So, four days ago Dad marked his fourth anniversary as a Cape Cod resident (NOT a Cape Codder – there are rules around here about who can claim that title, and neither Dad nor I will live long enough to earn it). When he moved out here, it was because we both knew he’d end up in a nursing home quickly if he stayed in St. Louis. Keeping him out of a nursing home had been our primary goal up until late October, when what he thought was constipation turned out to be a tumor in his colon. Over this past weekend, a day or two past that fourth anniversary date, he officially ran out of Medicare coverage at the facility where he’s been living since about Thanksgiving. So, we’re now in the spend-down period, when nursing home bills eat up all but $2,000 of his savings and he’s poor enough for Medicaid (called MassHealth in Massachusetts) to kick in. And, while this was just the situation we both had been dreading for years, it turns out it’s actually o.k., in large part because of my father’s amazing emotional resilience.
The first month or so after Dad was admitted to this facility’s rehab wing for physical therapy was pretty stressful for me. He still thought he could get well enough to come back home, while all I could think of was his weak, shaking hands and that colostomy bag, along with the blood sugar testing and insulin shots he now required. He was making some progress toward walking, but still was wearing Depends because he couldn’t make it to the toilet on his own. However, his early January hospitalization put an end to his dream of getting home again. He was flat on his back for nine days with congestive heart failure complications and, by the time he was readmitted back into rehab he had lost all his progress. He tried to recoup those losses in his physical therapy sessions, but then his oxygen levels and blood pressure started dropping anytime he tried to stand up, and the therapy had to be discontinued.
That was a dark day. I happened to show up just after he got the verdict from his therapist, and I’ve rarely seen him that down. It seemed like he might have hit that “What’s the point” stage, one hears about, when folks just decide their time has come. Overnight, though, some extraordinary wind blew through his psyche, and when I showed up the next day to check on him, those dark clouds had passed. “What else can I do,” he said with that familiar shrug when I noted the positive change of spirit. “This is where I am.” He’s maintained that equanimity in the weeks that have followed, and his acceptance has been a gift to me, allowing me to shed the guilt I felt with the thought that I might be forcing him to stay somewhere he didn’t want to be.
Watching Dad continue to interact with the staff in his characteristic smilingly sarcastic manner when I show up for what has become a daily game of gin between the two of us, I’ve also been able to put aside the thought that a nursing home would be hell on earth for any elder competent enough to understand they’d reached their second-to-last resting place. I’ve been an on-again/off-again member of caregivers’ support group at the local Council on Aging since Dad moved in, and many of the other caregivers have been dealing with parents or spouses at various stages of dementia. How much easier it would be, I’ve thought, to handle the emotions attached to admitting someone to a nursing-home if that person wasn’t in a state to understand the situation.
However, the last few weeks have put such thoughts to rest, because I’ve come to see that Dad’s quality of life really hasn’t diminished, despite his change of residence. He’s not going to be one of those life-of-the-facility types one hears about – he just doesn’t have much interest in all those other “old people” attending the activities. But he’s completely charmed most of the staff, and, as a result, likely has more interpersonal interaction than he did living with me. As before, he spends most of the day watching golf on TV, but nurses and aides are in and out of the room several times an hour. And when I show up for our daily gin game, we spend real time together, resentment-free on both sides.
And, on the other side of that false assumption, I’ve also seen, up close, the level of incapacity with which human beings can live and still sustain a heartbeat. Walking down the hall to Dad’s room, I often pass aides pushing wheelchairs that look like rolling recliners, with patients curled into near fetal positions. They’re being transported to a dining room where aides will spoon feed them their lunch. No sign of personality or emotional affect remains. “What was I thinking?” I asked myself, the first time I walked the hallway to Dad’s room and considered the heartbreak family members must feel when faced with this physical reminder of a mind that’s long since left. “Thank God that’s not Dad.”
Just as I began writing this installment, a friend posted a great quote from Abe Lincoln on their Facebook wall – “Most folks are about as happy as they make their minds up to be.” Through all of his stubbornness, and his refusal to acknowledge the health issues I saw staring him right in the face, Dad has demonstrated the truth in Lincoln’s observation. I hope my attention to exercise and eating (mostly) healthy will keep me in better shape if/when I hit 90. But, if not, I also hope I’m able to remember Dad’s example when facing any similar situation and make up my mind to be happy. Because, well, what else can you do?