Facing old age and mortality
“I grow old ... I grow old ...
I shall wear the bottoms of my trousers rolled.
Shall I part my hair behind? Do I dare to eat a peach?
I shall wear white flannel trousers, and walk upon the beach.
I have heard the mermaids singing, each to each.
I do not think that they will sing to me”—T.S. Elliot
I just completed Atul Gawande’s best selling book—“Being Mortal”. It’s a lyrical work that shares the struggles of older and terminally ill adults facing the final chapter of their lives. Dr. Gawande, a surgeon, shares his perspective as a physician often called to perform surgery on patients who are at the end of their lives. But the most moving part of his book is about his father’s final months. His story reminded me of my own.
I had the privilege of sharing both of my parents last days. My father contracted lung cancer at 87. He chose to forego treatment, wanting to have as much quality of life as possible. He lived in New York City and for a year I flew to NY every month and spent a weekend with him, sharing his final days. I was with him for his last two weeks of life, in a nursing home, providing comfort. Several years later, I was able to do the same for my mother. She told one of her aides that she didn’t want to die while I was present. She passed away two days after I left. Always my mom, she wanted to spare me the pain of her final moments.
Their endings taught me a great deal. They were courageous in the face of death, frightened, but able to retain their dignity and control over their care. My brother and I helped them, but they were able to issue orders to us even as they grew more frail and helpless. We were wise enough to do whatever they chose, no matter how painful it was to us. When my mother was in the hospital, she wanted the breathing tube removed. She didn’t want to end her days in the ICU. My brother and I insisted that they remove the ventilator tube. We held her hand, as she gasped for breath, hoping that this would not be her end. It was one of the hardest moments in my life. But we understood our mother’s wishes. Fortunately, she had a couple of months more.
Retaining our dignity in our later years is a challenge. The loss of function can occur slowly or quickly. A fall can bring a broken hip and weeks in a rehab facility. The nuts and bolts of our insides start to fall out of our engines a few at a time. Some can be replaced, but many can’t. Fortunately, human beings are the ultimate adaptable species. We can get used too most anything, given enough time and patience. But as we age, our ability to cope with change lessens. It’s hard to imagine moving—from our own home, to a retirement community or assisted living—even when we can no longer manage on our own.
It’s important to discuss these issues with your children and your parents. These conversations can be awkward and difficult to initiate. I have explained to my youngest daughter, my health care proxy, what life sustaining measures I would want and which measures I wouldn’t wish to take. I know that she and her sister will follow my wishes when that day arrives.
Talk to your parents and ask them what’s important to them when they come to the natural end of their lives. What are their values and beliefs? What do they want you to do? What about when they need more help? What role do they want you to take?
I hope to have the same courage that my parent’s showed at the end of their lives. They set a high bar for their wisdom and their willingness to face the inevitable.