Until I was 12 years old, I was lucky enough to have my great grandmother living right across the street. My Gramma always seemed very old in my estimation, although in actuality she was only in her mid 70's when she moved in with my aunt and uncle, and 85 when she died. But we spent lots of time together, watching her favorite stories on TV (General Hospital and Lawerence Welk), drinking Cokes and eating Fritos, and piecing quilt squares together. In addition to having this wise and wonderful old lady across the way, my maternal grandparents lived with us. So, I grew up with the elderly and I became quite familiar with the aging process. I only recall my Gramma becoming weaker and less energetic that last year of her life. She was often in bed when I'd dash over after school, and sometimes I would just sit in the chair beside her bed and read quietly while she slept. One day I came home to the news that she had fallen and broken a hip. Surgery was performed, but within a couple of days she developed pneumonia and died in her sleep.
"She was ready to go," I remember my mom saying through her tears. "Bless her heart, she was just all tired out from living."
Today, people who are "all tired out from living" have spawned their own cottage industry. Assisted living, memory loss neighborhoods, respite care, nursing homes - all euphemisms for warehousing the aged. My mother in law "lives" in such a place, and I place quotation marks around the word "lives" because I'm not sure that what she does qualifies as living, at least not the way I define it. She doesn't remember that she was married, that she raised a child, that she worked in a productive, responsible job. She recalls her mother- whose photograph she will bring to her lips and kiss - but she doesn't recall her own name, or her only son's, or her husband's, or mine. She's been "banned" from participating in the one activity she might enjoy (playing Bingo) because she becomes "adversarial" if she doesn't win.
I've just been conversing with my mother in law's physician (a young woman who sounds as if she's about 15 years old) and she tells me that recent test results indicate her creatinine levels are "alarmingly high," and her potassium levels are also "quite high."
"Normally a physician would be very concerned about this because it signals kidney failure," Dr. C. says. "I'm only telling you because I need to know how you'd like to proceed. With creatinine levels this high, we might start talking about dialysis. But considering her age and mental status, I'm not sure this is the direction you'd want to take. And the elevated potassium, if left unchecked, could lead to atrial fibrillation and heart failure."
(At this point, I press my finger to the ear opposite my cell phone because there's a cacophony of background noise on her end. Did I hear someone say "do you want fries with that?")
"Well," I say, taking a deep breath and looking over at my husband who is sitting at our dining room table on a business conference call of his own, "at this point we really aren't pursuing any course that will prolong her life. We basically just want to keep her as comfortable and pain free as possible."
Do you realize what I just said? I'm standing in my kitchen on a sunny spring morning, coffee cup in hand. My dogs are sniffing around the back yard. And I've virtually just pronounced a death sentence on my mother in law.
"I understand that," Dr. C. tells me. "I can document that you want me to check her potassium levels in three to six months and then go from there. If I check the potassium and it's dangerously elevated, we can do something as simple as providing medication to counteract it. Or you can decide to let nature takes it course. It's completely up to you."
Oh god. I speak enough "doctor" to know that she's asking me whether we should check her potassium levels at all or let her die a (semi) natural death.
At this point, I'm longing for the ease of a broken hip and pneumonia. How easy that would be.
Of course, it isn't really my decision to make. This is my husband's mother, every difficult, stubborn, pessimistic bone of her 90 pound body. She doesn't really belong to me - she never has. The two of us have absolutely nothing in common save our relationship with this man sitting at my dining room table talking to a fellow engineer about heat calculations.
"I need to talk to my husband about this," I tell the good doctor.
"Of course," she says again. "Just let me know how you'd like to proceed."
So here I am, plopped squarely in this brave new world of old age. It isn't anything like the old age of generations gone by, where the elderly tended to be cared for by one family member or another until they died. Oh no, it's much more complicated than that. Now we have "living wills" and "do not resuscitate orders" and hospice. We have to make "decisions about how we want to proceed."
My oh my, how life (and death) have changed in the last 40 years.
Of course, I'm not the only one in this predicament. It would take all my fingers and toes to count the number of people within my circle of acquaintance's who are currently dealing with similar problems.
Sometimes, I imagine myself in this situation at some point in the (hopefully) very distant future, when my son and daughter in law might have to make these same decisions. My worst fear is the loss of my mind, my ability to read, write, think, know what is going on in the world around me. Would I want to continue living in some institutional type environment, sucking up time and money to prolong my existence? Or would I advise them to "let me go" as peacefully and painlessly as possible?
And does one person really have the right to decide for another just when life is no longer worth living? But what do you do, how do you "proceed" when the person in question cannot decide for themselves?
When I talk to my husband about this, his reaction is basically what I've come to expect in regard to dealing with his mother. "I really can't handle this right now," he says, staring at me glassy eyed, the look that means "don't push me too far or I'll break."
I'm traveling through uncharted territory here, folks.
Wish me luck.