Do Not Go Gentle...

Dylan Thomas wrote

Do not go gentle into that good night,
Old age should burn and rage at close of day;
Rage, rage against the dying of the light.
                               (“Do Not Go Gentle into That Good Night,” 1951)

He wrote the verses for his father, a former military man who was growing weak and frail with old age, a condition familiar to many who have cared for aging parents – and one that will become uncomfortably familiar to many of us as our own years accumulate. Thomas meant to exhort his father to fight against the ravages of age, to try to become strong and vital once more; like many of us, it hurt and probably frightened him to see the father who’d been physically powerful and a commanding presence become someone who was now going blind and unable to care well for himself. The failing health of a parent is not only a distressing event for adult children – because, really, we’re never completely ready to be without our parents, no matter how much we understand that this is the way life works; it is also a sometimes unwanted reminder of our own frailty and finite worth.

Today, I found an article in The Washington Post (http://www.washingtonpost.com/wp-dyn/content/article/2009/12/22/AR2009122202489.html) describing the last two decades of a pair of sisters - Clarice "Classie" Morant was 104 years old, and her younger sister, Rozzie Laney, was 92. Both women had been widowed for decades, and neither of them had had any children. For the past 20 years, the article explained, Classie, the older sister, had been caring for Rozzie, who had Alzheimer’s Disease. She had made a promise to her sister that she would never leave her, would always take care of her, and she kept that promise, up to the day that Rozzie died quietly, in her own bed, on New Year’s Eve 2008.

The sisters had nieces and nephews, who helped them to stay in their own home and out of a long-term care facility, by bringing them to appointments as they were required, by checking in every day by phone, and by visiting regularly. The physical part of Rozzie’s day-to-day care was handled by a caregiver (who herself was near retirement age), and although Rozzie could no longer communicate in any intelligible way, Classie spent hours talking to her and just loving her. Except for the presence of a caregiver, and her sister’s bed in a downstairs sunroom converted to that purpose, the women lived together as many people do – quiet lives, domestically-centred, and relatively content.

The article was accompanied by two photo essays, both of which are beautiful (http://www.washingtonpost.com/wp-dyn/content/gallery/2009/12/31/GA2009123101687.html and http://www.washingtonpost.com/wp-dyn/content/gallery/2009/05/08/GA2009050803459.html). Reading the article, looking at the photographs that accompanied it, listening to the audio tracks with the photo essays, I found myself wondering what my old age would be like. It’s not inconceivable, for instance, that I should live to a ripe old age – it’s not that longevity runs in my family. In fact, it does not. But neither are we prone to dying young. There have been people in my family who died much too young (an uncle on my father’s side, an aunt on my mother’s); but equally, there have been people who lived well into old age (an aunt on my father’s side who died at 92). I do come from a family of dubious genetic inheritance (heart disease, primarily, is of concern, as is hypertension), but I mitigate my risk factors: I don’t smoke, I drink in great moderation, I exercise (though not as much as I should), and I try to make healthy food choices. I have a spiritual and intellectual life that serve to keep soul and mind alert and that I believe will ultimately serve me well in my dotage, though that’s not the reason I engage these things. I engage them simply because I enjoy them – that scientists, behaviourists, and the medical community identify these two things as fundamental to a healthy old age is simply the proverbial icing on the cake.

As I get older, though, I wonder more about what my old age will bring. Will I be healthy? Will I, like my parents, wind up unable to care for myself and dependent upon others to do even the most basic of tasks for me? I already know that I would hate that – not so much because of the idea of being a burden on anybody, to be honest; but like my mother, the loss of dignity involved when someone else (anyone else) has to help you to get dressed, or to bathe, or to go to the toilet, is terrifying to me. As well, I, like many people, tend to be a bit of a control freak about my own life, and my person. I like being autonomous. I like making my own decisions about what to wear, where to go, what to watch on TV, what music to listen to, when to go to bed… when to roll over in bed, for goodness’ sake! What will my life be like if I am no longer that person?

There is a great tendency on the part of many to treat the elderly – particularly the disabled elderly – as if they’ve also suddenly lost their ability to think and to speak for themselves. I remember well being very angry when out shopping with my mother in the last year of her life, when she had to use a wheelchair because she could no longer walk following a stroke, because clerks in department stores would address me, when she was clearly the person making the purchase. I was always polite to them (my mother raised me well!) but always pointed out that it was, in fact, the woman in the wheelchair who had the disposable income and was making the purchase, and that they should address her. And when we left the store, purchase in hand, I invariably railed about it to my mother, because I was so insulted for her. I knew how much she felt she had lost with the stroke, and it angered me that suddenly she had also apparently become invisible.

My mother eventually wound up in a long-term care facility herself. She was very angry about it and felt more than a little betrayed by her children, who had “put” her there. We were ourselves guilt-struck about the decision to make this arrangement for her, but honestly, there was no other way. There were 3 of her 5 adult children living here, all of whom had outside employment and could not be at home with her during the day. Two of us had partners who also worked outside the home, and as for me, I was a single parent, working full-time and also in grad school. We cobbled together care as well as we could, employing caregivers to come in to be with her initially for a couple of hours in the morning and a couple of hours in the evening (wake-up and bedtime, essentially). We would be with her for as many intervening hours as we could, and we tried to make sure that weekends were spent more with family than with caregivers (though we did, in effect, become her caregivers as well).

Our mother’s physical care needs grew ever-greater, though, as her condition deteriorated, and the cost of caregivers, who were now needed almost 24/7, became prohibitive. Even had we been able to afford the many thousands of dollars each month which it would have cost to keep her in her little apartment, at this stage, it wasn’t the best choice because her medical needs were growing more pronounced as well. Simply, she had to be within easier reach of medical attention. She lived in the long-term care facility (I hate ‘nursing home’) for just about a full year before she died. Although she had been sick for several years, and we knew that she would not miraculously get better, her death, though ultimately peaceful, still felt sudden.

And so now, at what we might diplomatically term the midpoint of my life, I find myself wondering what the end of it might look like. I have a wonderful daughter who says, to my protest, that she will never ‘put you in a nursing home.’ While I appreciate the sentiment, my daughter is 22 as I write this, and the last thing on earth that I want is for her to become my caregiver by the time she hits 40, and given genetics, it’s not inconceivable. I’ve told her for years (most especially those years during which we lived out my mother’s last years) that when I become unable to care for myself, the only reasonable choice to be made is not whether a long-term care facility, but rather, which one. I don’t want my daughter bathing me, or diapering me, and I know from experience what it feels like to be the daughter who does it. It breaks two hearts.

And yes, I know that she would do that for me as I did it for my mother – with great care and greater love, protecting as much of my tattered dignity as she could. She would do for me, as I did for my mother, and care for me tenderly, remembering the hundred things that my hands had done for her as if they were on autopilot.

That’s only one aspect of old age, though, and that’s not even the frightening one. If it happens, then it happens, and while I will do as much as I can to take care of myself in a way to reduce my risk factors, doing that is no guarantor of success. The thing that frightens me is being old and alone, in a little apartment, seeing few people, and being poor. It’s difficult to make a retirement plan when more than half your working life is spent as a single parent, generally with not enough money for living, much less for saving. I’ll have a pension, I hope – unless the Canada Pension Plan goes bankrupt by the time I need it. But there is what they call superannuation from my workplace which, cobbled together to CPP, should allow me at least to live. The question of how well I will live is an interesting one. I make jokes about being able to afford only the no-name cat food (not for a cat, either), but they’re tinged with a wee bit of anxiety, because what if that is what my reality will be in my old age? I don’t anticipate a retirement full of travel, or a subscription to the symphony; I worry that it’s going to be a subsistence existence. Should I retire from the federal government at the end of my working life, then I will at least have retiree medical benefits, which will be a help should I need greater than average care.

What I do know is that if I am well enough to keep out of a long-term care facility, it is almost certain that I will not live with any of my sisters, or with my brother. It’s not that I don’t love them, or that they don’t love me; rather, it’s that they have their lives, and I have mine. We don’t actually take care of each other now, so why would I expect that to change when I’m 75 or 80? What if the shoe were on the other foot – would I care for an elderly brother or sister to keep them out of a long-term care facility? Well, yes, I believe I would – on the other hand, my siblings also have spouses, so it’s unlikely that they will need me, even if I am the healthy one of the lot of us (that in itself might also be questionable, but I am the youngest!).

My friend Andrea and I have talked about this, and we each agree that we can picture ourselves as little old ladies, living together in a small house, and taking care of each other in the way that friends do. Our children would come to visit us, and perhaps we would go to visit them as well, but our lives, we imagine, could be bound to one another through choice and not necessity. We each agree that barring the possibility of by that time having established a long-term romantic relationship with some as yet unknown man, the only way to have more than a subsistence existence when we are old is to live with someone else. Andrea and I have a lot in common and enjoy doing many of the same things, so in theory this could work… but I’m not really going to know until the time comes. Perhaps right now, it’s just a bit of a comfort to have this possibility as an option – though I’m not sure whether or not it’s truly realistic.

Robert Browning wrote

Grow old along with me!
The best is yet to be,
The last of life, for which the first was made:
Our times are in His hand
Who saith "A whole I planned,
Youth shows but half; trust God: see all, nor be afraid!"
                                                   ("Rabbi Ben Ezra," 1864)


And so my question, then, is… what of those who have nobody with whom to grow old? Do they become invisible as they eke out a meagre existence, marking time until they die? And without some sort of financial security, how is anything else possible?