Nobody Smokes Anymore
My first visit to a hospital happened in 1983 when I was 8 years old. My mother picked my brother and me up from school and told us my grandfather had a heart attack and we were going to see him…at the hospital. Then we were threatened not to run around or fight (she was wasting her breath).
I will never forget the waiting room lobby. It had round brown naugahyde seating , dim lamps and the cigarette smoke seemed to be four feet thick down from the ceiling. Looking back now it looked a lot like a bar in Mad Men. Soon an orderly rolled a very old man down next to us with an IV bag; my mother started crying; and I tried to figure out what the words “congestive heart failure” meant. That old man was 57 yrs. old. In 1983 there was nothing special in my parents’ peer group about a father with a heart attack. Everybody’s father fought in the war and smoked 2 packs a day until his health demanded he quit. It was not uncommon for people in their forties and fifties to be walking one day and the next not because they had been stricken by a heart attack or stroke. That doesn’t happen now. Nobody smokes anymore.
Today I am 40. My other 3 grandparents all have lived into their nineties. My parents, aunts and uncles have spent the last few years with a job they never planned for: caregiver for the elderly who refused care outside of their homes.
Modern medicine and lifestyle changes have made it that unless one has cancer or another terminal disease people live easily into their eighties and nineties, by doing nothing special at all. Their bodies long outlive their minds and spirits. All three of my aged grandparents contracted dementia. Two of them suffer from it still. No one was prepared for the how long the slide towards the end was going to be.
All of my grandparents had done financial powers of attorney before they became too ill; so all their checkbooks, banking, bill paying, and taxes could be handled by others. But what they all failed to do was to think deeply about their quality of life and expectations. Making your children promise not to “put you in the home” does not count as good planning and provides a tremendous amount of guilt when the inevitable occurs. Thinking deeply means discussing with one’s doctor what medications are necessary, and which ones you should stay on if you were to get an Alzheimer’s or dementia diagnosis; deciding what circumstances you would be willing to enter assisted living and skilled care; what end of life care and life sustaining treatment you want and also preparing the documents to reflect all of your thinking and decisions.
My grandfather who had heart failure at 57 lived another 15 years by giving up smoking and wizard like cardiological care. But at the end he had not done any end of life planning and perhaps the last words he ever heard was a discussion among the family and the doctors as to what life support and care he would have wanted.
Good planning would have eliminated the need for that discussion, and my family would have been at peace knowing his wishes were being followed. These predicaments are going to find us all and we should all think about them, because the only other way I can think of to avoid it is that we all just start smoking again.
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