The following is an excerpt from “Dementia Unit,” which first appeared in The Gettysburg Review.

. . . “I can’t remember the recipe,” a woman in her nineties says to her neighbor in a panic. “Don’t worry dear,” the woman seated next to her responds. “We’ll call my mother.”

We laugh when we hear dementia-unit dialogue. We laugh because it is funny. We laugh because we know it is impossible for a ninety-year-old woman to have a mother who is still alive. We laugh because we are uncomfortable. We laugh because we are afraid. We laugh because we can laugh. We laugh because one day we will not be able to laugh. We laugh because we refuse to cry.

A woman is talking out loud to no one in particular. “My head hurts. My head hurts. My head hurts,” she says. “But you don’t give a damn.”

“I want to write a memory book,” another woman tells me. “But I forget what I want to write about.”

A woman screams, “It’s time to pee it’s time to pee it’s…”

Into her large bulbous nose, a woman thrusts her right index finger. She forages, extracts, rolls the booger into a ball between her thumb and forefinger and drops it onto the floor. She leans over. She rolls her left knee sock up and down and up and down and up and down.

When I was twelve and living in Providence, Rhode Island, I visited an old woman in a nursing home two miles from my house. She was a wanderer. She had Alzheimer’s. I don’t remember her name. I don’t remember why I chose to visit her. All I remember is that my school sang at the nursing home, and I began to visit some of the residents. I visited the residents because they looked lonely. I visited the residents because I felt sorry for them. I visited the residents because I wanted to help them. I visited the residents because society had cast them out. I visited the residents because no one else did. I visited the residents because if I didn’t visit them, who would?

A woman with painted blue eyebrows reports to anyone who will listen, “My eyebrows are tattooed.”

A woman screams, “The water is coming. The water is coming. The water is coming.” An aide walks her to the ladies’ room.

I spend hours on the dementia unit. Sometimes I feel sane. Sometimes I feel demented. Sometimes I feel the demented are saner than I am. Present to their emotions in ways that we, the undemented, are not. Listen to what they say: “I feel like I’m in prison.” “I feel like half a person.” “I’m useless.” “I feel unnecessary.” “I have no history.” “I go to sleep and I pray I will wake up and remember my name.” “We’re the forgotten people.” “Am I alive or dead?” “Who was I yesterday?” “The door is closed forever.”

A woman is walking down the hallway toward the nurses’ station, attempting to put on her maroon shirt. She cannot find her left sleeve. Her bare breasts hang down to her belly. A nurse guides her left arm into her shirtsleeve.

No one seems to notice this woman’s bare breasts. This woman does not notice. She is not embarrassed by her nakedness. She is like Eve in the Garden before eating from the Tree of Knowledge. She is innocent. Or, is she too far gone? I am neither innocent, nor too far-gone. I am embarrassed for her. I wonder if someday someone will be embarrassed for me.

A woman screams, “Let me die. Let me die. Let me . . .”

“I’ve got to go to the water tank,” she says. “The Pipe People live under here. Put me in a hole in the ground. My brains don’t work. You can’t say happy birthday to me. I was never born. I try to help people and I help myself. But I can’t help others. I will go downtown. And sit on a bench. And no one will bother me.”

“So how’s by you?” the man in the wheelchair asks me. “By me all is fine,” I say. Not a minute later, he asks, “So how’s by you?” Again, I say, “By me all is fine.” “You are a good person,” he says. “I can see that.” Again he asks, “So how’s by you?”

How do I respond when a ninety-five-year-old holocaust survivor cries and cries and can’t stop crying as she tells me that Nazis have come to take her parents? “They hate the Jews,” she says. “They are hurting my mother and my father. They will hurt me.” This woman speaks in both English and German and is unaware she is shifting seamlessly between the two languages. “The events you are recalling happened a long time ago,” I say. “These events are not happening now.” “No,” she insists. “My parents are alive. I said good-bye to them this morning.”

An emaciated woman speaks about a woman seated a few chairs away. “That jerk. I hope she dies. You are here for life,” she says to her. “Spare me. You always do as you damn well please. You think you look cute. You look like hell! You’re nothing! Shut your big mouth! You damn slob you!”

A woman cradles a doll in her arms. She believes she is the doll’s mother, and she will not let the nurse take her baby away.

Another woman says, “My mother, may she rest in peace. No, may she live a long life. No, we buried her. Anyway, my mother used to say . . . ”

A man walks over to a woman seated on a recliner. He reaches out and twists her right breast, as if her breast is a radio dial that needs to be tuned. A nurse shoos him away.

Nurses and aides sit at the nurses’ station, or they walk in and out of residents’ rooms, dressing them, bathing them, drying them, toileting them, changing their Depends, changing their sheets, wiping their butts, cleaning their vomit, applying salves, airing bedsores, responding to call lights, handing out medications, answering questions.

A woman screams, “Can someone tell me what is wrong . . .”

“How are you?” I ask a woman whose head rests on her chest. She does not respond. “Are you there?” I ask. “I think I’ll stop defrosting,” she says . . .