“I want to thank you, Lord, for life and all that’s in it.
Thank you for the day and for the hour, and the minute.”
I had been in pain long enough. Multiple knee injuries (ACL, left knee) complicated by years of wear and tear were causing too much pain. The orthopedic surgeon entered the examination room to review the results of x-rays and an MRI. We were there to discuss options. He was blunt. “We don’t usually operate on people as old as you.” I was stunned, and for a moment I wanted to be an 18-year-old again and say, “Dude! Have you looked in the mirror recently? You’re like 70, and I’m too old?” That was more than five years ago and the surgery was a great success – despite my advanced age.
I also had the recent experience of hearing some members of my extended family describe how much I remind them of my maternal grandfather. Apparently the way I walk and some of my physical characteristics offer quite a resemblance. He died when I was in preschool, so I never really knew him. Just a few faint memories remain with me. I was honored to hear this since I know how much he is admired in my family, until it dawned on me that I was being told, “You look like your grandfather!” Maybe a few more sit-ups will help. And I’ve seen Rogaine sold in large containers. Does it come in a 55-gallon drum?
It seems the middle of life brings us to a threshold; a kind of liminal space where we become too old for some things and see before us the challenges of aging that are inevitable. We care for the young and the old at the same time. This hit me hard when I spent several days in Pennsylvania recently to be with my Mom. She is 85 now and has lived without my Dad for the past 16 years. A stroke took him in his sleep.
Mom has a range of medical challenges and I have watched as her quality of life has eroded. She endures a great deal of pain, sleeps very little, and is finding it hard to eat. Her doctor described this situation gently by noting that she is in a very “fragile” state of health. The retirement community she has resided in for many years is a gift and now that she has entered the wing that provides “skilled care,” the decisions ahead become more complicated. Like many elderly individuals, she has a living will that outlines her wishes for “end of life” scenarios. This brings our family some comfort, but my last visit with her was an in-your-face experience of the realities represented in that document.
The intellectual dimensions are simple. The instructions are clear regarding the interventions she will allow and those she will not. I was asked on several occasions to confirm this with her doctors and remained steadfast in ensuring that her wishes will be followed. But the emotional dimensions are far more complicated. As I joined my siblings in the hospital room at her bedside I sat next to Mom and offered a few funny remarks that brought a faint smile to her face. It made me think that she is far from ready to die. Yet the next morning I had occasion to sit with her quietly for several hours. I witnessed the pain she is experiencing as I held her hands while she faded in and out of sleep. I could only hope in that moment that all this would end, and that became my prayer.
A dedicated medical staff provided superb care, and to our amazement she responded to treatment and her condition improved. Her pain was being better managed and her breathing and body relaxed. After a week-long stay in the hospital, she returned to the small place she now calls home. It has become a haven of rest for her.
We have all returned to our everyday routine, but lingering in my mind are the images of that hospital and the knowledge that one day a similar scenario will play out as the end of her life approaches. I remember a comment she once made reflecting on her mother’s death, “It doesn’t matter how old you get, there is just something about the death of a mother (or a father) you never get over. There is no longer anyone ahead of you.”
And so the cycle of life continues. We revel in the innocence of the very young as we come to revere the courage of the very old.
According to the Administration on Aging in the US Department of Health and Human Services,
The older population–persons 65 years or older–numbered 39.6 million in 2009 (the latest year for which data is available). They represented 12.9% of the U.S. population, about one in every eight Americans. By 2030, there will be about 72.1 million older persons, more than twice their number in 2000. People 65+ represented 12.4% of the population in the year 2000 but are expected to grow to be 19% of the population by 2030. (www.aoa.gov)
Our society is in for a big wake-up call and I don’t think we are ready. Life expectancy is increasing as the population of older adults is expanding. There are challenges coming to our health care system, economic implications from major changes in the workforce, and an infrastructure insufficient to meet the coming demand for support services.
We also have many families ill-prepared to meet the challenges of aging loved ones and provide the needed care. Care givers often suffer along with the infirmed as already complicated lives spin out of control with needs that overwhelm the best of families. The consequences can be tragic as the collateral effects bring stress that severs familial relationships.
On the day I returned to Iowa, I sat with my family as our Mom slept quietly. We had a deep conversation about the next steps. I have the comfort of knowing that we are all in agreement about these final stages, and we are confident of the quality of care she is receiving. My hope is that our story is the story of every family. As I look around me, however, I can’t help but wonder . . .
Are we doing enough?