Into the storm of the limits of age

An old man told me last week I had killed him, and my guess is that he was right. He came in looking for help and he left with a sense of doom. I gave him that with some antibiotics for his pneumonia because I found out he had enough dementia that he did not know where he was or how to get home. The dementia would not have mattered so much except that he was still driving on a daily basis, at the age of 90.

“You cannot drive any more,” I told him. “I am going to have to tell the state they probably need to take your license. Your neighbors say you are running into things with your car, and you are confused about your surroundings.”

“How will I get my groceries? How will I go for a drive when I get antsy?” he asked. “Are you going to do that for me if I can’t drive? No one else is going to do that for me.”

“You are going to hit and kill someone and I cannot let you do that,” I answered.

“You have killed me if you do that,” he said. “If I can’t drive I am going to just curl up at home and die.”

A few days later I drove to work in the face of a gathering northeaster to an emergency department on the coast of Maine. The ocean moved like an angry dog on a chain, the ground was bare, and the trees were dark evergreen or stripped. As the first spits of snow began to swirl and the gray clouds stole the light away, I noticed how early winter makes the world look its age, remembered the old man, and was reminded just how appropriate winter is as the seasonal metaphor for growing old.

For some, growing old is the wonderful adventure it can be. They have the winter wear of good health, the warmth of good medical care, the shelter of a good family, and the shovel of money.

They have a spouse or an adult child who plows through the piles of health care bureaucracy that drift in every patient’s way and appear insurmountable to the frail elderly. They don’t have it made but they have what it takes.

For others, growing old can be a harsh winter, the kind of winter a seasoned Mainer would remember with a shiver. At its depth their winter days are more darkness than light, and a blanket of chronic illness covers everything. Each day is cold with physical challenge. The infirm elderly walk knowing that old bones often do not forgive even simple falls to the sidewalk, and that life itself is as slippery as ice underfoot. Family participation, if they have it, is muted by senses of diminishing capacity; the joy of listening to the babble of family is slowly muffled by hearing loss, and the joy of seeing its daily richness is slowly lost to fading vision. The mind may not remain sharp enough to get a contributing thought in edgewise around the dinner table.

As though the cold and the dark are not enough, winter brings storms of illness. For the lucky ones, the storms are survivable adversity, winter’s challenge to be suffered from a place of warm shelter. The unlucky live alone and a long way from the nearest health care, as did the old man. Family is at best a neighbor who comes over after work and checks in on them. These elderly have little help, either for the winter of their lives or through the storms of illness. There is no one to make sure they eat well, or take their medicines without confusing the heart pill with the arthritis pill. Worst of all, there is no one to faithfully serve as their bridge to a world fading in the distance, and no hand to guide them through the gathering gloom. For them, getting old does what a vacuum cleaner does.

As this country’s baby boomers look to their winter of old age many of them may be facing it with even less shelter than their parents have. The government-funded social services that have served to protect many of us from the worst features of old age are being ravaged by budget deficits, and by political abandonment of government’s role in maintenance of the social safety net. The family will continue to serve as the shelter for many, but for a growing number of others, especially the elderly poor, there will be little protection against the chill of old age and the storms of ill health unless the rest of us protect them. We will have to give them political and social shelter, and prevent the dismantling of the systems of social support which have replaced communal life and extended families, such as home health programs, senior centers, Meals on Wheels, and more.

Otherwise, many of the least fortunate elderly will be caught out in the open during the winter of their old age and succumb to the numbing cold of progressive isolation and ill health. That is where the old man knew he stood when I told him he could no longer drive, which is why he figured there was little else to do but curl up and die. It was, after all, what we were leaving him behind to do.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.