By Eileen Flanagan
When pneumonia left my petite eighty-two-year-old mother too weak to turn the steering wheel, I wondered whether I should take away her car keys. I also wondered whether to force her to drink Ensure when she lost forty pounds, whether to pressure her to hire a caretaker when I felt she was no longer safe living alone, and whether to object when she stopped taking the antibiotics that made her nauseous and asked to go on hospice. In short, I wondered how to apply the Serenity Prayer to caretaking–accepting the things I could not change while changing those I could.
Many people face similar dilemmas. Over 22 million American households provide some care to an older relative–that’s 4 out of 10 Baby Boomers. When I give talks on the Serenity Prayer, people in this age group often mention their aging parents as the biggest challenge to their serenity. Caring for my mother during the last year of her life was certainly one of the experiences that taught me about the prayer’s last line, “the wisdom to know the difference.”
First, I realized that there were things about my mother I had to accept, such as the fact that she wasn’t going to give up her life-long stubbornness just to make things easy for me. I needed to respect her desire to remain independent, even though I worried about her hobbling to the bathroom alone at night. I needed to accept that I couldn’t control her and that trying was going to aggravate both of us.
Ironically, accepting my mother’s strength helped her to accept her limits. I had tried to scare her out of driving with the threat of a car accident, but she retorted that an accident wouldn’t be a bad way to go–better than the gradual decline she most feared. I argued that she might kill someone else instead of herself, maybe a child, and how would she like that on her conscience? She was upset by that argument, but wouldn’t give up her car until I finally backed off and acknowledged her fears about becoming dependent on me, her only child. I offered to ride with her while she gave driving a try. I said that if she really felt safe I would accept her judgment, but if she didn’t I would do all her shopping and chauffeuring from then on. She made it half a block before she admitted that she didn’t have the strength to steer. Once I let go of my desire to control her, it was easier for her to let go, too.
There were other times when I felt I needed to intervene more forcefully, to change something that needed changing, but even then, I found that offering my mother some choice–some sense of control– made compromise easier for her. For example, she didn’t want to move or hire someone to stay with her, even though my children and part-time job kept me from being with her all the time. She refused to wear the medical alert button I wanted to get her in case she fell out of reach of the phone. By the last weeks of her life, she was so thin and weak that I didn’t feel responsible letting her go to the bathroom at 3am, so I affirmed her decision to stay in her own apartment, then explained how worrying about her at night was a burden to me. I gave her a choice: start wearing Depends at night, or let me hire a nurse’s aide to stay with her when I couldn’t be there. Reluctantly, she agreed to the aide.
I know I was lucky to have a mother whose stubbornness was tempered by a sharp mind, even as her body was failing. I have friends who have had Alzheimer’s, alcoholism, and other forms of irrationality added to the burden of caretaking, and it’s not easy. Still, I believe that acceptance lightens all burdens, even if it takes different forms in different situations. My husband, a hospice social worker, frequently comes home with stories of families that refuse to face the reality of their situation. Some don’t make plans, even when plans are clearly needed. Some don’t want anyone to say the word “hospice” near their parent, as if the parent doesn’t know they are dying. (They usually do.) I’ve heard enough of these stories to be convinced that denial never helps anyone, though my husband points out that you can’t force people to accept things before they are ready.
One of the hardest things for both my mother and I to accept was the unpredictability of death. As my mother’s lung disease progressed, she frequently asked the hospice nurse, “How long have I got?” despite the nurse’s assurance that it was impossible to predict. I saw myself in my mother’s need to schedule, to plan this final event. Should we book tickets to visit my in-laws at Christmas, or would my mother still be alive then? Should I cancel my son’s Wednesday piano lesson, or were we really in the final days? The practical part of me wanted to know, and I had to accept the fact that I couldn’t know.
In the end, my mother was a wonderful model of facing things squarely. A week before she died, she asked me to read through her tattered address book and all the scraps of paper, which were falling out of it. After each name, she told me whether this was someone I should invite to the funeral. “No, she’s got Alzheimer’s,” she said of one. “Oh, yes,” she said, hearing the name of a friend from high school. “Call her.” It wasn’t until I was actually making those calls that I appreciated what a final gift she had given me. On a practical level, she saved me the hours I would have spent calling disconnected numbers and people like her auto mechanic, who were not really friends, but who were neatly entered by name in her address book. On a deeper level, she offered me a model of wisdom and the lesson that even when we are facing the inevitable, what we choose to do can still be of help to others.
Eileen Flanagan is the author of The Wisdom to Know the Difference: When to Make a Change-and When to Let Go, which was endorsed by the Dalai Lama and won a 2010 Silver Nautilus Book Award.