Allow Natural Death

Archive for June, 2011

Thank you, Susan Jacoby

A couple weeks ago I discovered a book that has been depressing me ever since. I am only about one third of the way through, but it’s never going to turn into a cheery read. I’m okay with that. As a matter of fact I love it. The book is Never Say Die by Susan Jacoby. It is an attack on our unreasonable denial of the realities of aging despite the lovely packaging that marketers have placed around our “golden years.” It is a learned and diligently researched account of how we have arrived at the manner of perceiving old age as we currently know it. As one reviewer put it, Jacoby reminds that “we all will die and most of us will get old first – not older but actually old.” Now do you see why I love it? Jacoby covers much of the same ground that I do, but with a broader view of how we got to this place where healthy practices of daily life will allow us to avoid all discomforts and indignities of aging. I have more to learn from this book and will keep you posted.

Jacoby’s book has reinforced what many who have read my own work have found the courage to say…this is depressing. Perhaps it is. To be reminded of our ultimate demise is indeed depressing and especially so if we have seen the truths I share here played out in the lives our loved ones. What is not depressing is to use the information in Jacoby’s book, and my own writings, to shape a more realistic plan for our end days. A plan that will allow for a shorter period of futile and painful efforts to prolong life while diminishing the quality of it. A plan that allows for a graceful acceptance of infirmity while finding enjoyment in what we can still give to life. A plan that will emphasize our desire for peace and dignity above all else. Sounds alot like allowing natural death doesn’t it?

Thanks, Susan.

The slippery slope of cane usage

There are two elders in my world  who are moving through their lives with growing unsteadiness. When I spend time with them I feel the same anxiety that I did when my children were learning to walk. I hover, trying to be inconspicuous while deluding myself that I really could catch them before harm came from a hard and unexpected landing. I breathe a sigh of relief when they get to where they are going and take a seat.  Unlike my children, when they finally do sit down elders (thankfully) stay put for awhile. But also unlike my children, if they do fall, it is almost certain that serious damage will be done. An elder body lacks the flexibility and elasticity of a younger one. Things that are old just break more easily and the resilience required to recover from injury is almost nil. The possibility of using an assistive device to aid mobility and prevent a fall  has been suggested to them both. Thus far their answer is “no.” But I am still trying hard to understand the reasoning for their refusals.

For one of these elders the idea of using a cane or a walker is something she admits would be helpful… but. “But it is too  hard to find it.” “But it won’t fit between the furniture.” “But I’ll be fine without it.” I try to be as kind as possible when I say, “it will be hard to feel sorry for you if you do fall and hurt yourself.” She says she understands. And I try not to bother her with too much haranguing…but.

The other unsteady elderly person in my life has an entirely different, and I must say unique, reasoning for his refusal to use a cane. “If I begin to use a cane then I will soon need a walker and soon after that I will need a wheelchair to get around.” Hmmmmm. I have to think about that a bit. At first I want to laugh. That’s absurd. A cane is used to prevent the need for a walker or a wheelchair. But maybe there is some truth to this. Because if a cane lends a little extra support to an unsteady elder, and that unsteady elder keeps walking because they haven’t fallen and done serious damage, then as they continue to age and weaken further, they will likely need a walker when more support is necessary. And to continue this way of thinking –  the walker will hopefully prevent fall injuries until further diminishing ability will make a wheelchair necessary. So I think I now understand the theory put forth that cane usage leads to a walkers…then a wheelchair. Because it is at that moment when a cane begins to be used that there is a symbolic admission that “old” is coming. Inevitable aspects of aging are embodied by a cane that alerts all who notice it that this person is no longer able to do what he or she once did with ease and alacrity…walk freely wherever and whenever they choose. Because it is true that  cane usage will not stop the progressive effects of aging from occurring.  Cane usage signals that we have admitted our descent down the slippery slope of aging…and none of us can stop it without dying first.

After more than twenty years working with elders in health care organizations I know how life changing a fall can be. It is the leading reason for a person to lose their right to live independently in their own home. It sends elders to nursing homes more often that any other cause. Returning to normal life after a fall injury is not even a part of the conversation for frail elders. Injuries from a fall can result in a cascade of further physical assault from resulting treatment; anesthesia, pain, medications and their many side effects, rehabilitation, infection –  that makes it the number one cause of death for those over 65 years of age.  This is an important fact to utilize when making a decision about whether or not to use a device to prevent falling. Falls are the leading cause of death for those over 65.  The risk increases exponentially with age. Falls = death for elders.

In order to keep our egos intact, we could forget those pesky canes, walkers, and wheelchairs that symbolize growing frailty. They are an advertisement to all that we are getting old. And we can’t have that. It would kill the elephant.

Courage my love.

************Click  here to read what the CDC says about falls.

…continuing the conversation with Mom

My mom had a cardiac stress test a week ago now. She says that she has felt a lot of fatigue since then and some itching all over her body. Oboy. Itching makes me think of allergy and I know she was injected with a chemical that is used to mimic/measure stress to her heart during the test. More than ever I believe that bodies must work hard to rid themselves of chemicals that don’t belong, and I am sure that is causing her fatigue. She hates it. She was already out of energy after little to no exertion for any number of reasons, but had enough gumption to get out and sit by my dad’s waterfall. She absolutely loves that. He has created an amazingly beautiful and grand waterfall and pond right outside the back door. Birds and chipmunks come and go and she tells me each day what exactly is happening out there. That is heaven for her.

I don’t even ask the questions and she has already volunteered,  “that was it. I’m not doing that again.” So there it is. We will see if the calls from her physician will change her mind or….off we go once again into the great unknown of advanced aging. She truly is amazing in her ways of coping with how life is now. I notice that the short term memory loss is a way to stop thinking of painful topics that come up and I am not one to bring her back to those things that remind her of how much she misses her youngest grandson. That would be cruel. Because it is the true heart ache of her life now. And then we recall the bird who while bathing gets caught up in the flow of the waterfall and down it goes until it is able to regain its bearings and get back to dry land…always good for a laugh, that one.

Thank you, god, for waterfalls and birds that are swept down them thus easing the pain in my mom’s heart and for memory loss that brings a new way of letting go.

I love you, mom.

asking the right questions

When I am trying to help people think about how they would like to spend the end of their lives, I find that asking good questions is really useful.  One way that the subject is first broached is this: I have heard more than a few elders state, “don’t ever send me to a nursing home.” Typically, whoever hears this says something like, “don’t worry, we would never do that.” But years or months later, situations change in ways that  no one taking part in this initial conversation could have foreseen. When it suddenly seems necessary to send an elder to a nursing home, it is almost always a tragedy. I have seen much long-lasting heart ache and family conflict lasting for years and years, when such decisions must be made. Because things happen after promises are made – promises that could not be well thought out when they were made simply because we can never know the exact path of our aging body and mind as it continues toward the time of our death. The when, where, why, and how of the inevitable end of our days can’t now be known. (I suppose it goes without saying that suicide is an option for those who would choose it, but that is an entirely different conversation.)

So how might the above conversation go differently? How about this: “Don’t ever send me to a nursing home,’ says the elder speaker. Then the listener(s) asks;

Mom, what would you like us to do when you aren’t able to make your own meals?

Dad, what should we do if you aren’t thinking straight?

What if you get unsteady on your feet and can’t walk very well?

Mom, will you be comfortable telling us when you need help keeping things going around the house?

Dad, would you consider coming to live with us at some point in the future?

The specific answers to these questions aren’t of great importance. It is most valuable that these new roads of possible futures are being thought about a bit by all members of this conversation. Nothing will get settled. Nothing really needs to if the conversation takes place BEFORE a crisis. It is good to begin the conversation with questions…never mind the answers.

Courage my love.

about last night….

Last night, I attended for the first time, a Book Club that included about 13 awesome local folks. It was so good for me to be around such thinking and thoughtful people. Today I get to smile each time I think of something that was said, about the book or anything else… Thanks everyone. I needed that. And thanks to my friend, Lisa, who was responsible for getting me there.

Last  night, I was also given an opportunity to give an elongated “elevator speech” about what I do. I am pretty sure that my words covered a lot of ground…maybe too much. I am so passionate about this work and believe truly that we must make it easier for end of life conversations to take place.  I believe that if we do that, much of the rest will take care of itself. We will already know what our loved ones want us to do when the time comes, because we will have heard it directly from them. And we in turn will have done the hard work of telling our loved ones what we want at the end of our lives. We will have learned to speak and listen in new ways.  Now if we can just get those in the systems where we receive our care to learn other ways to talk about the end of life too….

courage my love