Who Decides?

 

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His skin is mottled,

He is 94.

He stands erect,

He walks with assurance.

He says, I feel the same as I always feel.

 

Right now, I think.

He can’t imagine feeling different,

He doesn’t remember.

 

Months before, winter of 2016, hospitalized 5 times or more in Florida,

Weakened by persistent diarrhea and congestive heart failure.

We see his mortality as he lay in a hospital bed,

Grateful to have his ‘son the doctor’ by his side.

He felt his vulnerability – then, not now.

 

Summer of 2017, Saugerties, NY.

They have a full-time aide,

Living ten minutes from their daughters.

Close to their sons.

In an apartment, furnished with familiar things,

In a new community, in an unfamiliar place.

 

I arrive to take him to his doctor’s appointment,

We leave his wife, many years into Alzheimer’s, with the aide.

We step outside into the light so bright, he shields his eyes til they adjust.

He walks with purpose to the car.

Fall is in the air, he says.

Almost time to go back to Florida, he tells me

 

I start the car and drive,

I don’t respond to his comment about Florida.

What to say?

 

When was the last time he drove?

He would not be able to navigate the roads to the doctor’s office,

Or the paperwork,

Or explain his complex medical history.

 

He might understand the doctor’s instructions,

He is a compliant patient.

He has an iron will,

Which may explain his 94 years.

 

His long life brought him from the woods in Poland

Where he fought with the partisans against the Nazis,

To fight in the Russian army,

To survive by any means necessary.

To a displaced persons’ camp,

To immigrate to the United States,

To build a life.

To outlive friends and family, still bound to Paula, his children and his faith.

 

Should he and Paula go to Florida?

What is the right balance between their quality of life and their safety?

What is the right balance between David’s wishes and the peace of mind of his children?

Who decides?

No Easy Answers

I was in social studies in 12th grade in 1975 and the class was discussing the nursing home scandal that was unfolding in New York City. Terrible details of elder abuse and neglect were emerging in the newspapers.

The discussion moved from the scandal to elder care as a societal value. Our teacher explained that in some cultures, for example, Native American, elders were more revered than in American society at large. In those cultures older folks stayed with the family as they aged and were cared for until they died. One of my classmates, declared, “I would never put my parents in a nursing home! How can you put them away like that?” Others chimed in with their agreement.

I raised my hand to respond, “It isn’t so simple. Sometimes older people,” and my voice unexpectedly broke. I took a deep breath and managed to say, “need more attention than you can give.” I couldn’t say more.

My grandfather, my father’s father, was staying with us at the time. Grandma had recently died. In those years he stayed with us for some extended periods – during the period of mourning, after cataract surgery and while awaiting placement at the Hebrew Home for the Aged, My brothers were away at college. When I made the comment in class I was thinking of the impact that Grandpa living with us had on the life of my parents and myself. Unfamiliar with our house, with compromised hearing and vision, it was difficult for him to manage.

While he was staying with us, when I came home from high school, I would ask him if he wanted to take a walk. He was always delighted to. He would put on his trench coat and fedora and we would set off to the shopping center. Grandpa was always careful to walk on the outside, closer to the curb. I didn’t understand why he did that, so I asked him. He explained that the man should always walk next to the street, the young lady should be closer to the buildings to be safer. Grandpa had very gentlemanly, old world ways.

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Grandma and Grandpa in happier times, on our living room couch in Canarsie. With his trademark fedora, trench coat draped over his arm. In those days you could see travelers to the gate. I believe they were off to Florida.

We would go to the stationary store where he would buy the Forward, the Yiddish language newspaper, and a cigar. We would walk back home. Grandpa didn’t feel a need to fill the silence. I’m not sure if his reserve related to his hearing deficit, or if it was just his personality, Grandma certainly ran the show when she was alive – she was smart, funny and opinionated. Maybe she just overshadowed him and he got used to it. I wish I had asked Grandpa more questions. We were surprised at how long and well he did after Grandma died.

Perhaps we shouldn’t have been surprised. After all he came to this country by himself at the age of 17. He learned five languages, he ran several businesses, married and had a family. He played cards and a mean game of Scrabble. Even though English wasn’t his first language, he beat all comers.

When Grandpa had cataract surgery and was recovering at our house, I gave him his eye drops. Both Grandpa and my father had what’s called benign essential tremor, involuntary shaking of the hands, so they couldn’t do it. My mother had a thing about eyes and wasn’t comfortable giving the drops. I did the best I could.

As part of his recovery from the surgery, Grandpa was told not to smoke his beloved cigars. I think this was to minimize coughing which might impact the healing of his eye. We still took our walks and he still kept a cigar in his shirt pocket. One day at dinner, Grandpa started to cough. My father was enraged, thinking Grandpa was still smoking. Dad reached across the table and ripped the cigar from Grandpa’s shirt pocket. “You know you aren’t supposed to be smoking these,” he roared.

He also ripped the pocket clear off the shirt.

In that moment I thought it was possible that Dad hated his own father. After the explosion, Dad apologized and things calmed down, though it wasn’t that long after that Grandpa went to stay with Aunt Diane.

Dad told us that he remembered little of his own childhood, but he also told us that when his family moved to a new apartment on Prospect Park West there was a bedroom for his sisters and one for his parents, but not for him. He slept on a couch. He made himself scarce, going to school, working various jobs and playing ball.

Aside from feeling neglected, Dad also said that when he had the opportunity to go to Harvard or Yale Law School, his parents wouldn’t lend him the money (he didn’t believe it was simply a matter of finances). They did provide funds for his older sister to go to medical school. There was layer upon layer of resentment that was never addressed, it just smoldered in my father.

For the years that Grandpa was able to be self-sufficient, he lived in Century Village Deerfield Beach in Florida and we made our annual visits. When that was no longer an option, he moved to the Hebrew Home for the Aged in Riverdale.

So while it would be optimal if as folks aged they could be cared for in the loving arms of their family, I don’t think it always plays out that way. The needs of the older person may be too great, the capacity of the family to provide the support and the relationships may not be healthy enough to make it work. It wouldn’t have in our family.

A Bit More from the Sunshine State

We went to Florida to check on the folks. We left on a cold Spring day from Albany and arrived two hours later to a warm breeze in Fort Lauderdale. We picked up the rental car and got on the highway heading to my mom.

“Enjoy this ride,” Gary, my husband, said with a laugh, “it’s going to be the best part of the trip.” I sighed and smiled.

My mother lived in an “active retirement community,” which featured 12 tennis courts, a huge community pool and abundant palm trees. Unfortunately, age, spinal stenosis, lung cancer, and bouts of congestive heart failure took their toll and my 82-year-old mom wasn’t so active anymore. After the latest health crisis, my brothers and I prodded her into accepting the need to move into an independent living facility in New Jersey, closer to family. This was our last visit in Florida before her move – we were, in part, going to help prepare her.

We arrived at the gate to the community, pushed the buttons to ring her and she buzzed us in on the first try. We drove to her unit and found her waiting outside with a broad smile, happy to see us and proudly showing us the art gallery she set up in her garage. The walls were lined with her creations from the past 20 years. I have some of her paintings hanging in my own house. She doesn’t paint anymore; she got frustrated when she felt she wasn’t improving.

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Mom’s painting of their home in Livingston Manor which hangs on our bedroom wall. Mom and Dad’s ‘happy place.’

That day was a good one for Mom. Days were measured by pain level. Arthritis and deteriorating vertebrae are unpredictable; the pain can range from debilitating to manageable to nonexistent. My mother’s face lets us know exactly what the pain level is – it registers immediately in her coloring and in the sound effects that accompany any movement.

We visited with her for two days, ran errands and planned for her move north. We may have gotten in the swimming pool. I promised to come back down to help her pack just before the move.

Then we got back on the road and drove down to visit my in-laws in their retirement community.

Paula, Gary’s mom, has Alzheimer’s disease. The changes in her began about eight years ago. We have been fortunate in that it has been a very slow decline – long periods of time pass without further diminishment. But then there are dramatic changes. This visit we notice her eating habits changed. She craves sweets and she forgets that she has already indulged. This could be kind of funny, but it isn’t.

We ate breakfast and Paula took a Klondike bar for dessert. She enjoyed it thoroughly as she slowly savored the vanilla ice cream wrapped in a chocolate shell. She loves chocolate. We moved to the living room to sit and chat. After a couple of minutes, Paula asked, “Does anyone want an ice cream?”

“Paula, not now,” David said gently, reminding her that we were going out to lunch later.

She looked crestfallen, a small pout of her lower lip, but she acquiesced.

Gary suggested we take a walk. It took a while for Paula to prepare herself to leave the apartment. The four of us walked slowly, it is only about 100 yards to the pavilion with the pool. We found chairs in the shade and sat and chatted for a bit. Paula quickly turned restless, ready to return to the apartment.

“I think I’ll stay and read for a bit,” I said. Reading by a pool is one of my favorite things to do.

“Linda, you’ll come with us?” Paula half asked, half stated.

“Actually I think it will be all right if I stay and read for a little. I’ll be back in less than an hour, ok?” I looked to Gary to see if he was okay with this. He nodded.

“Ma, it’ll be okay,” Gary reassured Paula as he steered her back towards the apartment.

I watched them make their way through the gate. I took a deep breath and opened my book.

About 15 minutes later I heard the squeak of the gate and saw Gary and Paula heading toward me. Gary looked sheepish and said quietly, “I couldn’t distract her. She insisted on coming back to get you.”

I looked at Paula and smiled, “I’m sorry I worried you.”

“She thought the Cossacks would get you,” Gary said in my ear.

“Who would’ve thought that the Cossacks knew about the satellite pool in Pembroke Pines?”

It was a feeble attempt at humor. If you don’t laugh, you cry. Sometimes you do both.

Florida – The Sunshine State

I went on my first trip to Florida with Nana and Zada when I was in fifth grade. I’m not sure why I was chosen to go to Miami Beach with them – I was the fourth of the five grandchildren. It was my first time on a plane. I survived the flight without incident. I was proud of myself so I took the unused airsick bag as a souvenir and pasted it in my scrapbook.

It was dark when we emerged from the airport terminal in Miami and the three of us got into a checker cab to go to the hotel. The air outside was surprisingly soft. I had never seen a real palm tree before, but there they were: tall, narrow trunks lining the highway median, dark fronds etched against the violet sky. As I looked out the window of the cab, I could hear the music to the opening of the Jackie Gleason Show playing in my head and I wondered where the June Taylor dancers lived.

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We stayed at the Sands Hotel. I shared a bed with Nana, while Zada had the other double bed. I was excited to go to the hotel pool and show them my swimming and diving skills. Unfortunately my shoulders got sun burned that first day and it was hard to swim after that. My skin was super sensitive and the tropical sun was a new and ferocious challenge.

We spent some time visiting family that I didn’t know and friends of Nana and Zada’s who were also on vacation in Miami Beach. Nana and Zada tried to make me comfortable, but I got terribly homesick. I was embarrassed that I was teary-eyed while we visited with Red Rose (Nana’s friends had colorful names – Goldie, Sugar and multiple Roses).

It got better when Uncle Terry and Barbara, his girlfriend (a year later she became his wife), joined us. Though it was off-season, we went to Hialeah Race Track. Zada, who loved the horses, regaled us with stories about Citation as we looked at the statue of that beautiful animal.

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Uncle Terry, Nana, me and Zada in front of Citation (thank you Barbara for taking the picture; thank you Uncle Terry for sharing it with me!)

We decided to cut my trip short and I went home with Terry and Barbara while Nana and Zada continued their vacation. I came home sun burnt and disappointed with myself. Miami Beach felt to me like another borough of New York City, just sun bleached and hot.

I went to Florida with my parents every couple of years after that to visit the elders. Zada moved to Century Village in West Palm Beach in 1973. My father’s parents moved to Century Village in Deerfield Beach in 1974. One year we took a miserable ride on Amtrak (we arrived 24 hours late!), another year we drove. Those trips, usually during our April break from school, didn’t feel like vacations. They felt obligatory. They could also be fraught.

Zada met and married Laura not long after he moved into Century Village. Laura was no match for our memories of Nana. Even if you took that comparison out of the equation, I failed to see (m)any redeeming qualities. It was later speculated that Zada didn’t want to be a burden on his family, he didn’t have much money, and Laura did, so he did what he thought he had to and married her.

Laura hailed from Massachusetts and prided herself on her fine manners. I think she was of the ‘children should be seen and not heard’ philosophy. During our first visit with her, Mark and I were sitting by the pool playing some kind of board game while our parents were chatting nearby with Zada and Laura. We could easily overhear Laura grumbling about how crowded the pool got when all the grandchildren descended from the north like locusts during these vacation breaks. My mother responded icily, “Don’t worry, these grandchildren won’t be here again!” This was not the only time that my Dad had to calm Mom’s rage at Laura.

Despite that threat, we did go back down to Florida in the years that followed. Although I think it came as a surprise to my parents, they ended up becoming snowbirds themselves about 15 years later when they retired from teaching. They bought a place in Boynton Beach in 1988, not far from West Palm where Zada still lived (he outlived Laura by a number of years).

As an adult, with my own children, we would make the pilgrimage to visit the elders, too. Gary’s parents also wintered in Florida. After renting in various places in the Fort Lauderdale area, they settled in Century Village in Pembroke Pines.

We wanted our children to see their grandparents so we visited at least once each winter. Both sets of grandparents did their best to make it enjoyable – and it was. Except for one thing. I couldn’t escape the feeling that retirement communities were depressing. My parents were as active as people could be: Mom participated in no less than two book clubs, the cinema club, she learned to paint, she made jewelry and ceramics and more. She said she felt like it was the summer camp she never got to go to growing up. My Dad played tennis twice a day, worked out, played cards and continued to read voraciously. They went out to dinner several times a week. They couldn’t have been happier.

Gary’s parents were also quite active. David sang in the choir, performed with the Yiddish theater group, and served on the Board of the synagogue. Paula and David went to shul, socialized with a group of fellow Holocaust survivors and played cards several nights a week. They went to the shows at the clubhouse, and they would use the treadmills in the fitness center. Occasionally they went out to dinner, more often Paula cooked or they ate at the cafe on the premises. They too enjoyed their life in Florida tremendously.

Yet, it depressed me – even before their health started to fail. We would drive into sun-drenched Century Village, the buildings clustered like barracks, the tennis courts empty, the golf course sparsely peopled, the man-made lake with no discernible use just a decorative fountain in the middle, and I would feel the sadness descend. The same thing would happen when we drove into Banyan Springs where my parents lived, though it was less cookie-cutter and usually there were people on the tennis courts. It still felt artificial.

It felt disconnected from the regular rhythm of life. I had experienced that feeling before. When I moved into Cayuga Hall in College in the Woods at SUNY-Binghamton as a freshman I struggled. College and dorm life were supposed to be the best time of my life. Instead I felt disconnected, as though real life was going on somewhere else. I enjoyed college much more once I moved off campus.

While some of the melancholy I felt when we visited our parents’ communities stemmed from the constant reminder of our mortality that is a fact of life there, I think it was really that I never did much like summer camp (or dorm life). Too much forced camaraderie, too much pressure to join activities, too much judging of and by others. Maybe we aren’t meant to live only among our own age group at any stage of life – or at least I’m not. Taken all together, memories, associations and my temperament, I’m thinking, when the time comes, retiring to New York City sounds about right.