From Dr. Jane's Notebook

Family ties: I didn't see this coming

These days my friends fall into two categories: Those whose parents are still alive and those whose parents are not. For the past three years, my parents have lived in a state somewhere between life and death, between health and sickness. Married more than 60 years, I used to worry whether they could survive without each other. What I failed to consider until recently was the pain that I will feel when they are gone. Now as I face my parents’ illness, I feel blessed to still have them in my life, but anxious that there is so little I can do to help, and terrified at my impending loss of them. Here are a few more thoughts on the matter.

“Old age is what you’re stuck with if you want a long life.” In her epoch book, Necessary Losses (1986), Judith Viorst describes the beginning of parent-child relationships. In her words, “we begin life with loss. We are cast from the womb… as sucking, sobbing, clinging, helpless babies... (until) our Mother interposes herself between us and the world, protecting us from overwhelming anxiety”. From that point forward, the presence of Mother stood for safety and the fear of her loss is the earliest terror (or separation anxiety) we know.

In early childhood, we reluctantly learn to tolerate brief absences by our parents so long as we are not abandoned. Childhood and adolescence then become our testing ground for whether we are able to separate successfully from our parents. As we mature, we become better able to tolerate separations that are temporary and voluntary, but permanent and non-voluntary separations from our parents are another story.
On Death and Dying. In 1969, Dr. Elizabeth Kubler-Ross enlightened the world about the five stages of loss from terminal illness which include: denial, anger, bargaining, depression, and acceptance. Since that time, others have expanded upon her work. We know that anticipatory grief and loss takes many forms and the order of these stages varies. For example, even when a person has worked through all 5 emotional states and has finally achieved a state of acceptance, still a bit of good news from our doctor or the announcement of a new, promising medical procedure is enough to send us back into a state of denial or bargaining. Similarly, a dose of bad news on the medical front can send us into anger or depression like the flip of a switch. In other words, chronic illness is an emotional roller-coaster for patients and their family members, caregivers and love-givers because patients are rarely alone when they take this ride.
What about the love-giver and the care-givers? In earlier writings, I have explained that love-givers are the mates, friends and relatives who because of their close relationship have become default caregivers to their infirmed loved one. While the need for stress management for caregivers is more widely acknowledged these days, those of us who are love-givers have few choices. We are like side-cars attached to speeding motorcycles. All kinds of unexpected crises and hospitalizations create huge upsets in our calendars, affect our work and impact how we care for other family members. Exposure to germs in hospitals and doctor’s offices is an invisible hazard which often leads to more doctor visits. If that weren’t enough, when people are sick and in pain, they sometimes lose their typical manners and politeness which can feel like verbal abuse to those who care the most. In the end, there may be very little victory apart from the satisfaction of having done all that we could do.
As children we are cared for, as adults we become care-givers. Growing up, I was extremely close with my great-grandmother. On most Saturday nights, Grandma Gertie babysat for my brother and me. I have wonderfully fond memories of Saturday nights eating heaping bowls of ice cream as we watched the Lawrence Welk Show. As we entered our teen years, my brother’s social life quickly drew him away from our Saturday nights. A few years later when I also wanted to make other Saturday night plans, I was gently told that although my Great Grandmother had started out babysitting for us, somewhere along the line, we had begun babysitting for each other, and now, I was babysitting for her! At that moment, I understood my niche in our family tree. I knew that just as I had been cared for as a child, I would eventually be expected to and gladly care for family members as they grew old.

Just as my parents once walked me down my wedding aisle, I am now walking alongside them down a corridor from which they will not return. At some point, I will have to let go of them, knowing that our final separation will be neither voluntary nor temporary. Until then, I will do everything possible to help them enjoy a continued quality of life, while remaining ever-mindful that I cannot ignore the needs of my own family “for life goes not backwards nor tarries with yesterday” (Kahlil Gibran).

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