Getting Old Ain't for Sissies
These days we are talking more about advanced directives and living wills in health care. This is good, but at the moment as a member of the sandwich generation, I am more focused on negotiating the aging process. I don’t have kids, but I have parents and have the privilege of watching patients struggle with aging and helping loved ones grow old—walking the long, winding and thorny. Sometimes I’m not sure which is worse.
Patients have asked me, “Where are the golden years?” Aging is a process of loss and grief: letting go of what you can no longer do for yourself or have the energy to do, living with pain and discomfort, and sorting through the could have, should have, would haves.
As the caregiver eldest child, I have tried to respect my parent’s autonomy to make a decision even if I don’t agree with the decision, but temper it with the realities of what Mom or Dad could and could not do. With lots of sibs, it means working with siblings to be on the same page, sometimes easier said than done.
No surprise, there is no direction manual or easy answers. I am learning as I am doing. As a physician I have the benefit of watching others do the same: some do it well, some do not. Some day, I’ll have more authority when I am grieving the loss of my own capabilities.
My dad was disillusioned in his final years as he came to terms with the loss of his physical strength. He did make it out to spray the weeds along the fence rows at ninety, his goal. My cousin who saw him out there told me she watched nervously from the window, with one hand on the phone. Doing it once at 90 was enough for my dad. However, he may have benefited from anti-depressants in his final years, it might have helped him emphasize the cup half full as opposed to the half empty point of view. I know responsibility for my 50+ year old Down syndrome sister weighed heavily on him. Who wants to parent at 90? That said, we celebrated his 92 years of living two years ago this Christmas and knew that he was very ready to pass.
My mom has soldiered on without him, now alone after sixty some years of marriage. Her balance has been a problem and most recently she fell and broke her shoulder. Due to the nature of the break, she needed surgery if she ever wanted to use her arm again. Even at 88 years, the surgery was successful, but reclaiming independence is tough. It’s even harder to keep you balance when you can’t use one arm. What about dressing, bathing, toileting, cooking? She has reminded all her daughters except Mary Rose, what we take for granted. Mary Rose already understood, she survived a stroke more than 10 years ago and has resumed a full life despite the difficulty of using the left side of her body.
Mom faced the options of assisted living versus 24 hour caregiver aides in her home. She wasn’t thrilled with either and these are tough choices. With assisted living you have more privacy, but lose your own surroundings and your own bed. With caregiver aides, you are in your own home and bed, but you lose your privacy. The aides are always there, even if you send them into another room and because it is a low wage job there is turnover, and different life styles. There was the aide who went outside to smoke every thirty minutes, the one who stole money, the one with unkempt hair, tattoos and a nose ring. But there were some wonderful and caring aides as well. Big adjustments to make when you are under the weather and need help you wish you didn’t need—more grief and loss.
Of course there is the driving issue. In our culture, where effective public transportation is a rarity, losing the keys is an affront to independence. As a physician, I have been the bad guy and taken car keys away from patients at the request of their children. Sure you can get on the agency van to go to the grocery, line-up transportation to take you to medical appointments, but you can’t come and go when and where you want. Less control and more patience. More grief and loss.
How do we make sense of these challenges? Several of George HW Bush’s eulogizers and pundits talked about the lubricant of his humor and how welcome it was during tough times and tough decisions. A friend’s mother with dementia was able to make fun of her forgetfulness. Some patients have the ability to laugh instead of cry at the changes and losses. Hurrah for humor!
A spiritual life helps. My aunt who played and taught the piano and guitar for years now has numbness, tingling, and burning in her fingers. It seems like cruel punishment to have lost the use of the body parts that were not only your livelihood, but also your joy. Because of her faith, she believes that she is earning her place in heaven through her suffering. A spiritual life helps find meaning in the unpalatable and plugs us into something greater that ourselves, and provides community.
Mindfulness helps. Focusing on the smalls joys that are available to us day in and day out helps. That means celebrating the everyday lights or “de-lights” that cross our paths. But we have to watch for them. I remember James Earl Jones celebrating the rising sun at the end of a movie about the horrors of apartheid in South Africa. Quite honestly, I have seen much more joy and happiness in cultures that have a lot less material wealth than we have in the US. For me that is one of the gifts of global work.
Family helps. Patients that have family geographically close who are engaged with the elder, checking in, providing transportation to doctor appointments, bringing meals, engaging him/her in family activities appear to avoid loneliness and isolation. As I was arranging the 24 hour caregiving for my mother, one of the aides said to me, “Where is her family?” Shame on me, I thought, I am a product of my culture having left Ohio again. While some families in the US do venerate family connections, many do not and children move for jobs and other opportunities. Today’s economy also requires the caregiving child, usually female, to have a job of her own. Of course, close family is not without its own complications.
Perhaps these are the lesson here. Aging is tough, not for sissies, but how we live our lives, how we celebrate the people who come and go along the way, how we celebrate the delights, and avoid taking ourselves or others to seriously are the tools for coping with the grief and loss of the long, winding and thorny road of growing old.