The Fifth Wheel

Her husband died one year ago tomorrow. She says she still looks up from her thoughts to the chair near the door, thinking he’ll be sitting there, ready to respond. She listens to his voice on the answering machine just to be with him for an instant.

I asked her how it feels—to be without him. She indirectly answered my question, most likely with what she feels most strongly this moment.

“It’s like being a fifth wagon wheel,” she said. Her life used to be busy. Her children demanded her time and attention. Her husband needed her. Her vision, hearing, and physical strength were all in tact—once upon a time. Now, she said, she can’t do much. The bustle has been filled with emptiness and quiet. Her children are all grown up and have their own lives and their children to stay busy with.

A fifth wheel is unnecessary until something happens to interrupt the function of the other four.

I can imagine countless fifth wheels out there, waiting or thinking of ways to cause an interruption. Most family members or friends shrug it off with frustration, assuming he or she is old and crotchety—an extreme form of their younger selves. But really, it may be a loneliness so deep that it is indescribable any other way. Maybe someday our society will come up with a better solution to this end-of-life loneliness, this time when people are dealt with a universal slowness to life during which everyone else seems too busy to join them.

Bitter-Sweet Discoveries

Memorial services are a time of blurry emotion: family togetherness, tearful reflection, heartache, joyful connection, regret, hopeful blessing.

A brother and two sisters, with one parent lost in the recent past; another lost just three days before. They knew a childhood filled with their own interpretations, their own reactions, their own truths. They often found themselves focusing on the difficult rather than the pleasant.

This day offered an unexpected treasure, a retelling of the best of times through a process of creative redesign. Their parents came alive again—the story of their marriage shared with strangers and heard by children as something they did not know before.

It was a day of discovery. It was the perfect way to say good-bye.

The Importance of Family

It is amazing . . . how human life works. Children grow into adults. Adults meet other adults. They have children. They grow old. Their children care for them, almost switching from a son or a daughter to a father or a mother.

Today I saw the grace and strength of a daughter coaching her mother on how to think about the future. The mother's husband, and daughter's father, suffers from dementia. The mother has admitted that wondering what her husband will need in the future is something she has not yet done—something she is afraid to face.

Today I saw this daughter look into her mother's eyes with a deep concern and a gentle force. She rubbed her mother's arm with reassurance and reminder. "Someday, not long from now, he will have to leave your home and be taken care of by someone other than you." This is what her eyes, and her hands, told her mother.

It couldn't have been easy for the daughter to do this, and to feel her own sense of fear of reality. But in this moment she rescued her mother. She was the grownup to say the words out loud, to introduce the unwanted, and to pose the possibility that, in the end, this is what will be best for him. She allowed her mother to be a fragile child, to want to say "no" without even thinking first, and to reach up with fearful arms asking to be carried.

This is the beauty of being a family.

The Healthcare Puzzle

I spend much of my days assessing and counseling family and home situations to make it possible for older adults to stay independent in their own homes for as long as possible. But sometimes hospitals, clinics, skilled-nursing facilities, and other forms of outside-the-home health care services are necessary and important.

The question marks about the future of our health care system and, specifically, about available options for quality and affordable care to our elders, ring in my ears at night. What will the future hold for my clients, my friends and family . . . and for me?

This video of an interview from The CEO TV Show is helpful in considering the possibilities. George Halvorson, Chairman and CEO of Kaiser Permanente, talks about the flawed puzzle pieces of our nation's current approach to providing healthcare services. He discusses how to get ahead in terms of addressing issues before they become crises, how to level the playing field, and how to lower costs.

Only the Beginning

Most days my work involves entering into people’s lives where they live—in their home, their apartment, their room. Being granted this privilege means I am privy to their personal life, their family, their reality. While I enter with and maintain a hyper vigilance to all that I might observe and note, mostly I listen. I listen to what is said to me and what is said to others; and I listen for the opportunities to ask the better questions that might help me learn more about each person’s truth.

I arrive prepared to deal with almost anything. I walk into the home and family situation with no preconceived ideas about what I might encounter. I enter with peace and I demonstrate respect.

Because I’m not family, I often am able to get to the issues that the family members cannot see or hear or even be told. Family relationships of every ilk are so thick, and dense, and fragile, and pure, and true, and old, and new, and scary, and full of anger and history or no history at all. For any or all of these reasons it is difficult for family to hear and to know the truth that an old, vulnerable person needs to say or to be told.

Dialogue, unconditional regard for self and other, and compassion are the components of relational unity; they are fundamental to a non-violent approach to practice. This is my approach to elder care, and I apply this practice to long-term care planning, palliative care, and end-of-life care.

I hope to share my own experiences in working with elders and families and I seek comments from others who have experiences and perspectives to share. I invite a dialogue with the world about growing old, caring for the old, and anything worthy to share or question about this process.

All of us will either die young or grow old. We might as well live fully and share a little love and respect along the way.