By Karen Oslund
It is a tradition in my family that when we get old, we keep driving long past the time when we shouldn’t. This triggers anxious conversations among our progeny about what to do. Who is the right person to have “the talk” with Grandma, or even take her keys away?
Aging and the indignities that accompany it will come along for all of us if we are so lucky as to live a long life. Why is it difficult to discuss it candidly and make realistic plans for the phase of life when frailty or illness make it impossible for us to live independently, safely?
In the libraries of both offices of the Cancer Resource Centers of Mendocino County, there is one book on the shelf that I wish every adult in Mendocino County would read. It is “Being Mortal,” by Atul Gawande. This book is a loving, realistic and personal reflection on end-of-life issues from the perspective of a physician, son, father and husband. It is not morose or depressing. Gawande is a gifted writer as well as a surgeon. He draws on personal experiences from his profession, his culture, and his own family to give engaging examples of how people cope with age and illness in both elegant and disastrous ways.
I have given this book as a gift to puzzled family members for Christmas, who look at me strangely and ask, “Are you trying to tell me something?” Because this book deals with the complex cultural and emotional forces that work to keep every human being alive for every last possible minute using every intervention that modern science and medicine have made available, even though most of us say that is not what we want. Most of us imagine a peaceful death at home surrounded by our loved ones. According to Gawande, as recently as 1945, most deaths did occur in the home, but by the 1980s, just 17 percent did.
At the Cancer Resource Centers, we work with many clients who are dealing with these issues, some of them sooner than they ever thought they would. Gawande discusses the financial burden of healthcare in the last months and years of life, but also its emotional burden. “The question is not how we can afford this system’s expense, it is how we can build a healthcare system that will actually help people achieve what’s most important to them at the end of their lives.” The conversation Gawande suggests we have as a family and as a culture is exactly that one: What do we want at the end of our life? What do we want for those we love?
It is a difficult conversation to have because it forces us to confront that we, and our loved ones, will not always be together on the planet. In my mid-fifties, I am fortunate to have both my parents alive and well. I love them and, yes, it is difficult to imagine life without them. One opening for this difficult conversation for us has been a discussion of what occurred during the aging and passing of their own parents: “How can we do it better?” Most parents want to make things easy for their kids. This could mean downsizing to a smaller, accessible home close to shopping in anticipation of the day when they can no longer drive, or moving closer to family.
There are challenges related to aging in our society that are more mechanical than emotional. We live in a car culture. In most households, all of the working-age adults have jobs outside the home. We treasure our independence and privacy. Senior living options are limited in a rural area. We can all bring to mind examples of people we know who wrote a beautiful final chapter for themselves. Using those people as a model for what we want is a great place to start.
There is plenty of summer left, so add this book to your summer reading list: “Being Mortal,” by Atul Gawande. Find a hammock, a chaise lounge, or some shade under a tree. Then, gift the book to a family member and have the talk. Your family will be better off in the end.
The Cancer Resource Centers’ Cancer Awareness and Prevention series is sponsored by CRC in collaboration with the Mendocino County Health and Human Services Agency. This information is presented for educational purposes and is not intended to replace the advice of your health care provider. We encourage you to discuss any questions or concerns you may have with your health care provider. The Cancer Resource Centers of Mendocino County is a grassroots organization serving our communities since 1995 by providing information, advocacy, and support services free of charge.