Living in the Land of Limbo

This is not an impartial review. I’m a great admirer of Carol Levine’s work on family caregiving. Though we’ve never met in person, Carol has written seven terrific posts for Over 65. But despite my conflict of interest, I guarantee that if you read Living in the Land of Limbo: Fiction and Poetry about Family Caregiving, the book she compiled and edited, you’ll agree with me that it’s gripping and original!

The 35 stories and poems are organized into five sections based on the relationship of the caregiver to the person needing assistance: children of aging parents; husbands and wives; parents and sick children; relatives, lovers, and friends; and, paid caregivers.

The introduction tells readers the “story behind the stories.” Continue reading…


Fathers, Sons, and Books

In November, 2012, I wrote a post about my mother’s hospice care. Mom died peacefully on January 6, 2013 at the age of 93. This post is about my father.

Over the past three weeks I have spent more “quality time” with my father than ever before. We have had a lot to review about both the past and the future. The last time we spent this much time together was in the mid summer of 1961 when the two of us hastily drove together from Waco, Texas to Columbia, South Carolina and back again on a mission to find a new home to buy in time for my siblings and me to start school. I was the recent owner of a driver’s license and could share the driving on a non-stop trip of a thousand miles in both directions. My mother demonstrated an enormous amount of trust when she let us pick her next home. The task was neatly accomplished; our new home exceeded my expectations and was just a few hundred yards from my new high school. The real payoff for me was the beginning of a new relationship with my Dad as a collaborator to accomplish something that would have been hard for him to do alone.

The last 18 months since my mother’s death have been very difficult for my father. Continue reading…


Perry’s Graduation

My granddaughter Perry graduated from high school in June. It was a wonderful event on a beautiful day and she made us proud by winning a prize for her work in the social sciences. What made that event extra special was that she has lived with us for all of her 18 years, and this event was her first step toward leaving the family, going off to college.

Perry’s mother had died of a pulmonary embolism a day after her Perry’s birth in California where my son Peter was trying to make a career as a screen writer, a hard way to make a living. There seemed nothing else to do than to bring them home. Some six million grandparents help raise grandchildren, so there was nothing new to that.

But it was new to us, who had thought our nest had emptied years earlier. Continue reading…


Seventy-five Year Old Doctors Talk about Death

Here’s what George Eliot wrote in Silas Marner about how the elderly contemplate the prospect of death:

“…it is often observable, that the older a man gets, the more difficult it is for him to retain a believing conception of his own death.”

I observed the opposite at my fiftieth medical school reunion in June.

In a multitude of conversations, and in the entries classmates wrote in our reunion book, we displayed a vivid “believing conception of [our] own death(s).” No one I spoke with was morbid. No one evinced fear.

The dominant tones were (1) matter-of-factness, (2) gallows humor, and (3) curiosity about the future of our species and planet. Continue reading…


A Living Resume

On the occasion of my last birthday, a friend asked how it feels to be growing old? I proffered first, the old bromide that in my head I feelabout thirty, but my body groans a wholly different story. Then I joked that when people intone, “Well, you’re only as old as you feel,” I reflexively remark, if that’s true, then I’m really old!

Suddenly I found myself reflecting on my resume. Continue reading…

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Will guilt keep me from doing what is best for my Alzheimer spouse?

I met Vickie in Your Father’s Mustache, a sing-along place in Greenwich Village 46 years ago.  She had long dark hair and wore a poncho like Clint Eastwood in Fistful of Dollars. She was singing and swaying with such joy. She had the kind of face you could look at the rest of your life.  I noticed her eyes were different colors.  One was hazel and speckled with green, and the other a cloudy blue.  She asked me, “What do you do?”

“I’m a priest.”

She laughed uncontrollably.  That cinched it.  Continue reading…

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Robert Frost and the Decline of the Medical Profession

The title of this post is deliberately mysterious, but you’ll understand it at the end.

At my 50th medical school reunion in June, my classmates agreed that while the goals of medicine are as valid as ever, the profession itself is in decline. Here’s a quote from the Preface to our reunion book:

“A frequent refrain is our disappointment in the evolution of medicine in the 21st century…The art of medicine appears to have diminished in value.”

This isn’t just a reaction by grouchy old guys (my class, like other medical schools at the time, had relatively few women). In a recent survey of 13,575 physicians, 84% agreed that medicine is in decline, and 58% would not recommend medicine to young people. Continue reading…


Dementia and the Goals of Care

Even though you think and behave perfectly normally, you might already have Alzheimer’s disease. In fact, you might warrant the label of “pre-clinical Alzheimer’s disease” for a full 20 years before graduating to the full-fledged condition. That according to the latest definition of Alzheimer’s put forward by the National Institute on Aging together with Alzheimer’s Association 3 years ago.

Heralded as a radical departure from earlier clinical diagnostic criteria, the new definition is in line with how we think about other chronic conditions such as cancer or heart disease. Normal cells often mutate into cancerous cells and proliferate for a long time before there are enough of them to produce symptoms—and a cancer diagnosis. Plaques may be deposited in the lining of coronary arteries long before they narrow blood vessels enough to impair blood flow to the heart resulting in chest pain. In all these cases, the hope is that we may be able to intervene during the pre-symptomatic phase, altering what is currently the inevitable trajectory of illness.

In the case of Alzheimer’s, detecting various “biomarkers” in the blood or cerebrospinal fluid would signal the need for some kind of biochemical intervention. The problem has been that we don’t as yet have any such intervention. Continue reading…


A Retirement Community’s Private and Public Affairs

Our move from the Washington area to a retirement community in Baltimore called Roland Park Place came five ago when, I was 81 and my wife, Pat, was 80. It was concerns about our health and a concerted push from our seven children that propelled us to decide to move. It had become more noticeable that Pat might have Alzheimer’s. For me, Parkinson symptoms, dormant for a decade, had come alive.

At the beginning of our second year at Roland Park Place four falls in two days put Pat in a room in the health care center. I was able to move a second bed into her room and that is where I have slept for the past three years.

While caring for Pat is my main focus, I have become involved in discussion groups concerned with the world’s problems. Last year I became concerned about the morality of our government’s increased reliance on drones. For me it was a “distant mirror.” Continue reading…


Aging with Purpose

Near the end of my clinical career as a psychiatrist, I, like so many other psychiatrists, was required to do more in less time. In order to use that precious time as best as possible, I wondered if there was anything else I could do to offset that limitation. Soon, I recalled the landmark book by the psychiatrist Viktor Frankl – Man’s Search For Meaning – which describes how even those in concentration camps were better able to cope if they had a sense of meaning in their lives there.

I then decided to ask each of my patients what gave them the most meaning in their lives. That way, I hoped, I might quickly know what was most important to them, then also be able to connect how the treatment could help them achieve those goals. Continue reading…