their shiny badges and navy uniforms, Cathleen would shut up and stop her tantrum, becoming a model of decorum, albeit a sullen one. But that didn't happen. Instead, she continued raging and screaming and throwing things about, even as the police entered and tried to calm her. Ultimately, the officers' visit amounted to three hours of wasted time, as they merely stood around, and my tax dollars went to paying them for standing around. Cathleen deescalated on her own, without any help. And this incident today, with the oatmeal-throwing and the chair-throwing and all, was nowhere near the intensity of that incident.

No, I wouldn't call the police. I could manage perfectly fine on my own.

"Cathleen. Cathleen. Cathleen." Over and over, I repeated her name like a monotonous prayer. I held out my hand and she smacked it away, crying "Bitch! Bitch!" like a prayer of her own. I noticed something. Beside her was the kitchen counter, and resting on that counter was a knife. I had carelessly left it out when cutting up an apple for myself earlier. For a moment I stared at it, dumbfounded at how I could have been so stupid. What if Cathleen grabbed the knife? I would be toast, mud, biting the dust.

I made a quick choice. Swooping in as fast as possible, I grabbed Cathleen and wrapped my arms around her body, pinning her stick-like arms to her sides. She struggled and resisted and screamed, "Bitch!" I was not a strongman, but I was certainly stronger than Cathleen.

Her head jerked around, smacking me over and over; she had a very hard head. I held fast, however, and after what could have been an hour, for all I know, she calmed. Finally, she went limp in my arms. Our embrace could almost have been intimate, like two friends sharing a tender hug.

We went to the stairs.

"Come on, sweetie," I encouraged and prompted, but even I could tell that my formerly motherlike voice was dry and unfriendly; I had no energy left to pretend that I loved her. "One stair more. Can you lift your leg? There's a girl. One more stair, surely you can do one more. Come on—up! There's a girl. Just a few more and we're done."

I led her to her room, where, heart sinking, I observed the stain on the floor. It had entirely slipped my mind. Well, it wouldn't do Cathleen any harm to lie on the bed next to the stain—as if she'd notice the smell; she'd probably barely notice the smoke if the house was burning down. But as I led her to the bed, I saw that the nice white sheets were stained, too, where she had pulled them down to the floor and twisted them around her body.

I sighed heavily. "Into the bed with you," I told her. She obeyed, but not without giving me a resentful sneer. Tomorrow was Saturday; that was when I took Cathleen to a little meeting with fellow degenerative brain disease patients for a few hours, in the hospital, like a playdate for little kids. I'd leave her there, come home, fix the stain, and come back for her. Not today, though. I wouldn't deal with it today. There was still the oatmeal and chairs to think of, downstairs.

I stripped the sheets away from the bed even as Cathleen laid herself down. "Won't do to have you cold," I muttered to myself, and went downstairs to the living room, dropping the sheets off into the washing machine as I went. There, lying on the couch, I found a dusty old pink knit afghan. I brought this up to my sister and tucked her in, tight as a sardine.

I looked around her room. Clothes on the floor. Books on the floor. Food on the floor. I sighed.

"Would you please clean your room up, just a little? Won't take you long." Our daily ritual.

"Alright, Lou." She completed the ritual, emotionlessly lying.

I left her alone in her room and shut the door. Then, I went downstairs, descending the staircase with the ease of somebody whose brain isn't Swiss cheese. I would go upstairs and bring her back down for lunch in a few hours. Then, if I was lucky, she wouldn't turn whatever meal I made for her into a Jackson Pollock imitation on our walls.

I entered our kitchen and stopped, staring at the carnage and the wreckage. There, lying askew against the wall: a wooden chair, and another. One of them was broken, leg entirely severed from the rest of it. The other was perhaps still useful, if I managed to glue the half-broken leg back to itself. On the wall, against the fridge and the sink, and all over the counter, even on the ceiling, was the oatmeal I'd prepared, gluey and sticky all over the place. And on the floor, and on the table, and as I looked down, it was on my shirt, too. Our nice ceramic bowl, which I'd served the oatmeal in, was cracked down the middle, rendered useless.

"Bitch," I murmured to myself. It was inexplicably sweet to use Cathleen's word against her.

I set to work cleaning up.

O

Lunch that day was blessedly uneventful, and dinner too, and with Cathleen all fed and rested, I sat her down on the couch for another daily ritual of ours. It was 6:55 pm.

"Anything you'd like to do this evening?" I asked her mechanically. "Go out somewhere? Go for a walk?"

This was simply a routine. Cathleen didn't like to do anything but sleep, and sometimes eat, and sometimes hit me, and then sleep some more. I thought that it would be unfair to Cathleen not to at least ask her if she wanted to do something, but the answer was always the same: no, she didn't. I wondered if perhaps she slept so much because, in sleep, she escaped to a dream-world, where her Swiss brain refilled its holes, and she was able to love and be loved and live her life, once again.

I fully expected my sister to say "No," sullenly and abruptly, as though I'd asked her a ridiculous question like "Are you purple and made of peanut butter?" But instead she said, "Lou?"

She was hesitant, child-like. I was shocked into silence for a moment, just at the tone of her voice. "What?" I said.

"Can I sit down here with you for a while? Let's just watch some TV, okay?"

Her tone was halting, and her mouth opened and shut oddly between words, as though she was not entirely sure of what she was saying. I frowned—this was very different, a different Cathleen than I knew. She never asked things politely, and she certainly never wanted to spend any time with me. I almost wanted to refuse, but that would be unfair. I had asked, after all.

"Sure," I said. "Let's watch some TV."

We sat in the living room together, and on came Wheel of Fortune. Cathleen started out just sitting beside me on the couch, draped in another afghan, green this time. But abruptly and without warning, I felt pressure on my shoulder, and then on my entire side. Cathleen was leaning on me, her head resting against my head. She felt much heavier than one would have supposed.

My hand, clasped in my lap, felt pressure as well. Cathleen was clutching my hand tightly. "Is this alright, Lou?" she asked.

I couldn't answer. My throat was choked. This was the old Cathleen, sisterly, someone to hold close, gentle and warm. This was unfamiliar territory. Or, at least, it had been rendered unfamiliar territory by the destructive influence of New Cathleen, that surly, ungrateful, violent woman who destroyed all she touched. But this was not New Cathleen. This was something else. This was something that craved love and support and kinship.

I said, finally, "It's alright, Cathy."

We held each other. My hand snaked around her back and began stroking her hair; I felt a sudden surge of kind and nurturing emotions. She was warm and smelled nice, and we watched TV together. This was a long moment of shocking, jarring, totally-alien peace. I would relish it for as long as I could.

My mind sometimes wandered to the stains on the kitchen wall that I'd never get out, or the fact that my chin still smarted from all the times earlier in the day that Cathleen had smacked her hard head against it. But I pushed those uncharitable thoughts away, and allowed myself to love my sister and feel loved in return, for the first time in years and years.

If only she could have been that way all the time. Then, caring for her wouldn't be such a chore. Then, I'd be glad to see her in the morning and at night, instead of dreading the very sight of her pale moon-like face, whose hateful eyes tended to glare, and whose hateful mouth tended to sneer instead of smile, if they showed any emotion at all.

Oh, how I wished Cathleen would make caring for her this easy for me—that she'd be sweet and sororal and sober. Then, perhaps, loving her wouldn't be a chore. With that head against my shoulder and that hair against my hand, I could dream of that world, like Cathleen might dream of another world when she curled up in her bed. But neither of us would ever visit the worlds we dreamt of. Oh, well. That's life, after all. For now, I'd savor this brief moment of respite, and hope that another moment like it might be just around the corner.