Dignity or Indignity

I frequently visit a long-term care facility near my home. My dog and I go once a week to offer pet therapy to the residents. We walk from room to room, greeting the patients who pet the dog, smile at his simple tricks, and feed him treats as a reward. Occasionally, I also serve as a hospice volunteer in this facility, watching with someone who is dying through the dark hours of the night. For one reason or another, I’ve spent a good deal of time visiting nursing homes in Maine and Massachusetts, and this facility, in my experience, is one of the best. From an outsider’s point of view, it is clean and well-managed, with a full complement of services and a clientele that seems satisfied with their care. The staff is friendly to my dog and me, speaks kindly to the patients and treats them with gentleness.

            Still, even in this seemingly best-case scenario, there are sometimes heart-breaking and gut-wrenching situations. Recently, nearing the end of a morning visit with my dog, I approached a patient we know well, who loves the little pup and whose attention he welcomes. She was sitting in her wheelchair in the hallway outside her room, looking anxious. I asked her what was bothering her, and she said she had been waiting for a long time for someone to take her to the bathroom. The young social worker who had just left her side had gone in search of a nursing aide to assist her. “It’s so hard,” she said, “when one gets old and bladder control is not what it used to be, and you call and call, and no one comes. Things have gotten worse,” she said. “One waits longer and longer now.” I expressed my sympathy and felt frustration rising in my chest. I also noticed a high-pitched wailing coming from the room opposite hers.

Someone else was also in distress. The room had a barrier across the door with a large stop sign in the center, indicating that only authorized personnel could enter. These detachable and portable barriers became common at the height of Covid outbreaks. “Help! Please help!” came the weak plea from the bathroom inside the room, but I could not go in to see what the matter was. I surmised the resident, whom we also know well, had been sitting on the toilet for a long time and was in discomfort or pain. The social worker approached again and reported that a nurse would be along shortly, after she finished putting another patient in bed. Timidly, I pointed toward the Stop sign and asked if she knew someone else needed help. She looked daggers at me, I guessed, for interfering, so I said goodbye to our friend in the wheelchair and walked on, frustrated, sad, and embarrassed for all of us.

The next day, when talking about aging with a group of healthy women in their sixties and seventies, I told this story and commented that this sort of indignity may await us all. I believe this common occurrence in senior care facilities is not the fault of nurses or other staff, social workers, or families, I argued, but the result of an ageist society that does not value the lives of those who are no longer financially or physically productive. An uncomfortable silence, a few somber nods of recognition, and a change of subject followed my candid expression of opinion. Understandably, no one wanted to discuss toileting in nursing homes or dwell on the possibility of finding ourselves in similar situations down the aging road.

I wrote about the indignities of the senior healthcare system in an extended series on The Elderly and End-of-life Care in 2017 when I launched this blog. Things have not changed since then, and because of further staffing shortages, they have worsened in many ways.

This kind of indignity may await all of us. More and more of us are living into our nineties because of medical advances producing life-prolonging disease treatments and cures. The healthcare system is stretched beyond measure, caring for an ever-increasing percentage of seniors in our population. We take advantage of every possible means to prolong our lives. Covid has decimated the ranks of healthcare professionals, and the greed of insurance and drug companies complicates matters further. I frequently hear my contemporaries say that the system is broken. They can’t get direct face time with their primary care doctors, or appointments with specialists, or get their prescriptions promptly. Doctors and nurses are quitting in frustration or from burnout. In-home care is exorbitantly expensive, and the agencies that deploy homecare workers are limping along with a few staff members. Of course, the financially secure have it far better than low-income people. That goes without saying, but no matter how financially secure you are, your dignity will be in jeopardy if you can’t get someone to take you to the bathroom.

Or will it? In these recent posts, I’ve been encouraging us to think about practicing for The Big Let Go—death. I’ve been recommending we consider learning to let go in small ways in ordinary daily situations to be ready to let go in a big way at the end of our lives. Am I suggesting that we must let go of our dignity? No. I am proposing that we consider where our dignity truly resides.

Does our dignity depend on how others treat us, or is it reflected in and demonstrated by how we treat others? My friend waiting for assistance to go to the bathroom was calm, polite, and sad but not angry, even though she faced the indignity of potentially soiling herself while she waited. The other patient, pleading for assistance from her bathroom, said, “Please.” Can we learn to relinquish the external signs of dignity while holding on to our inner poise, beauty, and self-esteem? And how can we practice doing that today?

How do we respond when someone wounds our dignity in small or large ways? Can we still insist upon the outward recognition of everyone’s dignity while more highly valuing intrinsic worthiness, integrity, humility, and courage as the essence of our humanity?

We may not all end up in situations like the patient in the wheelchair waiting for assistance with toileting. We may be lucky enough to die suddenly or in the comfort of our homes, surrounded by those who love us and tend promptly and respectfully to all our needs. We may live an active and independent life, avoiding physical dependency on others to the end. But if we don’t practice letting go of external signs of respect while holding fast to inner dignity, we may lack the necessary interior resources to draw upon as we approach The Big Let Go.