More of Being Mortal, being realistic, and being present

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Dispatches from the 148 by Fred Ryan & Nancy Hunt


Dispatches from the 148 by Fred Ryan & Nancy Hunt

Reader response to this column’s October 24th subject – “Being Mortal: Medicine & What Matters in the End” – was surprisingly positive and indicated that the subject of ageing is on the minds of many Pontiac people. One reason is our growing seniors population, and decline of youth, but their reactions show that a lot of people are transiting this near-end terrain, including those facing serious
illnesses. Maybe they always do, generation after generation.
The response from those in the trenches makes it clear there’s a lot more to say and consider. The subject isn’t death itself. The subject is the utter turmoil, everywhere, during these final stages of life, and why it is so helpful to connect with others. That’s a necessity, absolutely, within the families of anyone entering this territory. The subject touches our own eventual demise as well, which, most psychologists tells us, is much scarier than we admit. 
We can’t go into this as a family member, professional help, or as the
traveller him/herself by ignoring it, whistling in the dark as we pass the
graveyard. This graveyard won’t be passed.
From our readers, two big questions seem to face everyone in this period. Both have to be talked out by the families. The first was also a big part of the Being Mortal book: when should we try to fix, and when not?
The second is how can we best make life meaningful in old age? This is
new, and needs imagination and invention – “not just safety!”, we heard more than once.
Both come together in Gawande’s book thus: “people with serious illness have priorities besides simply prolonging their lives. (Question One)  Surveys find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not burdening others, and achieving a sense that their life is complete. (Question Two)”  Seeing a sense of purpose in life, apart from merely existing – there’s a challenge.
Question two covers the Western notion of warehousing seniors, for the convenience and efficiency of everyone except the seniors themselves. This needs more direct action, contact, and decision-making by the whole family, to substitute for the practicalities that “seniors’ homes” do provide.
Ageing with grace, seems to be the key, not ageing with resistance. This covers the big topic of control – giving up control, by one, and taking on control, by the family. Agreements are necessary and they seem to work best if one member is given the authority and obligation of control – of finances, contacting key people at each step, advocating for the patient, sending thank-you notes, all that. Even spiritual matters should be discussed – basically, who will talk about these things, positively, and within which guidelines?
Of the many suggestions, these were common:
– plan many family meetings, remember that everyone reacts differently and all forms of help are needed; families are minefields, tread carefully;
– agree to in-home handicap devices early;
– find a doctor with geriatric skills and interests willing to support independent living as long as feasible;
– pay attention, ourselves, to how we will want to live when we need help (not when it’s too late, chaotic and too emotional to talk);
– finances, savings, sharing expenses – and address the fear of poverty;
– choose a nursing home for its positives, not to free up a hospital bed;
– set schedules for visiting and helping out; plan with creativity;
– recognize that positive emotions and happiness can come with age, often; they don’t require activities, but more being, less doing;
– shift your focus and theirs to the here & now, to everyday pleasures, to the people around and to those our elder loves, asks about. Focus on companionships, routines, the quality of their food, especially flavour, warmth, privacy, and as much autonomy and personal respect as possible;
– talk to the medical people often. The medical system cannot replace the family’s involvement, but they should not be in conflict;
– pay attention, inside yourself, and to all that’s happening.  You’re travelling this road, too.