Uneven aging: Denial's gift and danger
Dad sat heavily on a delicate boudoir chair that could barely support his weight. We'd been touring an assisted living center, and were checking whether the bedroom had a nice view.
I was in denial about my father's health, so wondered if they really needed assisted living, which a friend was pushing. Mom cooked the chops he ate heartily, and he walked every day to the nearby library. But that afternoon, Dad was too tired to stand; he insisted it was just "a rocky night's sleep".
They did not move to assisted living. Dad was appalled by the meal hours (he would not eat dinner before 8 p.m.), Mom hated the canned music in the public areas, and both wanted to to spend time with their condo crowd, a convivial group they had known for twenty years.
Instead, they created a Floridian Potemkin village of vitality. Mom hid his medicine from view, ducked any topic that had to do with his health, and reported a social whirl of day trips and poolside cocktail parties. Friends never heard a word about illness.
My brother Denny and I entered into what's-really-going-on phone calls, because neither parent would admit that Dad was thinner each visit.
That facade reflected their stoicism, pride, wish for privacy, and the refusal to "be a bother". We lived with their denial until my brother, a doctor, saw that Dad was deteriorating rapidly. He told them to board the next flight home, where specialists familiar with Dad could treat him.
But someone fought that flight like a cornered wolverine—and it was Mom, the healthy partner. Who was going to pick up the new car mats? Who was going to hurricane-proof the windows? She just needed another week or two. Denny told her that even several days could mean a slide into critical condition, and with her reluctant assent, booked the tickets.
Denial—often borne of love, deep commitment and hope—can devolve into a negligence that is not so benign as benighted. But the apposite quality to summon at that time is courage, the ability to face things as they are.
Today's intervention: Type 2 medicine
The chart above, from in Atwul Gawande's book, "Being Mortal", shows how modern medicine (Type 2) tends to treat the chronic illnesses of ageing. The red line in the illustration looks like the last stretch of a roller-coaster ride and like all rides, there is an ultimate end. (Type 1 represents early medicine or the lack of modern healthcare.)
In Type 2, a significant health issue creates the first dip. When treated successfully, the slope is slowed by a period of recovery, a plateau. However, the afflicted person does not return to the initial level. Dr. Gawande explores the costs, both social and personal, of this slope.
The Type 2 curve illustrates the wisdom lost since graveyards were moved from their customary proximity to churches: get your affairs in order rather than deny what is happening. The roller coaster's gradual glide allows one to plan, to talk, and most of all, to love.
In the hands of his usual doctors (and longtime colleagues), Dad, though low on the Type 2 slope, recovered so dramatically that he convened a family reunion. We gathered in our home town, at a cottage where he enjoyed every child and grandchild, cob of sweet corn, and sip of bourbon and branch water. He was no longer evasive, and told me, "You play the hand you're dealt."
Several weeks later, he died in his sleep in the hospital whose clinic he had co-founded sixty years earlier.
My brother's and my denial initially served both parents, but once dropped, we could barely recall why we'd maintained it for so long.
Our mother came out of denial only when Dad entered the hospital for his last few days. After he died, she placed Dad's portrait on her dresser—not one taken when he was healthy, but one from that last reunion. Friends asked why she chose that instead of her husband in his handsome prime.
She said, "It reminds me it was time to let him go."
I was in denial about my father's health, so wondered if they really needed assisted living, which a friend was pushing. Mom cooked the chops he ate heartily, and he walked every day to the nearby library. But that afternoon, Dad was too tired to stand; he insisted it was just "a rocky night's sleep".
They did not move to assisted living. Dad was appalled by the meal hours (he would not eat dinner before 8 p.m.), Mom hated the canned music in the public areas, and both wanted to to spend time with their condo crowd, a convivial group they had known for twenty years.
Instead, they created a Floridian Potemkin village of vitality. Mom hid his medicine from view, ducked any topic that had to do with his health, and reported a social whirl of day trips and poolside cocktail parties. Friends never heard a word about illness.
My brother Denny and I entered into what's-really-going-on phone calls, because neither parent would admit that Dad was thinner each visit.
That facade reflected their stoicism, pride, wish for privacy, and the refusal to "be a bother". We lived with their denial until my brother, a doctor, saw that Dad was deteriorating rapidly. He told them to board the next flight home, where specialists familiar with Dad could treat him.
But someone fought that flight like a cornered wolverine—and it was Mom, the healthy partner. Who was going to pick up the new car mats? Who was going to hurricane-proof the windows? She just needed another week or two. Denny told her that even several days could mean a slide into critical condition, and with her reluctant assent, booked the tickets.
Denial—often borne of love, deep commitment and hope—can devolve into a negligence that is not so benign as benighted. But the apposite quality to summon at that time is courage, the ability to face things as they are.
Today's intervention: Type 2 medicine
In Type 2, a significant health issue creates the first dip. When treated successfully, the slope is slowed by a period of recovery, a plateau. However, the afflicted person does not return to the initial level. Dr. Gawande explores the costs, both social and personal, of this slope.
The Type 2 curve illustrates the wisdom lost since graveyards were moved from their customary proximity to churches: get your affairs in order rather than deny what is happening. The roller coaster's gradual glide allows one to plan, to talk, and most of all, to love.
In the hands of his usual doctors (and longtime colleagues), Dad, though low on the Type 2 slope, recovered so dramatically that he convened a family reunion. We gathered in our home town, at a cottage where he enjoyed every child and grandchild, cob of sweet corn, and sip of bourbon and branch water. He was no longer evasive, and told me, "You play the hand you're dealt."
Several weeks later, he died in his sleep in the hospital whose clinic he had co-founded sixty years earlier.
My brother's and my denial initially served both parents, but once dropped, we could barely recall why we'd maintained it for so long.
Our mother came out of denial only when Dad entered the hospital for his last few days. After he died, she placed Dad's portrait on her dresser—not one taken when he was healthy, but one from that last reunion. Friends asked why she chose that instead of her husband in his handsome prime.
She said, "It reminds me it was time to let him go."
Comments
It was not until she fell and broke her hip and I insisted she be evaluated that we understood what the poor man had been going through. He could no longer manage his terminal condition and her mental decline, and passed her care over to me, an only child.
The remaining years were difficult. We had to put mother in a Special Care Home and built a suite for him so I could manage his health. It took Dad quite a while to accept that she was not going to get better. And when he did accept it, he died, in his own bed, at home.
There was so much more we could have done to help them, had he only been honest with us early on.
Those days taught me some important lessons, and my husband and I, not "old" but aging, have an open and honest relationship with our daughter, hoping to make things easier for her should we need help.
LmC
On a slightly less grim aspect, I can't help but say bully to your dad to be refused to be infantilised by some of those assisted living places that want to feed elders at nursery hours and deny them some drinks and good food - and that is the ones one needs funds to access!
We need better solutions, including the right to die, but also the right to life as long as that is feasible and meaningful to the human in question. If I am demented, please kill me kindly.