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Dreams are amazing things. To me, they are an indicator of just how expansive our creative capacity can be. They can be purely fantastic or so hyper-realistic that one can wake with questions regarding which reality – waking or sleeping – represents the true state of being.

I had just such an experience last week, when, in a dream, I watched Dad die right in front of my eyes. I was standing at the sink washing dishes. He walked into the kitchen, dressed up in his wool, houndstooth-checked trousers, white mock-turtleneck sweater and tan cashmere jacket, excited about Christmas. He stopped at the table, turned to head out of the kitchen and then gasped. This was all going on behind my back as I stood at the sink. Hearing the gasp, I turned to see him staggering toward the living room, as though to sit down on the sofa. Before I could really react, I heard a crash as he fell to the floor. I knew he was dead before I could make it out of the kitchen and around the corner. This was it, I knew, this was how it ended. I was so startled by the experience that I woke myself up.

Some researchers see dreams as merely the result of the upper brain’s attempt to make sense of random neuronal signals received when the lower-brain structure that usually helps route those signals has shut itself off for the night. Others have hypothesized a more psychological theory, that dreams are our mind’s attempt to make sense of life’s craziness. Whatever the truth may be, I think my dream somehow was the result of my need to truly visualize how this particular event might play out.

With a disease like, say, cancer, there are a series of tests, treatments, and more tests, that let patient and family know where that patient is in the path toward remission or death. In Dad’s case, though, with so many intertwined diseases and conditions, the end could come in the next 15 minutes or 9 months from now. This lack of knowledge of progression is a blessing, of sorts, I suppose, and I’m sure the not-knowing is better for Dad. Preparation has been a rare concern for him – packing for a trip, for example, means little more than throwing some underwear and socks into his bag, and zipping up his dopp kit. I, on the other hand, think out what I’ll be doing, where might I need a sweater or a nicer pair of shoes, and whether I might want to have my sheepskin slippers handy.

Part of this penchant for preparation comes, I think, from experiencing my own fair share of worst-case scenarios. When you grow up learning that the worst thing you can imagine happening actually can happen, you can become hyper-alert to signs and signals that could be pointing the way to another such event. The shortness of breath that doesn’t go away once the pneumonia has passed, the doctor’s order for oxygen 24/7, the diastolic blood pressure in the 40s and heart rate in the 50s, an unexplained weight loss. All are indications that all is not well.

So I research – pulmonary hypertension, pulmonary fibrosis, chronic kidney disease, diabetes, high blood pressure, low diastolic blood pressure – to try to understand what I’m likely to face, what warning signs to watch for, to try to feel some control over the situation. I’m thinking this recent dream is, perhaps, a similar effort on the part of my unconscious mind to prepare myself emotionally for what might well happen – Kind of like a flight simulator for the psyche.

It hasn’t helped, though, really, all these attempts at preparation. That bump in the night that I’d otherwise sleep through still wakes me, for at least the added few seconds needed to listen for follow-up gasps. When Dad sleeps in a bit longer than usual, I’m still easing his door open to hear for light snoring or see the up-and-down of the comforter over his chest. If I’m out shoveling snow and hear the dogs barking out of control, I still can’t just write it off to a random truck bouncing by or squirrel running past the window.

In this situation, the worst – which, really, isn’t the worst, just the death that’s a part of life – is going to happen, probably sooner rather than later.  I just hope it takes Dad as unprepared as it likely will take me.  I think travelling lightly into that world past that for which our dreams prepare us is the best guarantee for an easy passage.


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The phrase, “death by a thousand cuts” has been running through my mind lately, as I’ve been with Dad to multiple doctors’ appointments over the last couple weeks. Except, I’ve amended it for his situation to “death by a thousand specialists,” as each doctor we’ve seen seems to be delivering their own specific bad news.

Yesterday was a double-header, with a visit to the podiatrist and Dad’s new cardiologist. The podiatrist discovered a rather nasty ulcer on the tip of Dad’s big toe – if that’s not taken care of, infection could get down to the toe bone, which would require a rather large cut, I’m assuming, to remove said toe (see “It’s Ba-a-a-a-aack“). Now, as a result, I’m back to the hated toe-dressing routine on a twice-daily basis.

Then, with a break for lunch, it was onto the new cardiologist, to get his take on the echocardiogram taken a couple of weeks ago, along with a chest x-ray taken last week. On the positive side, congestive heart failure doesn’t seem to be a current concern. On the negative side, though, there’s sign of scarring in his lungs, called pulmonary fibrosis, which is a likely cause of his shortness of breath. Additionally, he has what’s called pulmonary hypertension, which means the side of his heart that pumps blood to the lungs has to work harder because of that scarring, and so has become enlarged. At least, I think that’s what I’ve been able to put together from what the cardiologist told us and what I found on Dr. Internet. So now, Dad’s scheduled for a procedure with the ominous name of “nuclear stress test” or, more commonly, a chemical stress test. I guess this will give the doctors more information about just how crappy Dad’s heart really is.

And, once this test is done, he’s likely to be referred to a lung specialist, which will, in all probability, lead to more tests.

I’ve written about this before (see “Decisions, Decisions“), but I’m just beginning to question the “why” behind all these specialists and tests. He’s 87. He has a hard time breathing. One of the treatments Dr. Internet suggests for pulmonary fibrosis – the scarred lungs – is a lung transplant. Do we really need tests to determine if an 87-year-old man, with compromised kidneys and heart disease, needs a lung transplant? Can’t we just get him one of those little oxygen tanks in a snazzy, nylon carrier and be done with it?

Instead, this system is geared to provide care at a level that seems to suggest an 87-year-old man with scarred lungs, an aging heart and failing kidneys could stay alive forever. Now, yes, we could simply say “no” to the tests and specialists – and, frankly, if the cardiologist suggests a consult with a lung specialist, I’m going to want some more information on the “why” behind that referral before we make the call for an appointment. But, still, there’s an urge to know and treat that is very difficult to resist, and the decision trees that sprout from each new test result often have at least one or two branches that leaf out with hopeful – or, at least, palliative – treatments at their very tips. And it’s only human nature to reach out to those hopeful, if not terribly weight-bearing, branchlets.

But I’m also beginning to see, not the end of the beginning, but, more probably, the beginning of the end. And, more sadly, I’m beginning to feel like Dad is having a similar vision. And it’s very difficult seeing that these tests, which, in a hopeful mind, lead to new opportunities, also, in a more realistic/less-hopeful mind also seem to place Dad in their cross-hairs. This is another reason why I question the need for yet another specialist – 999 cuts may have no less an effect than 1,000 to the outside observer, but, to the victim in question, there still may be a blessing in that one less violation of his mortal flesh.

So, have y’all noticed just how many people are getting really old these days? I mean, I’ve read all the demographic trend reports about just how the 80 – 100-year old age group is now the fastest growing. And, heck, I live on spit of land where the median age appears to be somewhere in the mid-70s, and every other car is either a Prius or a Mercury Marquis with an 83-year-old behind the wheel. But it wasn’t until I started talking to others in my age group that I realized just how many others have parents about the same age – and in about the same shape – as my father.

It seems that our parents are among the first and biggest beneficiaries of modern medicine’s major gains. They’ve had Medicare for the last 20 years or so, and half the latest pharmaceutical innovations seem to be aimed toward their needs, improving their sex lives, urinary-tract performance and ability to cast wheel-thrown pottery with a ghost over their shoulder. Most of their parents were lucky to make it long enough to milk a couple years out of Social Security, but now our parents are living so long they’re bankrupting the system. But, these negative actuarial aspects aside, I’m finding it very heartening to learn that I am not alone as a child of this greatest generation.

A college friend and I have been emailing regularly the past few days as her father has gone through a health crisis, involving falls, congestive heart failure and kidney disease. She wonders, just how did we get to be so old. Boy, can I relate. A friend from church has a dad complaining about his meds and his hesitancy to raise any questions with his doctor, out of fear of being a bother. Yep, I’ve got that one down, as well. And then there’s the caregivers’ support group I belong to, through which we all – spouses and children – are trying to figure out just how to remember the humor and humanity that made our loved ones, well, loved.  In fact, it seems like almost any gathering I go to involving other folks my age or older features at least one little conversation circle covering all these issues all at once.

My father and his twin brother, both now 87, are the youngest from their generation of the family tree. And I’m the youngest of my generation on that side of my family – I’ve just turned 50, and I have first cousins pushing 70. So I have many cousins who have tread this path already with their own parents. But a number of my cousins and siblings also came of age during – or before – the Summer of Love. All of us Boomers have thought of life as being eternal and everlasting, in a very physical – not just spiritual – sense. So, now many of us are confronting the physical signs of decay like they are new phenomena

For our parents, such signs of decay were merely another sign of life. This is a generation that can remember wakes held on their dining room tables, and small children dying of illnesses like scarlet fever or the measles. I have one photo passed down to my stepmother, from her mother’s generation, of a flower-laden corpse surrounded by mourners. I guess this was a form of grief-sharing for that generation, perhaps new to photography. Today it seems morbid, but, maybe, then, when a photo was so much cheaper than a carriage or train ride, it was a way to reach out to far-away relatives to say, “You see, we treated Uncle Friederich well. Isn’t it sad. Look at this and you can cry with us.”

Our generation, however, was raised on emotion and emotional processing. For us, it wouldn’t just be about the beauty of the floral arrangement shown in Uncle Friederich’s wake photo, it would be about who Uncle Friederich was – was his father an alcoholic, did he beat his wife or keep a young farmhand on the side. Was he kind to poor people, or weep when his favorite dog died. So it’s fitting, especially now, that the Greatest Generation went on to raise the Largest Generation, for now we all have each other, with whom we can talk about all this family drama.

My fear, though, is that all this sharing is just a prelude. Another 10 years or so, and the parents will be gone, but we’ll have all this built-up medical awareness and a range of conversational habits directed toward aging and dying. Oy. While the children of the next generation – now adults on their own right – got to know me and others of my generation through our memories of seeing Janis at the Filmore West (not me, so much) and our appreciation of irony in art (really, me, so much), they’ll end up remembering us for our ability to endlessly parse the difference between beta blockers and statins. And, given the demographics, there will be a lot more of us than there will be of them. To whom shall they turn for a little bit of levity in life?

So, to my fellow baby boomers, I suggest we work harder on the humor and lighten up on the drama. For example, Consider taking on the weekly ritual of filling your parent’s pillbox during cocktail hour. I did so tonight and cracked myself up at the irony of slotting drugs into daily compartments between gimlet swigs:  Metaprolol for him, Ketel One for me, Diovan for him, Ketel One for me, Proscar for him, Ketel One for me, etc., etc., etc. And when your parent suggests a final trip around the country – as Dad did tonight – to visit family and friends, encourage it as an adventure, even if – in your heart – the mere idea terrifies.  Because, as this generation – for good or ill – has been a role model for us, so we should be a role model for those that follow – do we want to be looked after with pity or awe?

And, just as important, our actions in helping our parents approach such difficult times could help us once we’re lucky enough to reach such advanced age ourselves. If we can model humor and adventure to our own aging parents, then, just perhaps, we can approach the experience with the same upbeat attitude, ourselves. I don’t know about you, but I plan to still be smiling,  behind the wheel of that just-perfect Prius or (God forbid) Mercury Marquis, as I make my own farewell tour visiting those whom I hold dear.

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