Cast me not away in my old age

Every year we recite Kaddish for our parents – also for friends who have died without someone to say it for them. We recall their hopes and dreams, and what they meant to us. We reflect on how they died – not from what diseases, but the process by which they came to the end of their lives. Not always pretty.

This year, I celebrated my 75th birthday. I am older than many of my close relatives and friends were when they died. Our generation, beneficiaries of medical advances our parents could only wish for, however, has yet to discover a way to close off our lives.

Both my husband and I had widowed grandmothers living with us. Few people contemplated tucking their parents away in a “home.” Children were supposed to take care of parents. That is no longer the assumption. Despite good intentions, finding an “appropriate level of care” in an institution has shifted the traditional way of caring for the aging from a personal to an institutional one.

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So, when a dear friend (thank you, G.Y.) told us to read Being Mortal: Medicine and What Matters in the End by Dr. Atul Gawande, it opened up the conversation on a completely new level.

I really, really want this man to be my doctor when I get to the stage of needing help. Failing that, the lessons learned from his book will certainly be incorporated into whatever decisions our family makes when the time comes.

Gawande describes the history of the nursing home, now called assisted living or long-term care facility, euphemisms for what is in essence a place where we go to live out our time once we can (supposedly) no longer “manage on our own.”

I do not denigrate these facilities; they can be light and airy places with trained staff and caring professionals. But, Gawande points out, too often they are run on a schedule and with expectations that emphasize safety, routine and top-down management of the residents. Too often, residents have little say as to what would make their lives truly livable.

What do we want out of the end of our lives? When we are creaky but still well, ask us what would make us happy, not just safe. When we are dying, help us to manage that.

The rise of hospice has been a great boon, although that option will soon be overwhelmed by the boomer bulge. Home care? Again, public resources are just not there to meet the needs.

These are topics Gawande addresses, giving brave examples from his own life as well as from those of some of his patients. And here I give a shout-out to the nurse practitioner (in the chapter “Hard Conversations”), a newer art that we should hope will be part of future health care at many levels.

One of the great temptations as we near the end is to hope medical science will somehow see us through, that there is always another treatment, remedy, pill, that will cure, or at least mediate, our disease. Recall that I said we have treatments that our parents could only dream of.

But maybe there is a wiser way.

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Gawande writes: “if to be human is to be limited, then the role of caring professions and institutions… ought to be aiding people in their struggle with these limits. Sometimes we can offer a cure, sometimes a salve, sometimes not even that. But whatever we can offer, our interventions and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life. When we forget that, the suffering we inflict can be barbaric. When we remember it, the good we do can be breathtaking.”

We pray: “Cast me not away in my old age.” I pray that our own community will take to heart the lessons of this book, sift its messages and hear its wisdom.