Dr. Atul Gawande

Aging Autonomously

One evening last week, a neighbor came by and dropped off this book. “After I read your post about caring for your Mom,” she told me, “I thought you might find this interesting.” 

It’s a book that’s been on my reading list ever since I read this article in the New Yorker a few weeks back. Dr. Gawande is initiating an important discussion for those of us caring for aging parents, and for those of us facing old age in the not-too-distant future. It’s a discussion about the limitations and failures of modern medicine as we know it in geriatric care, and why sometimes the quest for quantity of life impedes the ability to foster quality of life instead. 

My neighbor remarked that, since both of her adult children lived in different states, she and her husband were aware that a time would come when they would most likely need to move to be near one of them. “But then, we realize you can’t be chasing your children,” she admitted. “People don’t stay in one place for decades and decades now - not like we did when we were young."

Being in the same circumstances, we too have given that situation some thought. Recalling how much assistance my elderly relatives have needed in their final years, it occurs to us that we should be planning for that eventuality. Still, I can’t help but think about one of my former neighbors, an elderly couple who had lived in their home in Redford for 50 years. All their children lived in mid-Ohio, and, after much urging from the adult children, this couple decided to move to Ohio  so they “wouldn’t have to depend on the neighbors to help them.” I have never forgotten how bereft my neighbor was after the move, how he called me on several occasions and spoke of how much he “hated” it there, how he was “coming back to Redford” and was going to “buy his house back.” Within two years, both he and his wife were dead. It hurts me to know those last two years of his life were such unhappy ones for him. 

I was talking to my son on the phone the other night, and I jokingly made a comment that’s haunted me a ever since. “Take care of yourself,” I told him, “you know I’m counting on you to be around to take care of me when I’m old."

It’s a mark of how much this caretaking thing is on my mind, that in the midst of a conversation that was mostly about my son and his current stresses and strains, I would think of a scenario which is - I hope - many years in the offing. And the ironic thing is  that I have never consciously “counted on him” to take care of me. On the contrary, my thoughts on the subject gravitate to insuring my independence as long as is humanly possible. The last thing I ever want is to need him in that way. 

Thanks to the wonders of modern medicine, we live longer lives, if not always better ones. So how do we prepare for the possible infirmities that propel us into dependency? The best offense is a good defense, I think. It’s finding appropriate housing and support services before you really need them, not waiting until memory lapses, poor reflexes, or failing joints and organs force a need for assistance with the business of daily living. There are more options for those services than there were in the past, and more keep cropping up all the time. A huge market is opening up in the field of services for the aging, as those of us born post WWII begin to get old in droves. They aren’t cheap, of course. What will they cost in another 20 years? God only knows. 

But autonomy -at least to me - is priceless. It’s about more than being able to drive yourself to the market or take your medications on time. It’s about having the wherewithal to be in charge of what happens to you. As the body ages, there is so much that is completely out of our control, no matter how well we’ve followed the advice of all those healthy living experts out there. (Just the other morning I shifted position while reading in bed and I was horrified to notice how the skin on my inner arms looked as wrinkled as an alligator. This despite years of smoothing moisturizing creams and lotions on them every morning and evening.)

Give me the ability to have some freedom of choice about how and where I spend my final years. “Whatever the limits and travails we face,” Dr. Gawande writes, “we want to retain the autonomy - the freedom - to be the authors of our lives. This is the very marrow of being human.” I’ve shepherded a lot of people through old age and into death, and each one of these dearly beloveds have been my teacher. In my heart I believe they were entrusted to me for a reason - so that I might one day have the foreknowledge to be the “author of my life” in a more meaningful way than they did.