Mind Matters: Being mortal

None of us know when we will die, but we can’t deny that it is inevitable. Even tax evaders can’t avoid mortality. Atul Gawande, M.D., in his book, “Being Mortal: Medicine and What Matters in the End,” invites us to reflect on the process of aging and death.

Death can be instantaneous, sudden, but usually it isn’t. More than likely, we face the aging of our elders, our parents and then come to the brink of our own mortality in a process over time, rather than in a nanosecond.

When I was 50, I took care of my parents in their dying. Now I am almost 70 and wonder about my own end of life issues as I work with people older than I. Some are residents in assisted living; others are still living independently. Yet we all want the same thing: autonomy in our decision-making, and a sense of aliveness to continue.

Gawande articulates in his writing what I have observed first hand working with an aging population, particularly residents in assisted living. These folks have enough capital to afford such a safe and comfortable place, and even at that, the situation is far from optimal.

Yes, in general, the nursing staff is caring, competent and compassionate. Yet the operative words here are “nursing” and “staff.” Nursing implies a medical model where the hallmark activity is the dispensing of medicines in a timely manner. “Staff” conveys the regimentation necessary to maintain institutional structure. Sure, we all need structure. However, often times the institution supersedes the uniqueness and importance of the individual.

Gawande describes how the typical “nursing home” operates: “efficiency … [demands] that the nursing aide staff have the residents ready for the activity coordination staff, who … [keep] them out of the rooms for the cleaning staff, et cetera.” (p. 143)

In his research, however, Gawande found an alternate model of care, called the “Green House” where control no longer resided with facility managers but with the “frontline caregivers.”

These caregivers would focus on just a few residents and are thereby able to have more contact with the residents, becoming more like companions. My hunch is that the stereotypical assisted living model could incorporate the Green House idea simply by increasing the ratio of aides to residents.

Perhaps the most compelling message Gawande purveys is that medicine does not have all the answers, especially when it comes to aging and death. Sometimes the medical model attempts to prolong life to the detriment of living a life. And in the interest of “patient safety,” elderly residents are constrained and restricted from making choices.

I remember one woman resident of a facility who loved to go outside and walk. Given her dementia, she was considered an “elopement” risk. Eventually, she was confined to the locked unit — windowless, airless, but it had a TV. So there she sat with others like her. Was she safe? Yes, but to what end?

Unfortunately, the facility where she lived had no outdoor gated walks where she could be outside, yet contained. When I would walk through her unit and call her name she would always look up and give a big smile and say “Hello, dearie!” Was her will to run waning due to her dementia or to the medications that blunted her? To keep her “safe?” We know, with the medical model, how to keep people “safe” but we don’t know with that model how to let them really live.

Gawande invites us to rethink how we treat our elderly—who, if we’re “lucky”—will eventually be ourselves.

* Kayta Curzie Gajdos holds a doctorate in counseling psychology and is in private practice in Chadds Ford, Pennsylvania. She welcomes comments atMindMatters@DrGajdos.com or 610-388-2888. Past columns are posted towww.drgajdos.com.

 

About Kayta Gajdos

Dr. Kathleen Curzie Gajdos ("Kayta") is a licensed psychologist (Pennsylvania and Delaware) who has worked with individuals, couples, and families with a spectrum of problems. She has experience and training in the fields of alcohol and drug addictions, hypnosis, family therapy, Jungian theory, Gestalt therapy, EMDR, and bereavement. Dr. Gajdos developed a private practice in the Pittsburgh area, and was affiliated with the Family Therapy Institute of Western Psychiatric Institute and Clinic, having written numerous articles for the Family Therapy Newsletter there. She has published in the American Psychological Association Bulletin, the Family Psychologist, and in the Swedenborgian publications, Chrysalis and The Messenger. Dr. Gajdos has taught at the college level, most recently for West Chester University and Wilmington College, and has served as field faculty for Vermont College of Norwich University the Union Institute's Center for Distance Learning, Cincinnati, Ohio. She has also served as consulting psychologist to the Irene Stacy Community MH/MR Center in Western Pennsylvania where she supervised psychologists in training. Currently active in disaster relief, Dr. Gajdos serves with the American Red Cross and participated in Hurricane Katrina relief efforts as a member of teams from the Department of Health and Human Services' Substance Abuse and Mental Health Services Administration.Now living in Chadds Ford, in the Brandywine Valley of eastern Pennsylvania, Dr. Gajdos combines her private practice working with individuals, couples and families, with leading workshops on such topics as grief and healing, the impact of multigenerational grief and trauma shame, the shadow and self, Women Who Run with the Wolves, motherless daughters, and mediation and relaxation. Each year at Temenos Retreat Center in West Chester, PA she leads a griefs of birthing ritual for those who have suffered losses of procreation (abortions, miscarriages, infertility, etc.); she also holds yearly A Day of Re-Collection at Temenos.Dr. Gajdos holds Master's degrees in both philosophy and clinical psychology and received her Ph.D. in counseling at the University of Pittsburgh. Among her professional affiliations, she includes having been a founding member and board member of the C.G. Jung Educational Center of Pittsburgh, as well as being listed in Who's Who of American Women. Currently, she is a member of the American Psychological Association, The Pennsylvania Psychological Association, the Delaware Psychological Association, the American Family Therapy Academy, The Association for Death Education and Counseling, and the Delaware County Mental Health and Mental Retardation Board. Woven into her professional career are Dr. Gajdos' pursuits of dancing, singing, and writing poetry.

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