Dr. Gawande was raised in India, and in this book he talks
about how the elderly are treated in his birth country, and then how he was at
first surprised, and then understanding, at how they are treated in the United
States. From the comforts once afforded
by close family, our society has grown to prize freedom and independence – both
parents and children are happy when children move off on their own --- often to
far ends of the country, or even the world.
The close family ties Dr. Gawande grew up with are the
exception in America, and he does view our new norm with understanding and
sympathy --- and a realism many don’t consider.
“Everyone
grows old,” he notes, and with our good medical care, this is a much more
extended, gradual process than in times past, where often death was
sudden. Now the point at which one
begins to “feel the pains of old age” and when death actually arrives can be
many years or even decades apart, a time of gradual decline. During this
decline, many elderly become unable to do some of the basic things of living as
well as they did in the past, and perhaps at some point not even at all. Dementia and Alzheimer’s are two particularly
cruel illnesses which affect most elderly at some point, to some degree. And that degree is a large focus of this
book.
When is mom or dad not able to take care of themselves, and
when must the child step in to help, and when must he step to take
charge? Many don’t distinguish between
the two, and “helping” often means putting mom or dad into assisted living, but
as Dr. Gawande notes, most assisted living facilities are anything but assisted
“living”. They are places where
caregivers and administrators set a routine, a schedule for everyone to
follow: when to wake, eat, get
entertainment, take medications, and when to sleep. This schedule is set for the most efficiency
of the facility, and the safety of the residents: to keep costs down and safety up, and the
children who are “helping” mom or dad ---and who are paying the bills --- are then
kept happy as they can be.
But mom and dad aren’t.
Dr. Gawande notes that old age homes are too concerned about
safety, and lawsuits. They have a staff
which isn’t concerned about residents’ priorities or needs, but rather with
timeliness and neatness. Safety is
valued over happiness. He notes that the
three plagues of nursing home existence are boredom, loneliness, and
helplessness. He provides real life
examples of people in common facilities , and examples of exceptional facilities
which challenged the status quo.
One facility put green plants in every room, planted
vegetable and flower gardens in the yard, brought in two dogs and a cat ---- and
had parakeets in every resident’s room. Elementary
school children were brought in to sing, play, or even exercise --- and the
residents joined in. It was chaos to
begin; it was change. But what were the
results? He cited examples of the
depressed mute who spoke, the non-ambulatory who walked, and of the bed-ridden
dying man --- who went home! People
named the animals, children were patient with Alzheimer’s limitations, and residents
found something to live for. In two
years drug use fell 38%, deaths 15%.
Having a degree of self-control improved lives, and residents were given
freedom to choose when they woke, ate, went to bed, and staff was encouraged to
interact with residents, and facilities/equipment/space provided for them to
interact with each other --- even if there was some risk involved. And the people were living happier lives.
I think this is a great book to read (esp. pages 100 – 150) for
anyone caring for (or about to care for) an elderly loved one, and worried
about all those things loved ones worry about.
This book will help you get past your worries about how good a job you
are doing, and to being more considerate of how your loved ones want to live. (I am now on the board of an organization
caring for 90 developmentally disabled adults, many of whom are getting on in
years. This book will be a great
resource for our implementation of even more loving care there.)
Having cared for my mom for seven years, and now
coordinating a caregiver’s support group, I have seen some people present the
loving care espoused in Dr Gawande’s book --- and their witness has given me
great comfort. I have seen many come to
the caregiver’s support group afraid, wanting to do what is right, but not
knowing where to begin; they were helped by other caring people there, who had learned
without the benefit of Dr. Gawande’s book.
I recall K., who’s dad at some point began to be confused on
how to dress himself, sometimes wearing pajama tops for a shirt or mis-matched
shoes ---- much to her mom’s horror: “You
can’t go out like that!” But K., in
love, calmed her mom down: “Mom, who
cares? No one is watching, and if they
do, so what! That’s how dad feels
comfortable; let’s go shopping.” And she
took her dad everywhere with her and her family as long as he was able. What an example of love.
And I recall ME., who sat and looked into her husband’s
eyes, holding his hand and offering encouragement, as he struggled for long
periods of time, struggling to find the words to express his tangled
thoughts. But she waited patiently, hours
each day, searching HER memory for where his might now be lost, so she could
encourage him. She loved him with a
patience I’ve never before witnessed in my life.
And I recall H., who at 90 still carried his beloved wife around
their apartment, and fed her every bite of food she ate. And my own mom, who wanted to wear her
favorite gown every day --- without ever washing it, and so I bought her 10
like it so she could wear the same one every day (as far as she knew). And F. whose children moved her and her
Alzheimer’s-stricken husband into an assisted living home near where they
lived: “I know they mean well, and they want him safe, but he knows no one
there, and is becoming even more confused and troubled ---- and even though we
are now nearby, they don’t visit any more, maybe even less.” And so F. told her children she was moving
back to her home, and would take care of her husband there as best as she
could, as safe as she could, promising to hire assistance as needed, and she now
attends our monthly caregiver’s meeting smiling, and is an uplifting presence
to others.
I can recall many dozens of other stories like these, of
people so loving their parents and spouses, putting aside love of themselves
and convenience in their lives, to put comfort and love into their parents’ and
spouses’ lives.
Honor thy father and
thy mother, that you might have eternal life. I have seen this commandment put into action,
and I am so blessed for participating in its witness.