AGING IN PLACE OR WAITING TO DIE?

Aging in place wasn’t in vogue when I first became a gerontological nurse practitioner in the early ‘80s. And my patients certainly didn’t know they were aging in place. Especially Helen. She called it waiting to die.

The Senior Clinic I worked in had just relocated from a one-bedroom apartment on the 10th floor to a larger two-bedroom on the fourteenth floor of a subsidized city-run building on the west side of Chicago. Helen was overjoyed to live in the apartment next door to us. She stopped in every day to say good morning and sometimes brought homemade sugar cookies or zucchini bread. She was in her 90s and in good health. When her hearing difficulty became worse, she would ask me to check her ears to see if they needed washing out. Otherwise, her visits were social.

If the clinic was quiet, Helen would sit by my desk and tell me about her life. Since she was thin and small, barely over five feet tall, I looked at her incredulously when she told me she had worked as a guard in a women’s prison. The next day she showed me her badge: Deputy Sheriff Cook Co. #93.

She had lost a husband many years ago and her one son visited infrequently. Her life had narrowed and became routine. Helen accepted the inevitability of death and was the first to teach me that old folks aren’t afraid to speak of dying. “I lived a good life,” Helen said, “I’m just ready to die.” I can still see her warm smile and dark eyes crinkle as she said these words.

In the blue-collar community where I worked, when you got old and feeble and family couldn’t take you in, you went to a nursing home. If you were terminally ill, you went to a hospital to die. Helen hoped to stay independent and avoid institutionalization but who knew then all the facets needed to meet that goal. I did what I could to keep my older patients as healthy as possible so they could care for themselves but I never thought then to set up a knitting group, coffee klatch or potluck dinners to address the epidemic of loneliness.

Today, a grass roots movement is growing among the elderly themselves to develop/provide/support services and programs that promote independent living. In fact, in my own neighborhood of 160 single-family homes, those of us who are over 55 had our first meeting last week to discuss aging in place. We have come a long way in understanding what it takes to keep us older folks in our own homes. Various models have popped up across the nation, which are not just reliant on health interventions to maintain independent function but also on new technologies that open and lock doors, monitor outdated food in refrigerators, and help in sorting laundry.

I wonder how all this would have made a difference in Helen’s life. One day she didn’t show up for her “good morning visit.” I knocked on her door. No answer. When the janitor let me into her apartment, I found her crumpled on the floor next to her sofa. The ambulance brought her to the hospital where she had a hip replacement. She died shortly afterwards of surgical complications.

A couple of weeks later, after he cleaned out his mother’s apartment, her son gave me her Sheriffs’ badge.

Helen's badge

THE TIME IS RIGHT

A friend deliberated whether she should visit her father for his 95th birthday. She was swamped with commitments. Since he was unaware of his birthday as well of his surroundings and didn’t even recognize his three daughters, there was no urgency to travel to another state.

However, she cleared her schedule and made the trip, as did another sister and a niece. Both lived out-of-state also.

As it turned out, on his birthday, he had a choking episode with difficulty breathing. He stopped eating and died three days later, surrounded by those he loved who otherwise would not have been there had they not come to commemorate the day he was born.

This story reminded me of a patient I cared for back in the early ‘90’s when I worked as a nurse practitioner in a home care program. I had made a first visit to an elderly man in the western suburbs of Chicago who was referred by his doctor because he had terminal cancer (I don’t remember his diagnosis). But I do remember his sunny apartment. He and his wife sat on the sofa, holding hands, his wife’s face streaked with tears. She had just been informed she had breast cancer. The patient calmly told me he wanted to help his wife through her ordeal. He would call me when he was ready to be admitted.

Sure enough, a couple of months later, he called telling me he was “ready to die.”  In another sunny living room, the patient and his wife held hands as they sat side-by-side on a floral sofa in his daughter’s home where they had relocated. His appearance had changed little since I last saw him. His wife had had successful treatment of her cancer and now his responsibility ended. The serenity of that visit remains vivid in my mind as he, his wife and daughter discussed his impending death.

After he disclosed he was having pain, we agreed I would return the next day bringing morphine with me. When I arrived the following afternoon, he was comatose. His daughter called later that evening to say her father had died.

Was it a coincidence my friend’s father died during the time his family gathered around him? Did my patient let go when he knew his wife no longer needed his support?

Calla lilyMaggie Callanan and Patricia Kelley, both nurses, co-authored Final Gifts, a book that speaks to the dying experience. They use the term “nearing death awareness” which “is a special knowledge about—and sometimes a control over—the process of dying.” In a chapter called “Choosing a time: the time is right, they describe how some dying people “choose the moment of death.”

Vignettes of both sudden and lingering death portrayed in Final Gifts show us “what is needed in order to die peacefully” and how “those close at hand can help bring that person peace and recognition of life’s meaning.”

I read this book years ago. Having read it again, I only appreciate all the more how much of a contribution Callanan and Kelley make toward our knowledge and understanding of the dying process. They do this by telling their nursing stories.

I encourage you to read this book.

What stories can you share about your experience with “nearing death awareness?”