Hospitals are no place for fun. Being admitted to a Hospital for whatever ailments is not a good time for the patient and the family members. It’s definitely not a happy time for the 70 somethings as they do not have many more years to count and stay invisible for the bonus years of their life in spite of being present.
I got a chance to see the lives of few adorable 70 and 80 something in a super specialty hospital in Kerala where I served as a bystander for my mother.
From my mother’s room, I could clearly feel the melancholy trapped inside the opposite room where an 80 something husband was the bystander for his 70 something wife. He was looking very energetic for his age, well organized and well mannered. We exchanged hellos and I was amused to see their entrance door kept opened at night as well.
‘’Could you please watch over my wife while I go down and get these medicines’’ – He asked me reluctantly. I was glad to assist as I had nothing else to do in a hospital.
I peeped into the wife’s room and was welcomed with a broad radiant smile.
‘’I was seeing you from here. Who got admitted? What happened?’’-she was curious to know and longed to share what’s happening in her life with every single detail of it to anyone who was willing to listen. I checked with her whether she was allowed to talk. She said yes. And a seemingly endless conversation followed which opened a huge window to her life after retirement. She had meticulously told me the way she raised her three boys with value-based education, how intelligent they were, how much they loved her back, how much they needed her, the job positions they held at work, her daughters-in-law’s, how she was disgusted with their indifference, her adorable grandchildren, her properties, pension, etc.
Where are they now? –I asked in surprise. Hiding the pain roaring inside her motherly heart, she said “My kids live in Australia. They told me they will come. I said ‘no’ as they cannot take leave. That will affect their career graph’’.
This mother still treated her 40 somethings as kids and loved them as though they had never grown up.
The long queues at the billing counters and medicine collection counters took her husband more than an hour to return with the medicines.
‘’I am sorry to bother you and thank you for taking care of her’’ -he said.
I thanked the couple back.
I’ve noticed a bandage on his leg and asked him about that.
“I got a toe amputated due to diabetics from the same hospital last month. Every month we come here due to some health problem or another. My eyes go blurred after night and she can’t hear well. I am a diabetic patient and she suffered heart attack two times. Doctors advised rest for me. How can I rest when my wife is in this condition? Our children have no time to call us also. We are old and we can’t trust others for house help and similar errands. We end up doing all chores ourselves. Our kids won’t care’’.
The pain was leaking out of his words and he stopped his tears half way. The mother was still defending her kids denying the fact that they were busy building their lives with no love left in their heart for their ailing parents. Fear of a helpless future unmasked the penumbra of silence.
This story resonates the life of many 70, 80 somethings who feel left alone during the later days of life. The retirement bucket list item of spending more time with grandchildren may not work out for many grandparents. They describe the life after retirement as ‘The invisible dark age ‘where they are forced to stay invisible throughout the bonus years of life within the confines of their homes, children’s apartments, old-age homes, hospice cares, etc.
The sudden loss of work after retirement, the subsequent changes in lifestyle, the absence of the company of their children during the last phase of life, death or terminal illness of a spouse, lack of social support, and lack of finances makes old age look troublesome and stressful.
Ageism is the new stereotype.
The youth-fixated culture is afraid of aging and no one asks an old person how they are doing in life. The younger generation seems to be extremely impatient with this generational cohort who handhold us through all walks of life.
They are forced to live a lonely life with their spouse if they are alive or alone with no one to share their sage advice, ridiculed for their outdated knowledge, taunted for their repeated ruminations about their past laurels.
No more the big banyan trees of wisdom
They are no more the big banyan trees of wisdom where the grey hair was treated as a reflection of the grey matter inside and a repository of life experiences. Google Play and Play stations have stolen their much craved for bucket list time with their grandchildren. ‘Once upon a time, there lived a princess’ kind of Grandma stories that nurtured our imagination has no takers with the PlayStation generation. In many cases, the kids do not speak the language of their grandparents. The nuclear families are self-supportive and they do not want their children to pick up the accents and habits of their parents as those are not futuristic in their parent’s eyes.
The biomedical model of health
I never felt that the doctors of super specialty hospitals treat patients with TLC –‘Tender Loving Care’. What is still in practice is the biomedical model. The patient is treated as a diseased body and doctors prescribe medicine. A patient admitted for the disease will be asked to take tests from all the latest equipment in the hospital labs, an extended hospital stay with minimum attention from consulting doctors followed by a big fat hospital bill that can get the patient another panic attack.
Many a time, patients especially geriatric patients do not know why they need to take different laboratory tests and the doctors do not educate them on the same. They do not want to offend their doctors by asking questions but leave the hospital with so many unanswered questions in mind.
Who needs hearing aids? 70 something or the 40 something?
‘’Why can’t you use your hearing aid and talk? I can’t scream and talk always.
Are you not ashamed of bed-wetting?
Are you not ashamed of not flushing the toilet after potty?
Why do you always complain about pain? This is related to old age. Can’t you bear it?
Every time I can’t take leave and come with you. Can’t you manage? ”
I wonder who needs hearing aids- the 70 something or the 40 something. If the 70’s need hearing aid, the ’40s should definitely need a memory aid. If we take a trip down the memory lane, we had given lots of sleepless nights to our parents crying whole night; they had taken us to hospital in the middle of the night; we had peed on their mouth directly and done bed-wetting for years; they had happily taken our stinking potty for years; they had happily taken us to doctors whenever we were sick and painstakingly followed up on treatments.
What if an aging parent is toxic for their children?
Now we invalidate their presence, socially isolate them, verbally abuse them just because they age, do not teach grandchildren to respect them, corner them to a dark invisible phase of life to be left alone in their suffering without realizing that one day, in a very immediate future, it can happen to us. They fear being sidelined despite embracing the latest technology such as going on Facebook and Twitter. Majority of 70 somethings feel sidelined, invalidated and silenced.
Then I had come across an exceptional geriatric patient. She complained to me about her son who listened only to her daughter in law and ill-treated her all the time.
Later conversations with her son revealed that she was a control-freak and treated him devoid of love from childhood while acted out extremely sweet to the rest of the world who perceived her as an ideal mother. She had never validated the presence of his wife and treated her with implacable hostility as she believed that her son was her sole possession as she had given birth to him.
‘’You can divorce an abusive spouse. You can call it quits if your friend ill-treats you. But how about your own parent? Can you talk about this to anyone? They will say that you abuse your own parent. The only way to get around her is to avoid her at all costs.’’-he said.
Some people have the hard luck of getting a toxic person as their parent. It is a constant dilemma for children of toxic parents about how to set boundaries regarding their difficult and painful lifelong relationship with their parents who are dismissive, deceitful, emotionally unavailable, abusive and downright cruel. They suffer from codependency symptoms and struggle how to love themselves after narcissistic abuse. Most of the children of toxic parents realize their abuse but allow themselves to be a victim living a major part of their lives with their brain programmed by their parental injunctions. Others migrate forever to a different country altogether avoiding all future interactions in the name of work.
If you have an elderly, narcissistic parent or a patient, then it is like walking on eggshells. You can’t get away without getting some self-hurt. They seek tremendous empathy, in spite of them not showing any real love for anyone including their own children. You get to see power struggle, demeaning behavior, shaming incidents that hit your self-esteem to rock bottom. If they are more intelligent, they manipulate more though they appear calm. For some people, narcissism worsens with age and some others it improves. They demand to leave the hospital against medical advice and doctor’s attention. The doctor-patient relationship too witnesses shaming incidents however minor they may appear to observers. The confrontation of a narcissist directly won’t help as these patients are master manipulators. Trial and error method with a case to case approach looks good to improve the patient relationship.
Aging is not a disease.
We associate aging with disease and say that age-related diseases and very common. When the elderly cohorts hear these attributions they believe that they need to live with pain as it is inevitable due to age and may show an unwillingness to see doctors. The fact is age-related diseases are there for all age groups. For example, sore throat, ear pain, urinary tract infection, skin infection, bronchitis, cold, cough, etc. are the common childhood illness related to age.
Geriatric “syndromes” such as frequent falls, urinary infections, pain, and malnutrition are treatable. However, patients reach hospitals with chronic, multiple, and multi-factorial problems that need an integrated approach of treatment with an extra dose of TLC from the doctor. When doctors treat the patient with only medicines without knowing the mental make-up of the patient, one hospitalization leads to another; one side effect of a drug to treat one disease cause another disease; drug-drug interactions; complications of hospitalization as bed sores, geriatric depression, etc.
Family Support- critical in geriatric care.
Gone are the glorious golden days of Indian culture where the old were honored and worshipped. Under the Ashram system of ancient India as mentioned in the Ashrama Upanishad, the human lifespan was divided into four stages with prescribed life pursuits. The retirement stage starts at 48-72 and beyond where a person hand over household responsibilities to the next generation, take up an advisory role, gradually withdraw from the pursuits of pleasure and wealth creation to detachment from material life, letting go of attachments and leading a life of simplicity with less worldly responsibilities and engagements.
The Joint family consisting of brothers, sisters, maternal uncles, paternal uncles, cousins, nephews, nieces (in short a mini village) were the basic unit of social organization in ancient India that lived under one roof and were closely connected with each other. They owned movable and immovable property in common. Usually, the eldest male member was the head of the house and administered joint property and enjoyed enormous powers.
The rite of Shraddha (a ceremony to honor dead ancestors) played an important part in binding the members with the common ancestors and the rituals were performed in the presence of sons, grandsons, and great-grandsons of the deceased which naturally bound them together and keep the family united. Slavery was practiced and a master had a duty to look after the slaves in their old age and perform their last rites if they do not have children.
With the onset of modernization, consumerism, individualism, the centuries-old value systems eroded from the collective memory of the country and the Ashram system is no longer practiced in Indian society.
‘’In India, the change of family structure from joint to nuclear have affected not only the position of elderly but also the family’s capability to care. ’Says the Journal of Gerontology & Geriatric Research.
Happy and Healthy Aging.
Prayer for Longevity from the Rig Veda (7.66.16)
पश्येम शरदः शतं जीवेम शरदः शतम || Pasyema śaradaḥ śataṃ jīvema śaradaḥ śatam ||
‘’Let us see a hundred autumns, Let us live a hundred autumns’’.-says Rigveda, one of the most primitive religious texts still celebrated by a living tradition of renderings in the hindu way of life.
Committing yourself to a socially active lifestyle is a prescription to living better and living longer.
Make exercise a priority. Physical exercise gives you that endorphin shot to stay positive, to reduce chronic pain, to improve the quality of sleep and overall immunity. Exercising your brain by solving crossword puzzles, learning a new language, a new skill, etc. helps to enhance memory, improves cognition, builds self-confidence, and helps you to overcome boredom and loneliness.
Search for old friends, make new friends. Surround yourself with a social support group who likes your company. This may be your immediate family members, any community, volunteer groups of friends, associations who are willing to help you if you need immediate hospitalization and similar emergency situations.
Not all old folks are in old age homes; not every aging person has dementia, amnesia, cataract, arthritis, diabetics, and blood pressure. Many live a happily ever after life with or without their family members going about with the day to day activities, like getting up, going for walk, grooming, driving, cooking, eating, paying bills, attending events without being an economic burden to anyone, start painting, dancing, running marathon, doing standup after 75. Do not buy into destructive believes about old age diseases. If you do not pay attention, it won’t affect you.
Finally, understand that old age is the last phase of life and age gracefully. Say goodbye to the age-old habits of too much entanglement to possessions and people, stop competing with others, stop brooding over the missed opportunities in life and other negative habits and attitudes if any and embrace life with all its possibility without worrying about when will be the last day on earth. Whenever it is, let it bring some genuine tears on somebody’s eyes simmered by your noble acts. Just like the beginning of life and early childhood are celebrated, we need to celebrate the gracefulness of the wrinkled skin of the last phase of life. Since you have been there and done that, now show the world how to party in your unique way, I call it the second inningz way.