Tuesday, March 21, 2006

A Fate Worse than Death

A fate worse than death - I remember this cliché from my childhood - it connotes some horrible suffering, in that death would be the ultimate misery, so this fate alluded to must be worse.  

We all want to live long, but we don’t want to get old.  Or, in the baby boomer generation, we are even more concerned with not looking old.  It’s so ironic that we diligently exercise and watch our diets, some of us anyway, hoping against hope that we can extend our youth - perhaps stretch our forties another ten years.  Then we start to consider “having some work done” whereby we look like sixty year olds with face-lifts.  I saw a woman in the grocery checkout line, obviously a wealthy woman from her dress and her jewelry.  She had a sleek reddish pageboy hairstyle and the windswept smooth complexion that women with face-lifts have.  She was slim and well dressed, but looked strange nonetheless.  She was probably around 70, which is not old really, but her hair and her face were attempts to stay in her forties.  

My Dad recently celebrated his 96th birthday.  Now that is unabashedly old.  No more senior citizen, no more sugar coating.  96 is getting up there.  Still, there are those who are so amazing.  Right here in our community, there is a 96-year old woman who plays golf every day.  A TV station did a segment on her, and she was as alert and agile as a person many years younger.  No cosmetic surgery for this gal!  She was proud of her age, and lucky to live a full and active life.

But what about those who have not been so lucky?  Age is not always kind.  People, even in midlife are struck down by disabilities.  When a person gets past 85, the chances of their being able to live the life they lived in the past is greatly diminished due to physical or mental impairment.  This is where the gray clouds start to blow over old age.  How do they cope with the inevitable losses, and we aren’t talking about a few extra pounds, or an earlier bedtime here.  How do people live when they are disabled by old age?  They enter into the system.

The system is a dirty little secret, known only to the elderly, the disabled and those who love them.  The system is comprised of hospitals, skilled nursing facilities (“nursing homes” to a lay person), assisted living facilities (and all euphemisms marketing departments can come up with).  Being placed in assisted living or a nursing home is no one’s idea of aging gracefully.  Few will move into long term residential care voluntarily.

Why, in a country where we enjoy arguably the highest standard of living on the planet, is our treatment of our elders so bad?   We warehouse people in long-term care facilities, provide the residents minimal care and pay the people who actually provide the direct care a pittance.  It is a downward spiral for the frail elder, despite perhaps decades invested in trying to live a long life.  This is the payoff, a bitter pill.  They are confused and frightened surrounded by a chaotic environment full of many marginally educated people, often recent immigrants, who would be considered the working poor.  Low pay and other operational difficulties in facilities result in constant turnover, poor communication, mistakes and general lack of personal attention.  None of this nurtures the elder, or is even a pathetic substitute for a home life.  It is a result of a watchful eye on the bottom line by an administrator or corporate parent who has cultivated “disassociation”.  There are some exceptions, some caring wonderful people involved in facilities, and more power to them, very literally.  

We need to re-write this final chapter in people’s lives.  We baby boomers may have a better handle on why this can occur in our country.  We understand the goals of corporate America, and those who look to corporate America as their business model.  Their mantra - lower operating costs, maximize profit and shareholder return.  But this isn’t manufacturing widgets; this is people’s lives, the frail and the disabled.     We understand that employers are getting killed over Workers’ Comp and liability insurance.  We understand that “there are some jobs Americans don’t want” as our illustrious president George Bush said recently.  We understand the disparity between the salaries of people who sit in meetings all day and the people who are changing a diaper at midnight on a Saturday on a long weekend.  Let’s upgrade the salaries, educational opportunities, benefits and working conditions of these direct care jobs, lower profits and executive compensation, and then see if the standards of care are raised.

What else, besides pay the bottom-rung employees more, can we do to make it right?  Or will moving into a nursing home remain, 30, 40 years from now, a fate worse than death?

Monday, February 20, 2006

Mother's Birthday

I was never close to my Mother, in fact for many years, I would have said I hated her.  I guess hating your mother as an adolescent was probably not unusual, especially in the 1960’s considering the parenting styles of the day.  She was very strict and repressive, trying to raise me in a bygone era.  She tried to keep me a child in a decade that was characterized by radical social change.  I remember being quite young, under ten - she made me wear a scrunchy navy blue velvet hat to church.  I remember it so distinctly; I hated that thing.  None of my friends had to wear a hat.  She thought it was elegant or British or some such.  Church was a just a formality anyway, a social obligation; we went because it was the thing to do.  My Mother was oh so very concerned with what people would say or think, so keeping up appearances was her driving force
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I also remember when I was quite young that she tried to get me to curtsy to visitors when they came to our house.  That was really over the top, and even as a small kid, I knew it.  We had a lovely home, and she did a great job with entertaining my Dad’s colleagues at the bank where he worked, but this was 1960’s suburban New York not Windsor Castle.

She fancied herself to be British upper class I guess.  This was vaguely her heritage, via Nova Scotia, Canada where she was born raised.  As my cousin Bette, now 77 put it, she wanted to be much more than a fisherman’s daughter.  Bette said that “back home” when they were both much younger, my Mother’s nickname was “the duchess”.  Did not carry a lot of weight with me, in the 1950’s and 1960’s in Long Island.

As a teenager, I was not to wear makeup or God forbid have anything to do with boys.  I was not one of the popular girls, but these arbitrary restrictions made me feel worse.  I had no idea how to be anything but a smart underachiever, chubby, nearsighted, confused and as they said about kids at the time “emotionally disturbed”.  It wasn’t until I was about 16 or 17 that I began to realize that I had some pretty serious problem at home.  I guess before that I was just chronically depressed about my home life.  My parents fought all the time, and my Mother and I fought all the time.  It was my normal life on the inside, although we seemed quite proper from the outside.  

During these years, I guess my Mother read all kinds of horrible things in the paper about kids doing drugs. For years she terrorized me, going through my purse and my things, listening in on my phone conversations trying to figure out what I was up to.  If I nicked my leg with the razor, she would harass me for shooting drugs.  I must have been a terrible disappointment, because I was truly up to nothing during those years.  I was not a mature teenager with all the problems at home.  This paranoia was also reflected in her behavior toward my Dad - she thought he was trying to poison her.  She hid her medication up in the attic so he wouldn’t get to it.  She also was convinced he was seeing another woman.  I remember her dialing the phone one time to a woman named “Margie” and trying to get me to ask for my Father.  

I now recognize all these less than wonderful memories of my Mother as undiagnosed, untreated mental illness.  

At 17, I escaped home for college, far away from home.  I blew this opportunity big time, but that is another story.   Getting away from my parents was the only goal I had.   After a couple more colleges, I traveled a bit in the States and across Canada, and moved to Hawaii.  My disdain for family life was a huge motivator in my youth. Combine this lack of desire to marry and start a family with the tumultuous times in the late 1960’s and early 1970’s, led me to be quite the maverick.   Meanwhile, my parents left suburban NY when my Dad retired from Wall Street, and they moved to Lynchburg, Virginia, home of Jerry Falwell and what was then called the Moral Majority.  Meanwhile I had become a hippie.  My parents and I were on cordial yet distant terms for most of the 1970’s.

I met my ex-husband in the early 1980’s while still living in Hawaii. I had re-joined the straight world, at least superficially, and cultivated an adult-to-adult relationship with my parents.  I put the past behind me, and did not look back with regard to my relationship with my Mother.   I was preoccupied with a whole new set of problems, as I delved into the grown up world of work and relationships.  

When my ex and I moved to Southern California in 1983, my parents decided in 1984 to move here to be closer to us.   My Mother did not look well to me, although she tried to be enthusiastic about the move.  She had sold some of her antique collection when they moved from Virginia.  She was proud that she could make a financial contribution, since the California house they bought was more expensive than the Virginia house they sold.  

They were here only a few months when my Mother discovered a lump about the size of an almond on her neck.  Our lives changed in one day.  The diagnosis was metastatic melanoma.  She died in seven months, in October of 1985.  She was 75, I was 35.  It was relatively quick, but not painless.  Losing someone to cancer is awful - the chemo, the morphine, I was relieved that she did not linger like some cancer patients, whose families I spoke with during our many doctor visits and trips to the emergency room.

So I had no real chance to find closure to my childhood “issues” as we euphemistically call them today.  I’ve been told that just moving on is not quite the same as healing.  She would have been 96 today, the same age as my Dad will be in a few weeks.  Despite his frailty, the dementia, deafness and his own mental health challenges, he’s outlived her by 20 years.  

I often think how I would have handled her care if it had been she who outlived him.  My Dad and I have many differences, but somehow we have always managed in the balance sheet of relationships.  My Mother, different story.  Maybe it can be chalked up to classic mother/daughter conflicts, but we never seemed to have the closeness that some of my girlfriends have shared with their Moms, her delusions just didn’t allow healthy relationships.  

From my Mother, I got my sense of style, my creativity, and my tendency to criticize.   I look in the mirror and see that as I age, I resemble her more, especially when I’m annoyed.  She was not a happy person.  I share some of her talents, and some of her frustrations.  But I am a different generation, a different gene pool.  And oh, yes, I didn’t become a mother.

Monday, January 16, 2006

Driving in Snow

It’s January and the only real sign of winter here in San Diego is frost on the lawn and the rooftops. We aren’t even getting much rain this year.  It’s been unseasonably warm, and we chuckle that this is why we pay the big bucks to live here.  According to CNN, much of the country is freezing cold.  Born and raised in NY, I spent 21 years in a four-season climate.  For reasons that I now recognize as lack of confidence and low self-esteem, I didn’t get my driver’s license in high school.  I took drivers’ education but never took the test.  This was no small inconvenience in my early twenties, but back in the day, I was a hitchhiker, as they say, through the galaxy of my early adventures cross-country in the US, Canada and in Hawaii.  I also managed on the “loser cruiser” the bus.  It didn’t seem to hold me back a great deal, but those alternative modes of transportation required the tolerance of youth.

In the late 1970’s when I was about 28, due to some boyfriend crisis, I went back to Lynchburg, Virginia where my parents were living in their first retirement.  I had matured enough or somehow the planets aligned so that I took a driving school class and actually got my license.  Virginia does get some snow and I do recall my several-months-long visit was during the winter, but the weather there is much more moderate than the northeast.  So I got a pass on learning this advanced driving skill, and went back to Hawaii, where I lived until 1982.

Watching CNN this morning, Martin Luther King Day 2006, where the temperature is hovering at 0 degrees in NY, I try to imagine myself handling a regular life in that sort of climate.  After ten years in Hawaii and almost 24 years in San Diego, despite developing personal strengths in various ways, I am admittedly a wuss in the weather department.   I find myself reordering my schedule here when it rains!  Partly that is because people in Southern California, just like me, don’t now how to drive even in the rain, and there are hundreds of accidents.  

Seems like driving on ice is a metaphor for life, sitting behind the wheel with white knuckles, moving forward fast and feeling out of control.   I find driving is a sort of a laboratory for other emotional states - it is a real opportunity to learn detachment, and not to take things personally.  I constantly remind myself that other drivers aren’t doing things “to me”.  Even on a good day, hard to come by, even in sunny Southern California, driving is another less than welcome opportunity to develop patience.  

As I get older, I find myself “tsk-tsk-ing” at the kids today.  Many of the younger drivers seem so rude and aggressive and clearly possess the youthful feeling that they are indestructible.  Not to mention the all important cell phone conversations that hold their attention, rather than the road.  I’m glad I was not self-centered and irresponsible in my youth!

Since I live in a 55+ senior community, I also see a number of elders who should no longer be on the road.  For this population, driving equals living independently, which understandably, they cling to fiercely.

At 56, my biggest fear of death is around car accidents.  I don’t obsess over it, but it is much higher on my “worry list” than getting sick.  I guess I feel I have some control over my health because I live a health conscious lifestyle.  I’m a careful driver, not a perfect one, but I don’t drink and drive, I am cautious about night driving, since it has been compromised after LASIK eye surgery.  I use candy, gum and music as distractions in traffic, not my cell phone.  I try not to drive when I’m very tired although this is increasingly an issue with me, as middle-aged insomnia has become normal.

Instead of driving in snow, I will get in the car this morning, and drive through a massive road improvement project in my area.  This is a three-year much hated disruption.  The freeway here in suburban, cookie cutter San Diego looks like the Bronx or a war zone.  There is heavy equipment all along the shoulders, or what used to be the shoulder.  Now the borders of the freeway and ramps are temporary concrete and orange plastic barricades that seem to shift overnight into new configurations.  So much for control.  The population explosion here over the last few years I can’t control either, making me take a hard look into moving somewhere else.  Which brings me back to the topic of weather.  Life in the Sunbelt seems to attract us like moths to the flame.  So I’m driving in snow now metaphorically, moving fast and feeling out of control, into the unknown future.

Friday, January 06, 2006

My Two Old Boys

A girlfriend recently sent around an e-mail asking three of us if we wanted to have a garage sale.  I replied that I had a 95-year-old man and a 12-year-old cat I’d like to sell.  Both of them mess up the house, and neither of them listens to me.  

My two old boys - I think they are both bored.  I spend loads of time doing FOR both of them, but I’m sure I don’t spend enough time doing things WITH either of them.  I make tasty meals for them, and clean up after both of them (my hobby).  The cat I can tell is bored when he walks around under my feet meowing.  I realize he can’t sleep all the time, but throwing the furry mouse holds my attention like 30 seconds.

Periodically I get some great article or book on activities for a person with dementia.  I set it aside, and tell myself “I am going to do this with Dad.”  Well, lately I have been trying to set some goals for my own activities - writing, journaling, goal setting, reading, meditating, and expanding my exercise routine.  It has been a HUGE struggle to incorporate even ONE of these activities into my own day, let alone multiple activities!  I guess I just need a wife so I can enjoy a clean house, tasty meals, errands and desk work all completed PLUS my own activities.  Then I also would be able to better entertain my two old boys.  Meanwhile, the cat gets to watch birds, sunbathe on the warm furry throw blanket and sniff the air outside his favorite window.  Dad gets to do his Jumble puzzle, and space out in front of the TV when he is not at the adult day care program.   Days gone by I used to be quite social with Dad, taking he and his lady friend to the beach, the park, special events etc.  That’s when we all were younger I guess.  I read this morning that after 50 it becomes more difficult to multitask.  At 56, I consider myself just on the cusp of aging.  But clearly, as a girlfriend said, I just don’t get that much done in a day.  Two old boys and one getting older girl  -- around here, we are just muddling through another year.   Not complaining, just not doing cartwheels and jumping through hoops.  At some level, I need to adjust to this, so my brain doesn’t turn it into stress and guilt over things undone.