Letter From the Editor

Bruce D. Cheson, MD

The child is father of the man.

—William Wordsworth (1888), Gerard Manley Hopkins (1918), or Blood, Sweat & Tears (1968)

The date of this writing is a palindrome, 1/1/11, a chance to look forward and backward at the same time, as 2010 ends and 2011 is just beginning. The new year has to be better than the last for some, including those who live near the Gulf and the New York Giants. It has been an unusual year, as many of them are, but this one more than most. For my family and me, it was a year of beginnings and endings, notably the birth of my first granddaughter, Samantha, a few months after the unexpected death of my stepfather at age 90. If the latter wasn’t bad enough, what has consumed most of my thoughts and sleepless hours was the nightmare of the something in-between, that never-never land that holds no answers. Since the death of her husband 11 months ago, my mother had been living fairly independently, playing cards at the country club 5 days a week, going to dinner or a movie with friends, and always dressing quite fashionably as appearances are quite important to her. All of that ended on November 22, less than a month before her 90th birthday, when she awoke unable to move her right side or to speak coherently. She was diagnosed with a thrombotic stroke. Six weeks later, little has changed other than, perhaps, a modest improvement in her speech (which is clearly more comprehensible than Dick Clark’s on New Year’s Eve). Although her thought processes are reasonably intact, her physician has informed us that she will never regain function of her arm or leg and will remain bed/chair-ridden for the rest of her days. She is currently in a lovely rehabilitation facility in Boca Raton, receiving hours of physical therapy, occupational therapy, and speech therapy a day, to the point of exhaustion. But, the question that looms large is what happens on January 31, 2011, when rehab pushes her out the door? Fortunately for her, she has an insurance plan that provides 24/7 home care coverage, but for only a year. My wife, my sister, and I have been struggling with what we think is best for her. Her only family is in Maryland and Virginia, with her two children, her only grandchild, and her great-grandchild. Moving to an assisted living facility nearby would enable her to spend more time with her family, sharing in their life events, many of which she has missed out on in the 35 years she has lived in Florida. But, her world is in Boca Raton, and remaining in her home in the gated community would be familiar territory. However, she has not yet grasped that it will be a markedly different world now without the card games and the meals at the country club, and with socializing restricted to visits by her friends to her home. One of my mother’s friends hasn’t been to visit because she is afraid to see what her own future may be. I suspect visits from other friends will also dwindle once this relatively acute period is over, and with the natural attrition that befalls a group of octo(plus)genarians.

So, how do you decide what is best for someone else who is alert and oriented ×3, but whose judgment about the future is clouded by the pull of the past? There is a magnitude of difference between being alert and having reasonable insight. All we can envision is her spending her days in a hospital bed in her house with some relatively unknown caregiver turning, feeding, and changing. One of my mother’s best friends recently moved to California to be nearer her children. Other good friends feel she is better off up here with us. Our sporadic visits to Florida would be limited by the need to have our own lives and jobs up here, and would be nothing compared to how often we could visit her if she were to relocate. Indeed, there is a lovely facility .6 miles from our house as the bike rides. We visited it the other day and noted the potential to drum up a card game for her.

We are clearly not the only ones going through this same process at the same time. Other friends and colleagues are suffering similar angst. These situations are all alike, but all are different. Our parents saved their money for their entire lives and, instead of using it to enjoy their final years or to provide a college education for a great-grandchild, they are now forced to use it sparingly to sustain a life of barely minimal quality. The solution to this mess is not clear.

But, at least for now, we are not able to wrest the control of her future from her and have to accept whatever decision she will make. All I know is that if this situation befalls me, I would hope to have the judgment and the help from loved ones to demonstrate what George W. Bush never sufficiently considered—a good exit strategy.

Until next month . . .

Bruce D. Cheson, MD