When Death Knocks, And Knocks, And Knocks

When you reach your 50s, as Kish and I have, part of life is dealing with death.  Whether it is more senior members of your family succumbing to age-related conditions, or colleagues who die in inexplicable, tragic accidents, or friends who finally are taken down after long battles with cancer, at some point death becomes a significant, unfortunately recurring part of the reality of your life.

IMG_1087The question is how to deal with the losses, particularly when the deaths come in bunches — as so often seems to be the case.  People find themselves grappling with complex combinations of emotions that they don’t typically experience at the same time — such as grief, and guilt, and also anger — and everyone needs to deal with them in their own way.  When multiple deaths hit in a short period of time, and strike down people who are about your age, you can’t help but think of your own mortality, and wonder. 

Kish and I try to go to calling hours or memorial services, as a kind of tangible sign to the surviving family members of the significance and impact of the departed; I’m not sure whether the family members appreciate it or not, but it makes us feel better.  Collecting your thoughts about the person, mentally composing your own personal tribute, and focusing on the good, also seems to help.  And as we’ve gotten older, and seen how people respond to such losses in different ways, I find that I’ve become a lot less judgmental and a lot more accepting about how people respond.  

Ultimately, though, you just hope that the period of bad news finally ends, and a period of good news begins.  We’ve got a family wedding coming up, and we’re looking forward to it.

My Periodic Glimpse Of The Aging End Game

With Mom in an assisted living facility, my visits to see her have exposed me to the impact of old age in ways I’ve never seen before.  It’s been an eye-opener.

Typically my interaction with the residents happens in two scenarios — coming and going, and in the dining room.  When you enter the facility, you pass outdoor benches and rockers.  If the weather permits, there are usually some residents outside.  Most of them are smokers.  It was a bit jarring the first time I saw 85-year-old women dragging away on cigarettes, but the smokers probably figure what the hell — why not, at this point? Curiously, the smokers seem to be among the residents in the best overall shape.

IMG_1147Many of the other residents are congregated in the large common room near the entrance.  Some of them are in wheelchairs, and most of the rest use walkers.  Some are sleeping — usually deeply, often with heads back and mouths wide open — and others are just sitting.  Although there usually are many people in the room, there typically isn’t much conversation.  Even when I walk in on an event, like a bingo game run by a chipper assistant or an accordion performance, many of the residents are disengaged.

Some residents still get dressed up and take care with their appearance, and others have just let it go.  You’ll see women in make-up and jewelry and coordinated outfits and others who just wear loose shifts.  Some of the people clearly are with it, and others aren’t.  Recently, when Mom was still down in the dining room when I arrived, I sat at her table with a cheerful woman who, upon being introduced, immediately told me that she had no short term memory.  Within a minute, she repeated herself several times.  She clearly was aware of her condition, but there was nothing she could do about it.

Mom’s assisted living facility is a nice place, as such facilities go.  It’s kept very clean, the meals are well-prepared, and the staff members are friendly and attentive and work hard at what has to be a very tough job.  Most of the residents seem to have accepted their situations and are . . . waiting, and trying to make the best of things.  They can’t take care of themselves, their spouses are gone, and they really don’t have any good alternatives.

Even though I’ve been visiting the place for more than a year, I’m still sorting through my reactions to the very complicated issues raised by the end-game scenario.

AIDS And Alzheimer’s

The New York Times has a thought-provoking piece contrasting the public health reaction to AIDS to the public health reaction to Alzheimer’s disease.

The article notes that this year AIDS has fallen out of the list of the top 10 causes of death in New York City — replaced by Alzheimer’s.  In fact, the article reports, research now indicates that deaths attributable to the latter disease are grossly underestimated and that it may be responsible for nearly as many deaths in one year as AIDS has been in the more than three decades since its terrible emergence.  And yet, while AIDS research remains a public health focus supported by a robust social movement, there is no similarly active movement lobbying for increased Alzheimer’s research, prevention, and treatment.  Why?

IMG_2947Although the article correctly points out the success of the fight against AIDS as a public health movement, it was not always that way.  In the early days of AIDS, there was a lot of denial and politicization of the underlying health issues, discussed in appalling detail in the excellent book And the Band Played On:  Politics, People, and the AIDS Epidemic, by Randy Shilts.  It wasn’t until people got past the denial and politicization and focused on the awful public health cost of AIDS that effective education, prevention, and ultimately treatment programs were developed.  The fact that the disease was so terrible in its toll, and cut down our friends and family members in the prime of their lives, helped to drive the public health effort.

With Alzheimer’s, the toll of the disease is great, but the catalyzing circumstances that energized the fight against AIDS seem to be lacking.  Alzheimer’s is an affliction primarily of the elderly, who are regarded as already in their twilight years.  It’s a painful and somewhat embarrassing disease for surviving family members to deal with, as the victim gradually loses his mental faculties and all memories of loved ones.  So far as we know, Alzheimer’s is not readily communicable, and we’ve already got facilities in place where those unfortunate souls who become debilitated can be kept and cared for while the disease does its grim and inexorable work.  Those different circumstances, perhaps, explain why Alzheimer’s simply doesn’t command the same kind of attention that AIDS received.

Or, alternatively, it may be that these factors have simply kept Alzheimer’s in the denial stage for a much longer period, and only now are people finally confronting the disease and its awful consequences, which leave formerly vibrant people empty, haunted shells of their former selves.  The aging of the Baby Boom generation no doubt will help to increase awareness and attention.  I hope so, because the clock is ticking, and the prospect of contracting Alzheimer’s should scare the hell out of us.

Facebook And The Arc Of Coolness

There’s been lots of chatter lately about the future of Facebook. Millions of teenage users apparently are no longer using the social media network. Some Princeton researchers have concluded that social networks are like communicable diseases that infect people rapidly then just was quickly burn out; they predict Facebook will lose 80 percent of its peak user base by the 2015-2017 time period.

There’s no doubt that Facebook is not as cool as it once was, but that result always was inevitable — because nothing stays ubercool for long. The equation of coolness is simple: young people add to coolness, and old people who aren’t rock stars detract from it. Once Moms and Dads and people in their 60s started to use Facebook to post boring pictures, send inspirational messages, and attempt to make “hip” comments about their kids’ drunken selfies, any self-respecting youngster would realize that the coolness luster was gone . . . and move on to the next big thing.

That doesn’t necessarily mean that Facebook is doomed. My guess is that Facebook wants to end up as a kind of utility — that is, an invention that initially is cutting-edge and used by only a few people and later becomes so broadly accepted that it is unconsciously integrated into everyone’s daily life, like the electric light or the telephone. iPads might not be as cool as they once were, but does Apple care if they are being sold by the millions to uncool people in the business community who love the idea of a lightweight device that they can customize to meet their unique business and personal requirements?

The key for Facebook, or for that matter any other form of social media, is whether it can make that transition. If Facebook sticks around and keeps that critical mass of users, will those coolness-sensitive teens return to the Facebook fold when they hit their late 20s and realize that the social media network is a really handy, one-stop place to keep in contact with high school buddies, college friends, and former co-workers, remember their birthdays, and have some sense of what they are doing with their lives?

When You Realize You Are Completely Out Of It

One of my mentees and his wife have welcomed a new addition to their growing family.  The baby’s name will be Maxwell.

I wanted to make a mild joke about the newborn with my other mentees, so I asked them whether they thought it would be appropriate to get little Maxwell a silver hammer.  In response, I was greeted with absolutely blank stares.  “I don’t think a hammer would be an appropriate gift for an infant,” one of my mentees politely responded.  “Is there some kind of tradition involved in giving a hammer to a child?” another asked.

“You know, the Beatles song,” I prompted.  Additional baffled looks.  “Maxwell’s Silver Hammer?”  I added.  More uncomfortable silence.

Occasionally, an incident occurs that crystallizes the fact that you are getting incredibly old, and the common cultural touchstones that used to be assumed in every conversation are common touchstones no more.  My references to Beatles song have no more resonance with my 20- and 30-something mentees than the latest Jay-Z song (assuming Jay-Z is still a popular artist — which I of course am blissfully unaware of) would have with me.

Abbey Road

Tonight, as we ease into the weekend, I decided to listen, again, to the Beatles’ timeless Abbey Road.  It’s only, say, the 10,000th time I’ve listened to this album, which has been a staple on my music rotation since it was first released.  It’s one of the few pieces of music I’ve listened to consistently over those 40+ years, from the teenage years through college, to the D.C. era, the early family years and now to my mid-50s.

As I’ve listened to the music over the years, my perspective has changed.  At first, I just loved the music because it’s great music.  In college, I listened in fervent hope that the Beatles might reunite and create more fantastic music like this.  By the late ’80s, when CDs replaced albums, Abbey Road was one of the very first CDs I bought, because the album is an absolute foundation stone, an essential element of any collection of modern music.

Tonight I listen, marveling at the extraordinary musicianship of this group of four British lads and thinking hard about what it must have been like, in the late ’60s, to be in the studio when the music first came to life.  At that time, the Beatles were at the absolute pinnacle of popular culture, in a way no single person or act has been, perhaps, before or since.  Their every move was flash-bulbed, their every every lyric and note was scrutinized, and their every album was breathlessly anticipated by millions as yet another opportunity for the Beatles to break the mold, bend the arc of popular music and culture, and move the frontiers forward.  What must it have been like to write a song under those conditions?  What must it have been like to know that, by sleeping in an Amsterdam bed or being photographed with a new girlfriend or attending the show of a new act you could control the stories that appeared in tomorrow’s headlines?

And I think, as I listen to side two of Abbey Road, which has been my favorite piece of music during those 40+ years, period, I wonder:  what must it have been like to sit in that Abbey Road studio, at the very peak of the popular world, and think:  “Hey, let’s combine all of these great songs into one continuous song, blending seamlessly one into the other” — and know that you have the complete, unfettered freedom to do something like that because, for you, at that moment in time, there are no boundaries whatsoever?

Yes, It’s November

It is November 1.  Today many Americans will shake their heads sadly and say to a loved one, co-worker, or friend:  “Wow, can you believe it’s November already?  This year really has flown.”

If you find yourself making such a scintillating observation, you need to face facts — you’re obviously getting up there.  There is no surer sign of aging than remarking ruefully on the rapid passage of time.  AARP enrollment scouts that have infiltrated the general population listen for such comments and immediately arrange for membership mailings to be sent to the speaker.  Salesmen of retirement planning products target such people for detailed sales presentations on the merit of annuities.  You may as well make permanent reservations at the “early bird” sitting at the nearest inexpensive cafeteria that gives the Golden Buckeye card discount, lay in a lifetime supply of bluing rinse, and hitch your trousers up to nipple height.

In case you’ve forgotten, young people never say such things.  If they even notice that another month has gone by, it’s probably because it means that Christmas is another month nearer and, perhaps, it’s time to start behaving so they have a reasonable chance of being rewarded by Santa Claus.  Or, they are excited about Thanksgiving and seeing whether they can eat even more turkey and mashed potatoes and pumpkin pie than they did last year.  Or, they’re in high school or college and are looking forward to that long winter break when they can sleep in even later, get together with their friends, and worry their parents when they don’t come home until 2 a.m.

So, if you’re tempted today to express sad surprise that November is here, do yourself a favor and refrain.  You’re only demonstrating that, mentally at least, you’re far along on the road to geezerdom.

The Fertility Factor

On Friday former Florida governor Jeb Bush — who apparently is entertaining notions of a run for the White House — gave an interesting speech on immigration in which “fertility” came into play

Bush is a proponent of immigration reform who believes that immigration is good for the United States.  (Of course, it’s hard to argue with that proposition, in view of the fact that the vast majority of Americans trace their family trees to hardy, self-sacrificing, risk-taking immigrants.)  In making the economic case for reform, Bush noted that immigrants start more businesses, have more intact families, and are more “fertile” — leading to a younger population.

Odd to hear politicians talking about “fertility,” isn’t it?  It’s a subject that makes people uncomfortable.  Those of us who lived through the “population bomb” era remember the dire predictions of mass starvation, food riots, and other threats from overpopulation, so how can having large families suddenly be a good thing again?  There are socioeconomic and religious and other factors at play as well.  Unmarried teenagers are fertile, but we aren’t encouraging them to have babies to help the country grow.  “Native-born” Americans, to use Bush’s phrase, are fertile, too — in the sense that they are physically capable of having children — but many of them have taken steps to control that fertility in order to end up with manageable families they can provide for.  Those families think they are being responsible.  Is Bush suggesting, instead, that they are being selfish and unpatriotic?

The mathematics of population growth, maintenance, and decline are indisputable.  Around the developed world, there are countries that are shrinking, with birthrates that are too low to fully replace those who die.  The demographic reality has a devastating political impact, because without young people to pay for the generous retirement and health care and housing programs for the aged, the social welfare model becomes unsupportable.  That’s why many countries with low birth rates are taking steps to encourage young couples to have larger families.  Have more children, so they can grow up, get jobs, pay taxes, and help those long-lived seniors enjoy their comfortable retirements!

Perhaps America will join the list of countries that provide economic incentives for larger families — or perhaps we’ll achieve that result through policies that welcome more of those “fertile” immigrants.  Either way, look for “fertility” to be an increasing topic of national conversation in the years to come. 

The Dog Years Apparently Have Been Hard

Thanks to everyone for their expressions of concern about Penny.

We learned today that she has advanced arthritis in one leg.  The Vet was surprised, because Penny is only six years old.  Using the familiar dog-years-to-human-years equivalence ratio, she’s about 45 years old — and how many people of that age are dealing with arthritis?

Fortunately for Penny, The Vet assures us that the condition is manageable with medication and a reduced exercise regimen.  This means that Penny will never again take a morning walk around the Yantis Loop.  I’m sure it will be an enormous struggle for her to stay home with Kish rather than hoofing it a few miles before the sun comes up, but I’m confident that eventually Penny will able to deal with that loss.

In the meantime, Penny has shown a sudden and curious interest in going to Early Bird specials at local restaurants, getting a bluing rinse the next time she goes in for a grooming, and driving 25 miles per hour in a 65 m.p.h. zone.

Dying With Dementia

Several recent studies about dementia among America’s aged are profoundly disturbing — especially for those of us who aspire to live to a ripe old age.

IMG_1111One study, by the Alzheimer’s Association, concludes that one in three elderly dies with Alzheimer’s disease or some other form of dementia.  The dementia does not necessarily directly cause death,  but does contribute to an earlier demise because the senior forgets to take her medication, or is unable to recognize symptoms that should lead to prompt treatment.  Another study, led by an economist from the RAND Corporation, concludes that 15 percent of Americans over age 71 — about 3.8 million people — have dementia, and that number will increased to 9.1 million by 2040.  The study also found that the direct health care costs for dementia patients, at nursing homes and other care facilities, is $109 billion, and the costs of care also are expected to increase dramatically.

As a society, we must worry about how we are going to pay for such care, but as individuals we worry about becoming one of those statistics.  If you’ve been around someone with dementia, you realize it is an awful way to go.  So many of the afflicted appear to be perpetually frightened, or angry, or both.  They don’t recognize family members, or understand when people are trying to help them.  The disease works terrible, fundamental changes to their personalities and characters, turning the quick-minded former executive into a simpleton or the happy, encouraging aunt into a bitter font of hateful, deeply wounding comments.

So much of life’s joy and richness comes from our interaction with spouses, children, and loved ones; what must it be like to be stripped of those pleasures, left to cope with strangers with only a dim understanding of who you are and why you are there?  It’s a depressing, terrifying prospect.

Looking Older

Russell will be coming home for a few days later this week.  It will be good to see him — and to subject him to the initial parental once-over.

IMG_3183If you’re a parent, you know what I mean.  When your children leave home and you see them only once in a while, you can’t help but give their familiar faces some careful scrutiny the next time you see them.  The passage of time always brings a fresh perspective.  Usually my reaction is:  they look and act so much older, like the adults they have become.  The chubby cheeks and white-blond hair of childhood are long gone, replaced by the visage of a mature, functioning twenty-something who is in control of his life.

With this visit, though, I suddenly realize that the tables may be turning.  When I was a twenty-something living in D.C. and came home for a visit, I remember looking at my parents and thinking that they were the ones who were looking older — a bit grayer, a bit more lined, a bit more stooped, and a bit more deliberate in their actions with an occasional wince as they rose from the kitchen table after dinner.  When Richard and Russell come home for their occasional visits these days, will they now be checking us out and seeing those telltale signs of age?

I’m going to have to pay more attention when I look in the mirror this morning as I get ready for work.


You know you’re getting old when your health issues have that distinctly aged, slightly decrepit feel to them.

IMG_3032Today I went to see my doctor because recently the hearing in my left ear has been somewhat muffled.  The doctor looked in my right ear with that ear examination gizmo, pronounced everything A-Okay, then took a look in my left ear and said “Whoa!”  When your doctor says “Whoa!” it’s never a good sign.  The doctor then explained that there was so much impacted wax in my left ear that she couldn’t see the ear drum.  The nurse came in, irrigated my left ear with some kind of solution, and withdrew a hard, disgusting black bullet of ear wax.  Now my inner ear is just full of the solution, and we’ll have to wait until it evaporates.

Why do we have ear wax? I asked the doctor, and she said it serves the same function as snot — it’s supposed to trap bacteria, germs, and other bad things that are trying to invade your body through every open orifice and then fall away.  That’s why the defenders are sticky.  Sometimes, though . . . and typically in the (ahem) older population . . . the ear wax gets impacted, and it interferes with ear functioning rather than helping it.  How can you try to avoid it?  Her advice is to not clean your ears beyond using a washcloth to swab down the outer ear.  Anything inserted into the ear itself might just shove the wax back, leading to waxy build-up and impaired hearing.

Fortunately, the doctor didn’t offer me an ear horn.  I thought about my impacted ear wax problem and other likely age-related ailments as I buttoned the top button on my shirt, hitched my trousers up to nipple height, and hurried off to the Early Bird special at the MCL Cafeteria.

Picking Out A Skilled Nursing Facility For A Loved One

You’re happy that your loved one has survived a serious health problem — then you realize with a jolt, perhaps with a nudge from a social worker, that you must figure out where that person will go when they are discharged tomorrow.  But . . . how do you decide where?  We haven’t been trained for these kinds of decisions.

Although hospital social workers won’t express an opinion, they’ll give you names and, if you live in Columbus or another metropolitan area, probably will tell you that you’re lucky because there are many options.  Sometimes, however, broad choice can be less a blessing than a curse.  How do you narrow the field down to the one place that is the best choice for your loved one?

photo-89There’s lots of information out there, but what does it mean?  There are ratings on-line, but how are they developed?  If you’re in your 50s, talk to your friends and you’ll learn that many of them have already gone through the process with their parents.  They may recommend a place or warn you away from a place that they describe, in awful terms, as a kind of institutional hell on earth.  You appreciate the warnings, but it also scares you to know that such places may exist and a bad decision may land your loved one there.  The significance of your decision seems increasingly overwhelming.

So you go visit places, because everyone says to do so — and you realize that the places look pretty much the same.  There’s a chipper female administrator who takes you on a tour.  The facilities are ranch-style, with no stairs, and are brightly lit and decorated.  You hear about the therapy equipment and nurse-and-therapist-to-patient ratios as the professional staff walk briskly past, look in at a resident’s room that looks just like the resident’s room you saw in the last facility you visited, and scan the therapy room with its machines and balls and mock stairsteps.  They all look pretty much the same, too.

You see the residents, of course.  After the initial shock of seeing crumpled figures in wheelchairs and beds — poor, hurting, older people unlike the healthy, vigorous folks you see every day — you realize that’s why the facility is there.  You can’t disqualify a place because you encounter a groaning older person gesturing at you with an outstretched, scrawny, grasping arm and a haunted look in their eyes, because virtually every place has them.  You just try not to imagine your loved one eating next to that poor soul, because you can’t.

You soon understand that the tours and the chipper administrators and recommendations and warnings from your friends can only get you so far.  How can you tell whether this place, or that place, has the kind of patient, upbeat therapists who can give a scared, exhausted person the incentive to get out of bed and try to walk again, or talk again, or use their injured arm?  How do you know how the food will taste if it must be prepared in low-sodium, pureed form because your loved one needs to relearn how to swallow — and is it even possible for bland pureed food to be appetizing?  How do you know whether the seemingly competent staff will really pay careful attention to your  loved one, rather than the angry man causing the commotion three doors down?

You really can’t know, of course.  It’s an impossible decision that you must make, but you do the best you can, trying to weigh the competing considerations and hoping that your instincts move you in the right direction.  Mostly, you hope.

Savoring Summer Fruit

I had my annual (well, occasional) physical last week, and saw the concerned face that our family doctor probably puts on whenever he talks to a guy in his mid-50s who has a desk job.  There was talk about test results (normal, whoo-hoo!), aging-related diagnostic checks (an MRI to evaluate plaque build-up in blood vessels), and statistics that show that, for men, the late 50s are the danger zone for heart attacks, strokes, and other unwelcome forms of sudden death (yikes!).

Inevitably, the discussion turned to diet.  Time to eat fewer juicy cheeseburgers and more dry, unadorned fish and chicken!  Let’s try to choke down more leafy green vegetables, shall we?  And watch out for those evil “empty calories,” too, while we’re at it!

Fortunately, the good doctor also recommended that I eat more fruit.  No problem!  I felt proud of myself when I drove to the neighborhood grocer and, following doctor’s orders, bought fresh raspberries, strawberries, blueberries, and melons for some welcome, juice-dribbling-down-the-chin goodness.

With this group of fruit choices, timing and sequencing is crucial.  You always start with the raspberries, before they get soft and soggy, when they still have the crisp snap as you bite into them and savor their tart flavor.  Then you move to my favorite, strawberries, perform the necessary surgery on the stem remnants, cut them into sections, and gobble them down — in my case, typically on a bowl of Corn Flakes or Rice Chex.  Next up is the blueberries, to pile heaping spoonfuls into your mouth and get that explosion of flavor as your teeth breach the skin of the fruit.  And finally you reach the melon, after a few days of ripening, scoop out the seeds, and then enjoy the succulent spoonfuls of sweet melon flesh.

These are some of the best tastes of summer, which is the golden season for local Ohio fruit.  If only every instruction from my doctor were so easy to follow!

Laugh, And Live Long — Maybe

Yesterday I noticed another news story about another study about longevity.  This one says that people with a sense of humor and a positive outlook live longer.

That sounds good, I thought.  I like to think I have a good sense of humor, I enjoy a hearty laugh as much as the next person, and I have a positive outlook about everything except my sports teams, politicians, and the outlook for the world at large.  Maybe I’ll live longer!

But then I started to think about how many of these longevity studies are released every year.  I think it’s because the Baby Boomers are growing older, and researchers vying for government funding figure that aging saps like me are suckers for reading about such studies in hopes of finding the Fountain of Youth.

Each longevity study evaluates some different characteristic, habit, practice, or genetic trait.  It makes things so confusing!

How do we know whether longevity is really tied to sense of humor, or to so many minutes a day of vigorous walking, or to drinking regular glasses of wine, or to avoiding cyclamates and red dye no. 2 — among thousands of things that have been the subject of such studies?  How can I precisely align my diet, exercise regimen, and daily activities to maximize my chances?

I don’t understand how, from a scientific standpoint, you can possibly screen out the influence of all other factors and determine that one activity, item of consumption, or quality is the crucial attribute that puts you over the top.  In fact, I think human beings are such complex organisms, and our daily lives involve interaction with so many different things, that even trying to figure out what causes long life is an exercise in futility.

I think that means that if you like to laugh, laugh — just don’t expect that it’s going to be the key that unlocks the door to some day being recognized by the Guinness Book of World Records as Earth’s oldest human.

Gee, I guess maybe my outlook isn’t so positive after all.