Tag Archives: aging

August 31, 2014 · 5:35 am

Going The Distance

Dad on January 8, 2012

Dad on January 8, 2012

On a good night, when the wine was flowing and we were gathered as a family around the dinner table, my father told jokes. My brother Bruce and I were given to puns of the worst sort, and for a time I specialized in the foul humor I picked up from the ad agency where I worked, but Dad was the family story teller. One of us usually handed him a cue, a short sidelong reference like, “There’s a pony in there.” Off to the races he’d go.

He straightened, there at the head of the table, and made eye contact with his audience as if to ask if we really wanted to hear that old story. His pause, his expectant look, was all he needed to gather us in.

There was one about the boy who found a strange spotted creature he called a “rarey” that began to grow so fast it threatened hearth and home, prompting the boy to load it in a truck and attempt to drop it over the edge of a cliff on a high mountain peak. The punch line? “That’s a long, long way to tip a Rarey.” (Insert groan here.)

But my favorite was the one about the optimist and the pessimist.

He avoided the usual start. No “once upon a time.” My father launched right into the action of the story, setting the stage. In the setup for the optimist and the pessimist, he described a family’s problem with a pair of twins. One looked on the bright side of everything, so much so that he could imagine no problem that could not be surmounted or that wouldn’t dissipate all by itself. The other saw only gloom and doom, and no matter what wonderful opportunities arose, he felt he was sure to fail. The parents decide to engineer a resolution by giving the optimist truly terrible Christmas presents and the pessimist, truly wonderful ones. The story ends with the parents standing by, confounded, while their optimist son gleefully digs in a huge pile of horse manure, exclaiming, “There must be a pony in here somewhere!”

My father loved to tell stories, but in the end, he left me a riddle. My father, who was doled out more than his fair share of dung in life, never gave up, never became bitter, never stopped believing in the possibility that things would get better. While many people become curmudgeonly as they age, he became gentler. Why? What drove him?

If my mother had her druthers, the answer would be faith. Her faith sustained her through the loss of her father while still in her twenties, the war, the loss of her daughter to leukemia, the death of her mother, and the long frightening years of my father’s struggle with heart disease. Resting on the levee of the river during one of our many walks, I asked my father if he believed in God. I wanted to hear him say yes. I wanted that little bit of reassurance that, when the time came, he would be welcomed into heaven to join my mother, even as the little doubter in my own mind wondered if that’s what really happens after we die. “I wish I could believe,” he told me. He just couldn’t make the leap from concrete reality to ephemeral faith. The closest he ever came to saying he believed in an afterlife was to say he looked forward to seeing my mother again.

Perhaps it was love that fueled him. Love, to my father, wasn’t about what you said, it was what you did. His place in the middle of three sons, with an emotionally abusive father and a bully for an older brother, had a lasting effect on his dedication to others. My grandmother lived out her last years in a convalescent home in our community. After he ate with us, my father took her dinner every night. I’ll be honest. I didn’t like my grandmother, and she didn’t like me (she thought I was entirely too outspoken, my father confirmed much later). Why my father would want to spend time with such a sour old woman I couldn’t understand. But in his last years, I saw my grandmother as my father saw her: she was a gentle woman trapped in a loveless marriage with a philandering egotist. I remember how her face softened, how something flickered across her features, when my father spoke to her. His nightly visits were driven by more than filial duty. They were borne out of love.

Or maybe it was hope that kept him going. Within a week of his death, he still believed he could recover his strength, if he just got out there and started walking again. Anthony Scioli, a professor at Keene State College in New Hampshire, has been investigating the link between hope and health. Writing in Spirituality & Health magazine, Louise Danielle Palmer summarized his conclusion, that “…hopeful people tend to be more resilient, more trusting, more open, and more motivated than those less hopeful, so they are likely to receive more from the world, which in turn makes them more hopeful.”

I’ve used a lot of trite quips to explain my father to others. “Like a Timex, he took a licking and kept on ticking.” His health challenges alone would have flattened most men: three heart attacks, three open heart surgeries and three strokes.” While we were growing up and he still had our college educations on the horizon, I know he felt he had to recover. He had to provide. That was duty. But how do you explain his dedication to come back from strokes after my mother died, after his duty was discharged?

He did it a step at a time. With the help of a physical therapist, he learned to concentrate on swinging his weaker left leg and striking with his heel. He had to think about each step to avoid stumbling. When he was in acute rehab at the UW Medical Center, I remember how proud of himself he was when he demonstrated the new skill he had relearned with the occupational therapist: he made me a cup of instant hot cocoa. Even now, when I write about it, I cry. To be so reduced by a stroke that completing the steps – take out a cup, fill it with water, microwave it, pour in the cocoa and stir – was an accomplishment. It could have been humiliating, but it wasn’t. It was a milestone. A good day. The medical professionals predicted he would be wheelchair bound; then they revised it to “he’ll never walk independently without a walker.” But he did. For years, he just used a cane.

Every day on our walk, he set a goal. Sometimes it was to make it no farther than the third driveway down. He felt the load in his chest, was breathing hard, but he rarely stopped short of his goal. When I said that most people would quit when they started to feel the strain, he simply said, “Every day I try to go a little farther.”

My father went the distance.

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July 20, 2014 · 6:08 am

Aging Gracefully… or Disgracefully?

Official Portrait, Promotion to Colonel, 1959

Official Portrait, Promotion to Colonel, 1959

Somewhere along the line, word got out that I knew something about aging parents. During the seven years that I cared for my father, and the eighteen months since, I’ve received many a call or email from adult children – correction, daughters – who were deeply concerned about their parent’s welfare and at sea when it came to figuring out solutions. One was a friend who was actually collecting information on behalf of her husband, although the husband didn’t know she was looking for advice and she was uncertain how much she could suggest to him. If the wise men had been women, so the old joke goes, they would have arrived on time, helped deliver the baby, cleaned the stable, made a casserole, brought practical gifts and there would be peace on earth – all because they asked directions.

After a while, my marketer’s brain started to look at their stories as data that fell into two groups: those whose parents who were grateful for a little help, and those who seemed to become nasty and difficult. Call it aging gracefully versus disgracefully. I don’t mean to be flippant or suggest that a bunch of elders are out there besmirching the family reputation. Aside from a few outliers who were sociopaths in their youthful years and whose tendencies ripened with time, the latter group is made up of people who were once decent human beings before age stripped them of their filter and embittered them. Their younger selves would be disappointed in their older selves.

My father fell into the changed-for-the-better group. When I was growing up, his authority was absolute. He did not yell or hurl scornful statements or fling barbs. He said little. He didn’t have to. I knew – my brothers and I all knew – when we were on thin ice. It was in my father’s eyes. He froze and simply looked at us – a level stare, unflinching. We were put on notice without a word. He transformed into The Colonel. There were no coiled muscles waiting to explode – the telltale sign of a violent father. Nothing in our experience suggested that he would strike. He was too controlled. But something in his eyes hinted at a potential. He later described his own father as “severe” and his older brother as a bully; harassed to the point of retaliation, he described futilely trying to wound his brother only to be held out of reach as his brother laughed at him. Maybe my sense of threat came from a glimpse of something long buried, the soldier self that enabled him to survive WWII. He said nothing, he did nothing, but I feared my father; loved him, longed for his approval, competed for his attention, but feared him.

The danger dissipated with age; whatever reservoir of anger he had stored up leaked away. He did not rail at the indignities of aging, though he did not like them. This business of the bladder for example. Whose idea was it to make peeing both difficult – a long time coming and an anemic stream once started – and hard to control, so much so that my father avoided going anywhere without a bathroom in sight and more than once ended up urinating in my neighbor’s yard when he couldn’t make it back to my house during a walk? And no one expects an old person to be funny. My father would jest and I would have to explain to his audience, in the silence that followed, “That was a joke.” Most people did not address my father; they would first address me, speaking of my father to me, treating him like an imbecile. His aging made me angry but it did not seem to affect him that way.

I can’t let go of my questions. During those seven years and in the time since he’s died, I continue to wonder: how is it that one elder becomes kinder, and another mean? Is there a way to influence or control how one feels about the many cruelties of aging? What will happen to me?

I read and hypothesize. An op-ed by Arthur C. Brooks in the New York Times boils things down to an equation. One describes oneself as a happy person when one’s happiness (y) is greater than one’s unhappiness (x): when y > x. He wasn’t writing about aging, in fact his point was that the most unhappy people are self-aggrandizing, materialistic fame-seekers or promiscuous hedonists, people who are generally in their prime. The answer to happiness, he concluded, is to love people, not things: “It requires the courage to repudiate pride and the strength to love others – family, friends, colleagues, acquaintances, God and even strangers and enemies.”

Aging is nothing if not a punch to the solar plexus of pride. But assaults on one’s pride don’t seem to explain who will transform into kinder and gentler versions of their younger selves.

One friend of mine theorizes that women are better prepared for old age because of the many adjustments they have to make in their self-image. With the arrival of one’s “monthly visitor” or “period” or “curse,” suddenly you’re transformed into a woman, someone capable of bearing another human being. Being pregnant is a different kind of shock. Love or hate the experience, hardly anyone is neutral. Besides feeling like an alien in one’s own body, or worse, feeling like one is gestating an alien, the cultural rules bend sideways and suddenly someone you’re meeting for the first time puts his hand on your belly by way of introduction and says, “Hi, I’m Pete and I see you’re expecting a baby.” And let’s not even talk about menopause. (Beware, says the menopausal woman.) Unfortunately, I’ve heard just as many stories about difficult mothers as difficult fathers. Maybe more, because mothers more often push the hidden buttons that fathers don’t even know exist.

Then there is the school of suffering. As David Brooks wrote in the New York Times, “Recovering from suffering is not like recovering from a disease. Many people don’t come out healed; they come out different.” I know this was true in my father’s case. He was a different father after the death of my sister Midge, who died just short of her fourth birthday. He often referred to the different way he and my mother parented my two older brothers compared to how they raised us two “youngers.” The difference can’t be explained by the seven year gap between the pairs of children or my parents’ increased age – 40 and 41 when I was born. David Brooks continues: “Instead of recoiling from the sorts of loving commitments that almost always involve suffering, they throw themselves more deeply into them. Even while experiencing the worst and most lacerating consequences, some people double down on vulnerability. They hurl themselves deeper and gratefully into their art, loved ones and commitments.”

In Brooks’ statement, “vulnerability” sounds right, but it’s the “gratefully” that resounds. My father became more grateful as he aged, grateful for the wife and daughter he loved, even when they were beyond his reach in death, grateful to be welcomed into a family, even though he lost his independence, grateful for the years of life that had somehow, miraculously, been granted to him, even during the days of pain and confusion. Did gratitude make him more tender, or did tenderness make him more grateful?

This is a problem I am unable to solve. My father’s kindness overflowed; I know because I experienced it everyday. Gordon Morino, professor of philosophy at St. Olaf College, wrote, “…in moments of tenderness it is as though the ego and all its machinations momentarily melt away so that our feelings are heightened and we are perhaps moved by the impulse to reach out with a comforting hand.” My father did not mourn what he lost – his virility, his independence, his place in the world. On Christmas Day, eighteen days before he died, I asked if he had enjoyed his holiday morning. He answered, “It’s enough being here.”

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January 28, 2014 · 11:35 am

Something Happened

Official Portrait, Promotion to Colonel, 1959

Official Portrait, Promotion to Colonel, 1959

Most of my life, my mind has raced. While I was physically present, in my head I often was thinking about something else, half-attending, listening for what I had to sock away in short term memory while filtering many of the other signals and information that flew past my head. Way back, in first grade, my teacher reported, “I found that Betsy reads well in a second grade book, but has almost no comprehension of what she has read, so we gave this up for now.” To which my mother wrote back, “We’re reading aloud to Betsy more frequently so this may help the comprehension too. She’s had much less reading aloud than our other children. Her Dad is reading Oz books now.” (Thank heavens. Reading the L. Frank Baum series is one of the most important memories of my childhood.)

About seven years into my career, when I first began to achieve some success, a leadership styles assessment found that I was seen by others as analytical, decisive and self confident. That was the positive side of the coin. It also found that I was seen as detached, determined and independent. I was a woman on a mission, more focused on what I had to get done than building relationships.

Fast forward 17 years. Before I left corporate life, another battery of personality and leadership assessments found something quite different. According to the 16PF Fifth Edition Personal Career Development Profile (yes, that’s a thing), my personality was found to be most aligned with people who are most interested in “helping” professions, particularly counseling. “Are you interested in counseling,” the consultant asked.

“God, no,” I thought. I wouldn’t have the patience for it. But I wondered, how does someone change from “detached” to “receptive” and “attentive to others”?

Experience. Age. Or both.

I find myself doing what I often do — thinking about my Dad. Looking back on his aging process, I accelerate it in my mind until it resembles time-lapse photography, those film sequences that capture a plant as it transforms from a seed that germinates, pushes a green sprout toward the surface, shoots up toward the sky and blooms.

Memory is like that. I look back on the father of my childhood, adolescence, adulthood and now middle-age and I piece the images together until they become a narrative arc.

It was hard to get Dad’s attention when I was young. He looked distracted in most of our old photos, uncomfortable, often unsmiling. It wasn’t that he hated having his picture taken. In college snapshots, he looked relaxed and confident, maybe even a bit full of himself. In my childhood, he barely tolerated the ritual of the family photo. His mind was somewhere else.

Fast forward 70 years. Dad sat at my kitchen table savoring his coffee and the morning newspaper. When we conversed, I had his full attention.

His mind worked vastly differently in his nineties than it did in his twenties. When asked a question, he would pause for some time. In a social situation, well-meaning people might try to rescue him by filling the void with chatter.

But if you waited and watched, you could almost see his thought process. He would consider the inquiry, mentally find the correct file cabinet, and eventually the right memory. Sometimes, the answer would escape him for a while and he would say, “I’ll come get you at 2 a.m. when it comes to me.” When he stopped worrying about retrieving the sought-after tidbit, it often emerged as if by its own volition.

What would once have taken seconds took minutes, maybe even hours.

In today’s “New Old Age” column in the New York Times, Benedict Carey writes, “(T)he larger the library you have in your head, the longer it usually takes to find a particular word….” Accumulated knowledge, vocabulary and expertise, Mr. Carey reports, represent “crystallized” intelligence, which some scientists suggest actually grows over time, while “fluid” intelligence (short-term memory activities like remembering a phone number) shrinks.

I find this heartening. Every “woman of a certain age” I know complains of the annoying tip-of-the-tongue syndrome and short-term memory failures that seem to move in about the time we are finally rid of the equally annoying biological systems that plagued us from age 12 on.

This summer, I will start a Masters in Fine Arts program in creative nonfiction. Part of me is mildly terrified to engage with a group of students whose median age is likely to be under 30. No doubt their fluid minds will quickly digest the volumes of reading that come with the territory. While I try to remember them.

Dad is again my guide and mentor. His love of people — and literature — only grew as he aged. I don’t think it was just the easing of daily demands that enabled his internal life to flourish. Something happened to his patience. Something happened to his ability to savor, appreciate and feel gratitude. Something happened to his depth of understanding.

I’m praying for something like that to happen to me.

[Author’s note: One of my friends messaged this photo to me. Thanks, Kristin Warren Vandersluis!]

IMG950426

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November 10, 2013 · 7:37 am

Dad Deconstructed

Dad comes to me in pieces.

As I approached what would have been his 97th birthday, it was his smile that came to me, the smile I felt he saved for me, the one I thought of as my smile.

This week, I’ve been thinking about his voice.

During the years when he was at the peak of his career in the Marine Corps, his voice was a primary instrument of his authority. Years of practice leading men in war and ceremonial parades at Marine Barracks afforded him the ability to issue a command like a rifle report. Without moving a muscle, he could expel a directive so that it burst out of him, sharp and clean. It was the voice that brought me to heel when I was out of line, that sliced up my spine and froze me in my tracks.

After Dad was forced into retirement following his heart attack, his command voice was repurposed for domestic use. It became a vehicle for entertainment. When family or friends lingered around Mom’s dinner table, Dad might without warning boom, “Speak!” Having gained the startled attention of the audience — for it was an audience then — Dad would continue, “Speak thou fearful guest, who, with thy hollow breast still in rude armor drest, comest to daunt me!” His voice would slip into a conversational “just between us” tone as he launched into Antony and Cleopatra, “The barge she sat in, like a burnish’d throne, burned on the water: the poop was beaten gold; purple, the sails, and so perfumed that the winds were love-sick with them.” Or he would channel Richard Burton, dropping his voice a register, intoning, slowly, “Alone, alone, all, all alone, alone on a wide wide sea! And never a saint took pity on my soul in agony.”

His Marine Colonel voice still made rare but memorable appearances. When my newborn son arrived home from the hospital with an inch and a half of black hair, standing on end, my five year old daughter approached her brother with a pair of scissors. Dad, reading the paper in our family room, suspected her plan was benign but as a father of five children knew something of the jealousies of older siblings. He ordered, “Stop! Put The Scissors DOWN!” For several seconds, she didn’t even expel a breath. Then she put the scissors down.

Dad’s voice continued to make an impression on my daughter, even though he never again raised it to her in anger, as far as I know. This week, I ran across a get well greeting in the form of a comic strip that my daughter created while in third grade to send Dad when he was hospitalized. The first frame was easy enough to understand: a drawing of a hand holding a balloon. The second frame stumped us for a bit. The hand held the balloon in front of a man labeled “you,” for my Dad. The speech bubble above him read, “tehupt!” In the third frame, the balloon appeared to be vibrating, rocked by Dad’s voice, and in the fourth, it had popped. Above the second frame, my daughter had drawn an arrow pointing to the speech bubble next to which she wrote, “My Dad said this is how you spell it.” She wanted to exonerate herself of any blame for the phonetic spelling of the call-to-attention drill command that Dad would demonstrate upon request.

Something happened to Dad’s voice over time. It dropped in pitch and took on a gravelly character. His voice, his calling card, led some people to falsely assume that he was a curmudgeon, or worse.

In 2003, after blowing out a tire on a new curb on a familiar side street in Tacoma, he decided to give up driving and moved to an assisted living community just two blocks from my brother Dean’s home. When I visited the first weekend after his move, I passed the front desk where I heard the staff member describing Dad at the request of a resident. “He’s very angry,” she said, “he might even be dangerous.” She had gone so far as to file an incident report with the nursing staff.

After a small stroke two years before he died, a speech therapist suggested we have an ENT physician examine his vocal chords with a scope, suspecting organic damage to the vocal chords. The physician found evidence that Dad had been experiencing acid reflux without knowing it. Although we tried a medication to control it, the damage was done.

In Dad’s last years, his voice was sometimes more breath than speech. He had to actively concentrate to gather his breath and push it through his vocal chords to produce sound. Reciting his favorite poetry required conscious effort to break the long passages into phrases supported by more frequent breaths.

Two nights before he died, when my husband came home from work, Dad was determined to greet the head of household, his host, properly.

“How was your day, sir?” he boomed, sharp and clean.

I hear it still.

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June 24, 2013 · 3:44 pm

Dad’s Affair with the Military History Channel

My Dad was an avid reader. Foreign Affairs kept him current on geo-political dynamics. The Economist informed him about money and economies around the world. The New York Times and Christian Science Monitor made sure that he kept up with U.S. news. Until a couple of years ago, he consumed non-fiction books about Shakespeare (Harold Bloom), history (Jared Diamond) and military strategy (Stephen Ambrose).

As he lost his concentration for longer works, the ratio between the printed word and the boob tube reversed itself. Television went from an evening pastime that would begin with the evening news shows (a vestige of the time when they used to be actual, thoughtful shows presided over by thoughtful anchors like Huntley and Brinkley or Walter Cronkite) to the status of electronic companion.

During his last few months of life, he consumed the Military History Channel almost exclusively.

Hour after hour, day after day, he watched familiar black and white images culled from news reels. Military advances were demonstrated with ever more lethal efficiency through film clips and interviews about wars from the Revolutionary War forward. Some documented in painful detail the creeping advance of the Marines in the Pacific Theater of WWII. Dad’s war.

I worried about the effect of this steady diet of war video. Why ingest gruesome images of loss and destruction? Would it trouble his dreams?

He was, like so many veterans of his age, not one to talk about the war. Certainly he didn’t regale us with tales of his buddies, near misses, brave efforts or hijinks. War was a serious topic, rarely broached.

I sometimes felt like Dad’s own movie clips were running in a loop in his head. Without preamble, Dad would occasionally look up from a glass of wine and remember standing on the loading dock in San Diego with the sudden responsibility for loading a warship that would soon be bound for Kwajalein.

Did the images on the small screen take him back to a time and place he needed to revisit? He seemed expressionless when he watched the scenes. How could they not depress him?

I considered switching the channel, suggesting different fare, but I stopped myself. He had so little control over his life at that point. Who was I to legislate what he watched? I wondered if perhaps he needed to review this important part of his history. Or perhaps he just followed a habit formed long ago when he used to be a student of military strategy.

In those last, long weeks, I sat next to him and wondered what he thought.

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May 30, 2013 · 6:24 am

Older Men’s Urinary Problems (and what I wish I’d known)

Okay this is a bit crass, but it’s the first thing that came to mind as I started this post. My Dad used to cite the three rules of being an older man: 1) never pass up an erection, 2) never trust a fart, and 3) never pass up a bathroom.

As I look back on his last year or two of life, I know we did things mostly right, but I wasn’t aware of the options for urinary incontinence, and I wish I’d known to pursue it a little harder. I’ve been surprised to find how many people found my blog posts about end-stage congestive heart failure, so I’ve decided to put one more bread crumb out there for adult children who are trying to figure out how to help their fathers with urinary urgency, benign prostatic hyperplasia or acute urinary retention.

Urinary urgency – especially that interrupts sleep — is a common complaint of older men. My Dad, like many, took Proscar (the generic is finasteride) for the presumed source of the problem: an enlarged prostate.

His concern about having to “go” urgently kept him from activities he might have enjoyed. When he had an independent living apartment, he said the reason he wouldn’t participate in group outings was the lack of a bathroom on a bus. He didn’t want to go to movies for the same reason. The first thing he did in any new location was to locate the nearest bathroom.

His urgency increased significantly over the 12 months before he died. On a trip to Seattle, he couldn’t make it from the dining room to our guest room and wet himself – twice. It was heart breaking. Those accidents increased in frequency.

The month before he died, he was in excruciating pain in the morning when he was unable to void — at all. For a long time, he had experienced a weakened stream. But looking back on it, I realize that he was also having real trouble starting to go. And that had been true for some time.

When my brother took him to the urgent care center at the nurse practitioner’s urging, they drained 1 liter of fluid from his bladder and he came home with a diagnosis of acute urinary retention. Three days later, the same thing happened. This time, he went home from the ER with a catheter, which became permanent. (To his credit, the Sutter General triage nurse listened to what we said about how much urine was drained a few days prior and he immediately admitted Dad, saying, “Wow. That must hurt.”)

It had never occurred to me that there was more he could do besides taking the Proscar. I knew he had some kind of prostate surgery years before, but apparently the prostate can enlarge again.

In conferring with the urologist, we learned that he wasn’t on a second medication that is frequently used for benign prostatic hyperplasia (BPH), Flomax (tamsulosin). He started on the drug, but later discontinued it when his condition deteriorated (and we realized that the potential of a fall due to a dizziness as a known side effect was worse than dealing with the catheter).

Unfortunately, Dad’s health went into a slide about the same time that we figured out the BPH problem, and the urologist, Dad and I agreed that he needed to get stronger before it made sense to remove the catheter and try a non-surgical treatment. (Though my brothers and I were very concerned about Dad’s dignity and comfort, the catheter turned out to be a blessing in disguise. Dad quickly lost strength, and having the catheter kept him from having to endure adult diaper changes.)

If Dad had improved, he would have been a candidate for cooled thermotherapy, a therapy that is feasible even for patients on blood thinners. This is how the urologist’s brochure described it:

Cooled ThermoTherapy™ is performed in your urologist’s office in just under 30 minutes. You will be on an exam table in a comfortable position. You will be given medication to help you relax and may receive local anesthesia. The treatment is performed with a small flexible catheter that is inserted into the urethra. This catheter contains channels to circulate cooled fluid around an antenna that produces targeted heat within the prostate. The heat reduces excess prostate tissue. The proprietary cooling technology protects the healthy urethra and maintains patient comfort during treatment.  Once the treatment is completed, you will be able to go home. You will typically wear a temporary catheter for a few days to allow the prostate to begin its healing process.

For us, it’s all water under the bridge. We did the best we could. But maybe we could have made life a little less anxiety producing if we’d known sooner that there were some options for Dad’s urinary urgency. I hope you find this helpful.

By the way, I found MayoClinic.com to have the best information about BPH symptoms, causes and treatment options.

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May 25, 2013 · 9:49 am

The Anxiety of Aging Parents

hospital bill

The title of this post can be read two ways. As parents age, they become more anxious, but we adult children become more apprehensive, too. Like a migraine headache, financial security just keeps pounding away. Especially when bills like the one above arrive. Dad came out one morning unable to speak clearly, having experienced what we later learned was a TIA or mini-stroke.

My Dad was unusual for recognizing his increasing limitations as he had plenty of medical reason to expect that a period of incapacitation could precede his death. He had a will, gave one of my brothers financial power of attorney, had a checking account with two of us on it in addition to himself, turned over bill-paying to us, and purchased long term care insurance (though, regrettably, without an inflation rider making those years of premium payments a ridiculously bad investment).

That said, he constantly worried about whether his financial resources were adequate. Anytime an “Explanation of Benefits” arrived from his supplemental Medicare plan insurer, it set off a new round of questions – even if it clearly stated that he did not have to pay the amount. I took to carrying with me a handwritten ledger of his monthly income and monthly obligations.

“See? You’re fine,” I would reassure him.

The flip side of the parent-adult child financial anxiety coin is harder to solve. How do you have “the talk” with a parent who doesn’t think his or her financial situation is an appropriate topic of conversation? At a financial seminar hosted by UBS last week, I learned that the average age of a widow is 55. Older married women – still – don’t necessarily know the details of their financial accounts.

This morning’s New York Times carries a great article, “The Talk You Didn’t Have With Your Parents Could Cost You.” Among other tips, it quotes Amy Goyer, a caregiving expert at AARP, who offered these practical suggestions:

  • Know what type of information you are seeking before you start a conversation, such as: whether a will exists, a financial power of attorney, a medical power of attorney or health care directive; what their health insurance covers, including long term care insurance; whether they have life insurance; and if there is a list of every singe account they owe or collect money from.
  • Start conversations with an “I” statement such as, “I’m concerned about doing the right thing when you pass.”

Although my Dad shied away from the Internet (after a few attempts), the article also reminds adult children to secure passwords for any Internet-only accounts. And the worst place to keep legal documents and instructions, the article suggests, is a safe deposit box, because survivors often lack access to them.

I know it’s “nature’s way,” but certain aspects of aging have always struck me as cruel; high among them, our parents’ feeling of insecurity as they lose ground. Though adult children have a moral obligation to protect aging parents’ security, we can’t lose sight of the need to ease their hearts and minds. That often takes finesse, driven by caring concern.

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May 17, 2013 · 4:51 pm

Our Common Cause as Adult Children

Dad bird hunting

You won’t find this blog post until you’re ready to think about what we have in common: the sometimes-painful, sometimes-rewarding responsibility for caring for a parent during their “golden years.”

The senior years can be tremendously active and exciting – a period of freedom after a long life of work. But for our parents and most of us – yes, us, too – there comes a period when the world shrinks.

Our job, if we love our parents and choose to be involved, is to make their passage during these years as good as they can be.

Almost every day, I stumble across someone who faces their parents’ elder years with trepidation. It happened again this morning, walking with a neighbor.

These are the truths I hear over and over again:

  • Parents don’t want to be a burden; they actively wish to die in their sleep or go quickly, and don’t want the adult child to feel pain over their departure.
  • Parents often live near their lifetime’s worth of friends, while their children are sometimes states away. Adult children worry how they will provide the assistance needed when one or both parents need more help.
  • One sibling bears most or all of the responsibility for looking after their parents.
  • Often, there’s a sibling or sibling’s spouse who is not on the same page about what should happen.
  • We feel drawn and quartered. We may face pressure at work or be trying to support our young adult children or spouses through rough patches in their lives even while we are trying to pay more attention to our aging parents.
  • Having candid conversations with parents about their intentions, physical limitations and financial preparedness is very, very difficult. Few aging parents are realistic and proactive, leaving adult children to worry about whether (or when) they will have to step in and take over.

I learned some truths of my own along the way, truths that surprised me. I fully expected Dad, who had advanced heart disease for more than 50 years, to go out with a big bang. Instead, he rallied over and over again, never quite recapturing the ground he had lost, but persisting even so. He lived at least 15 years with congestive heart failure.

I also learned that quality of life didn’t depend on the things he thought it did. His perspective changed with time, and he was able to be pretty satisfied even though Mom was gone and he couldn’t hunt, fish and enjoy the outdoors as he once did. His world was small, but there were people in it who loved him.

I learned that Dad’s long decline was an important time for him in coming to terms with regrets. He regretted that his father wasn’t more interested in him. He regretted that he couldn’t save my little sister when she became ill with leukemia. He regretted that he couldn’t protect my mother from feeling afraid during her terminal illness with lung cancer. Eventually, those regrets ran their course and were replaced by peace.

I learned that I could give him my love and attention without resentment, even though it meant living my own life in the very slow lane.

I learned that I could have a far deeper relationship with Dad after my Mom’s death than we ever had before.

I learned so much from the last seven years caring for him.

But I understand the fears of those who stand at the precipice of their parents’ old age, wondering and worrying how they will handle it. All I can tell you for sure is that it won’t go quite the way you expect it to. There will be parts that are harder, but there will also be surprising gifts.

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April 6, 2013 · 3:04 am

With Dad Gone, A Void (Part Four)

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Napping…

To start at the beginning of this little series, click here.)

Now that I am home, really home, after Dad’s death, I am coming to terms with my identity all over again. Carol Mithers wrote a very poignant essay in the New York Times entitled, “Suddenly, They’re All Gone.” Instead of being relieved when five years of caregiving for her mother-in-law, then her father-in-law, then her childless aunt and finally her mother died, she felt worse. She concluded, “While you’re caring for the old, you can’t believe what you’re called on to do and where you find yourself, can’t believe that your time with them will ever end. Then one day, it just does.”

As Dad became more fragile, and I became more vigilant, caregiving did become all consuming. I was neither angel nor martyr; like Carol, I had my days when I lost my temper when Dad locked on to something about which he was dead wrong. But many times, it was a pretty zen experience.

Dad always asked me if I got tired of walking with him or hearing his bits of memorized poetry. I could honestly answer, “Never.”

I miss it.

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April 5, 2013 · 4:03 pm

Naked Shredding and Other Awkward Retired Moments (Part Three)

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The project plan and portfolio of materials for Friends of Hospice (design by Pat Davis of Pat Davis Design)

(To start at the beginning of this little series, click here.)

What came next was… a whole lot of nothing. I had cleared the decks in anticipation of Dad moving to California, but he was hesitating. Even though he had already made THE BIG MOVE out of the family house three years prior, he was now nearly 89. Moving sounded so daunting: packing, change-of-address, changing doctors, etc.

I no longer had to check my Blackberry constantly for new texts or messages. My phone wasn’t ringing, and I didn’t have to coordinate my calendar through my assistant.

No one was looking for me, needing my input or approval.

I found out, as many retired caregivers do, that you are not quite as essential to the world as you thought you were. The void of your departure quickly fills. You find out who your real friends are.

I enjoyed walking in the cool of the mornings in Davis. I started going to yoga. And I began cleaning out my house with a vengeance.  I started tackling old papers, many of which needed to be shredded.

During those early days, with Maddie and Tommy off somewhere, and Todd at the office, I began to question my old routine of showering, blow-drying hair, dressing and putting on a little makeup. I dropped hair and makeup.  Who was going to see me? Then I started skipping showers on some days. Who would notice? And one day it just seemed stupid to dress. Why dress if no one could see you? It just adds to the laundry.

Which led to the naked shredding incident. There is something that just seems wrong about shredding with nothing on. House cleaning or cooking without clothes seems okay, but to shred just seems unhygienic.

“What are you doing,” I asked myself. I wrote my friend Jim – my mentor even then – about my crisis of productivity. How would I measure the value of my days without project assignments and milestones, without output? He counseled me to just breathe and I would figure out what I was meant to do.

I breathed all summer.

Then in the fall, with Maddie installed at college, a thought bubble appeared above my head. I had the rare opportunity to use my skills to further a cause I cared about, without having to charge for it. And I cared a lot about hospice.

My mother had the bad fortune to be admitted to a hospital on the weekend. Three physicians were involved in her care, no one seemed to have any idea what was planned, and the nursing staff was reluctant to “bother” a doctor when Mom “sundowned” and became deeply paranoid. I asked the nurse manager to arrange a meeting with whatever physician agreed to be in charge.

Mom’s doctor came in, sat at the conference table, and said, “Your mother is terminal. It would be kinder for all parties concerned if she winked out right here in the hospital.” Then he rose.

“We’re not done,” I said. I explained that we were under no illusions about her prognosis. But she was scared. And we wanted her to be able to die at home, with hospice.

Another doctor took over her care, one who was on the same page with us.

I knew then that hospice – still, after two decades – was poorly understood by lay people, and worse, by doctors. Having been responsible for communicating about a hospice program early in my career, I knew that hospice was not “giving up.” It was better care, more caring care. I knew my mother would want to be at home, looking out on her garden as it bloomed in the spring, surrounded by familiar things. Hospice was our best shot at being able to let her die at home, in comfort.

I offered to develop a pilot program under the auspices of the California Hospice Foundation to raise awareness of hospice among consumers. The “Friends of Hospice” public relations campaign was implemented successfully with the cooperation of three hospice programs and CSU Chico’s Tehama Group Communications in Chico, CA.

Sometime that fall, I talked to Fr. Greg Bonfiglio, president of Jesuit High School, about my transition. He asked,”Have you ever thought that perhaps you are being called to this work?”

Even after Dad moved to California in March 2006, I found that I still needed something beyond caregiving to provide meaning in my life. Maybe it’s that his needs weren’t that demanding. But I suspect more of it is what Mom recognized when she made her hospital bed speech and said that I was “competent, with a high level of activity.” It’s who I am.

As when Maddie and Tommy were young, I couldn’t completely let go of my own needs and focus only on theirs. Maybe it’s selfishness.  Some would certainly say that it is. I have a Puritan work ethic without the Calvinist self-loathing (as Dan Pallotta recently described it in his Ted Talk).

I wanted to make a difference in Dad’s world, and keep contributing to the broader world. That stake in the community was a source of strength that sustained me through the very hard times.

Next: What happens now, when the merry go-round of caregiving has stopped?

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