Middle age is when your parents are old

Dr. Jerald Winakur, who lives a few miles from me, but whom I've never met, was interviewed last week for National Public Radio's "Fresh Air." The topic was the essay that he recently wrote for Health Affairs,, "What are we going to do with Dad?" which was re-published in the Washington Post early this month.

Dr. Winakur, as a geriatrician, specializes in the treatment of the elderly. He's also an associate with the Center for Medical Humanities and Ethics at my alma mater, the University of Texas Health Science Center at San Antonio. But he is just as surprised by the realities of having elderly parents as any of us would be. He notes that even though he has the advantage of knowing the system and understanding the medicine, he still has daily problems with handling the realities of a father with dementia and heart disease and a mother who can't read pill bottles.

My mother was diagnosed with a very rare cancer (thymic carcinoma) last year. The body fights the cancer by making antibodies that also affect the muscles and nerves of the body, causing pain, confusion, weakness, and the respiratory crisis that landed Moma in the hospital, and which probably saved her life because it led to an early diagnosis. We believe that she's cured of the cancer, but the nerve and muscle damage appears permanent.

Like Dr. Winakur, I believe that one of the most dangerous places for a patient is in the hospital. In addition, I worry that Moma had an added risk factor: her daughters are medical professionals (my sister is an R.N., as is her daughter.) Sometimes it seemed as though this knowledge caused special treatment - but I'm convinced that at times it just got in the way and caused delay and assumptions.

Dr. Winakur mentions the blessing of dying peacefully in one's sleep, and the probability of dying due to the long term consequences of a fall. His story skips very briefly and lightly over the subject of euthanasia ("and perhaps this is one way our society will ultimately deal with its flood of elders in this age of limits.") and even suicide in the face of our own debilitation.

These last themes should be condemned. It is acceptable to admit to wishing for a peaceful and swift death in the middle of crisis and while watching a loved one in pain or when anticipating our own vulnerability. However, it is never acceptable to fail to argue against euthanasia or suicide.

Moma took to jokingly referring to herself as "She" in the third person, since techs, nurses and other hospital personnel would as my sister, my father, or me, "Is she....?," even though Moma was awake and right there. In the case of delirious or demented patients, it becomes difficult or impossible to engage the patient in making decisions about his own care, but that does not mean that he or she is dehumanized. When families and caretakers begin discussing "do about" rather than "do for" we move dangerously close to "do to."

(Note about my title: until a year ago, I thought of my parents as middle-aged, so I was not. Then, they started to have the diseases I associated with the elderly. I may be middle aged, now.)