November 9, 2015
I’m just back from a trip to Georgia with Cozy and Andrea. I was invited to do a presentation to the Georgia Association of Criminal Defense Lawyers on hate crime. The trip also doubled as an opportunity to introduce my wife and child to the places where I grew up. Anyone who knows Atlanta knows that you can leave it for five minutes and come back to a completely different city. To be from that area means you have to be willing to let go of the things you loved. Those great woods I rode bikes in in Stone Mountain have been five different shopping plazas since then. That historic bar in Poncey-Highland is being bulldozed for condos. Just let it go. At some point all of us are dust.
I flew out a few days early with Cozy since Andrea was working at the law firm. Yes, I flew across the entire country with a toddler by myself. The reason for this insane act was the chance to spend some extra time with my father who recently had some pretty epic back surgery and is looking at six months of recovery. He had’t met his granddaughter yet (or Andrea) and who knew when I’d next be heading to Georgia.
It was a great meeting, even if Cozy was a little unsure of who this guy was who looked a lot like me. (The irony was that the first seconds after Cozy’s birth I thought how much she looked like my father, but then all newborns sort of look like old men.) Cozy and Dad did high fives and stared at each other a lot and I thought about this genetic connection that links over 70 years before it blasts backwards into time.
But the whole thing transpired not at my dad’s home in Alpharetta but at the recovery center in Marietta, where he is doing rehab from the surgery. It doubles as an assisted living center for elderly medical patients which meant the place reflected the best in geriatric medical care and the worst in what we do to the senior members of our families. While not a hospice, my dad was sharing the space with folks who probably didn’t have that much time left to live.
It’s now common knowledge that 30% of our medical expenditures go to end of life care. We spend billions each year to keep our grandparents alive for just a few weeks more. Why? Is it for them? For us? For the pharmaceutical industry? We ship our seniors off to cold care facilities where they share rooms with other old-timers and we bill the insurance companies to pay for staff that treat them as humanely as possible until they drop dead (well you don’t drop in a bed hooked up to machines) and the next old-timer can be moved in to wait for the Grim Reaper. It’s quite bizarre when you think about it.
Other cultures bring their elderly close in to garner as much wisdom from them while they are still on this earth. We warehouse our aged far out of sight in nursing homes so we don’t have to witness the reality of our own eventual fate. I don’t know what’s to blame for this: patriarchy (Goddess cultures generally revere the elderly), capitalism (“eldercare” is a booming industry), or just our own stubborn refusal to acknowledge the we are not here forever.
It’s a uniquely American problem. (USA! USA!) Andrea’s grandmother lives in a village in Mexico surrounded by five of her eleven children. Her wit and wisdom are a part of their lives. Grandchildren come to help fix things and keep her company and great-grandchildren run around her wheelchair (and she sneaks some of them beer). It’s so different from the great charade we play with our elders. Dying at home? How barbaric!
So it was really hard to see my dad in this setting. He’s only 73, the same age as Mick Jagger and the eternally touring Paul McCartney. Folks in my family live well into their 90s, and that was before people discovered that you shouldn’t have lard as a primary component of your diet. So Dad has at least a few more decades to share with us. If this was 300 years ago, he would be Methusala, but the life expectancy in this country keeps expanding. There are plenty of centenarions down at the Zumba class these days.
My dad will get better and be back on the golf course in no time. I took him skydiving for his 70th birthday and I want to take him diving with sharks for his 80th. But being in the setting of good folks who are just watching the clock to death really shook me. What happens when I hit that age? Am I going to spend my last days drooling and watching Wheel of Fortune? I can do that now!
It reminded me of one of my favorite poems by Liverpudlian Roger McGough called, “Let Me Die a Young Man’s Death.” Here’s a stanza:
When I’m 73 & in constant good tumor
May I be mowed down at dawn
By a bright red sportscar
On my way home from an all night party
I’m ready to stick around as long as possible but there are only so many trips around the sun left. When Cozy graduates from high school, I’ll be 68! (I’m going to encourage her to skip a few grades.) When I’m my dad’s age she’ll only be 23 and facing the issue of an aging parent that so many of us are now dealing with. (C’mon fetal stem cell research!) Hopefully, I’ll be the old wise man of the village with lots of kids on my lap and not in some sad “managed care facility.” When I go, let me die in my footsteps.
My mother likes to say, “When I get that old, just shoot me.” While I’m not willing to go to prison for homicide, it does make you think it would be so much better to go out in a blaze of glory than peeing on yourself in a hospital bed. Let me die a youthful death. I’m going for moshpit mishap at 98.
great post Randy! I decided to bring my mom back from Atlanta to live with me here in Spokane. It is both tough and satisfying having a 73 yo Sicilian woman in my home.
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Randy,
Having worked several years ago for the Nursing Home industry, I can tell you I saw three kinds of situations in Alabama’s 122 nursing homes:
1. Guilt/Denial- families placing loved ones there and not visiting out of guilt. The minority of cases.
2. Skilled Nursing Required- the last place a family wanted to take a loved one, but they weren’t capable of providing skilled nursing care that the loved one required in their last days. For frail elderly patients, families run the risk of accusations of neglect if direct nursing care is not provided. Not many families are equipped to provide catheter, dialysis, nasal feeding tubes, etc. If the patient is an Alzheimer’s “runner, ” you better get them into a facility and FAST before they get out and injured. Again neglect accusations of you don’t . (BTW This was the majority of situations I saw in AL….frail health needs requiring placement.)
3. Persons of many ages with no family or other place to go. These were usually misplaced MI or the mentally challenged of all ages who had no family. Again, by no means the majority of the nh population.
Before painting the situation with a broad brush, please know that this industry, like the criminal defense profession, is one that no one likes UNTIL they are needed. There are many excellent facilities, but like criminal defense lawyers, you have to shop for the best service, for those who are willing to treat their patients with dignity and care. In AL there has been a moratorium on nursing home beds since the Wallace Administration which translates into “long waiting lists.”
Just wanted to state the reality of the field I worked in. There are a lot of public misconceptions about placement and the issues of long term care.
Sadly the Silver Tsunami of boomers is heading to an industry that is ill prepared to handle the case load here because of bed shortages. Medicare and Medicaid won’t be able to handle the numbers.
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Thanks for this. And all the people I have met in this industry have been really great. Culturally, it’s just weird, if you know what I mean.
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i plan on dying in my own bed. i have besides the usual legal paper saying do not apply breathing stuff. mine is very specific, no hospital, if it can’t be fixed in e.r. take me home. no tubes or shots of any kind except for pain. i have a 35 year old granddaughter that has signed a legal paper stating all this. i am sure she will honor it. you see from hospital it is a “hospice for you to linger forever. whether it is legal or not , i don’t know. but i know she will fight tooth and nail to see my wishes are honored. i was in one of those places for a month and thank you but no thank you. not for this old gal. anyway i can avoid this i will.
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I appreciate this post and your writing, Randy. Collecting stories of folks who live alone, I’m learning how twisted things are around the world when it comes to isolation & missing communities, lack of access to affordable groceries… a mess. I dream of a world where SNFs are vanquished. And elders deserve way more attention, conversation, and connection than the 1-2x/week visits from home health workers.
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I believe the cycle of life is aided through the empowerment and inclusion of all our citizens, specifically our elders. And on a side note, my friends can tell you, when it is close to my time, I’m skydiving w/o chute while targeting my hurling body for the corporate office of Bank of America.
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Lovely writing. Having seen both sides of the story with my parents, it is hard. Hard choices and hard to live through.
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I am studying dying in this country in preparation to do death midwife work and family bereavement support work in hospice settings. The book ‘Being Mortal’ by Atul Gawande is a great study on how we got to where we are around how we treat our elders in this country. The author is an MD, so has a unique perspective, from the inside, of the ‘hero’ model that makes it so hard for medical professionals to stop trying everything at all costs at the expense of any quality of remaining life to patients that are dying. I highly recommend it!
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