My first poetry collection is announced in the Maine Authors and Publishers Alliance Ex Libris newsletter for late June.
It is available on Amazon for $7.00, or by contacting me at:
moriahfree@gmail.com
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I have mentioned here before that I meet monthly on Zoom with a group of women who talk about our experiences of aging and our musings on death. We explore our stories, insights, discomfort, and fear about the inevitable decline of our bodies and the certain end for us all. A few weeks ago, we had a courageous discussion about dying, our own and that of those we love. Not surprisingly, most of us expressed more fear about the possibility of a painful, demeaning, drawn-out dying process than about the moment of death and what, if anything, comes after it. We ventured onto the delicate topics of Death with Dignity and Physician-Assisted Death, which is legal in some countries, including Canada, where I was born.
I told the story of my Canadian cousin’s husband’s death. I’ll call him Leigh and her Meredith. He suffered for years from debilitating cancer, which was diagnosed just after his retirement when they had planned finally to begin their travel adventures together. Leigh, supporting and delighting in Meredith’s wanderlust and love of natural beauty, encouraged her to go exploring on her own and with their daughters. He enjoyed her travels vicariously and enthusiastically. However, as time went on, she traveled less as he needed more care and experienced frequent hospitalizations for treatment and long energy-less periods confined at home.
Though he tried his best not to be a burden for his family and patiently bore the symptoms of his disease, it troubled him that Meredith’s life centered around him and his ups and downs. He recognized her profound sadness as she watched him suffer, helpless to alleviate it, and worried about how she would cope with what they had good reason to believe would be a painful and degrading end. As the pain increased and his energy ebbed, recognizing his own and Meredith’s exhaustion and the toll his suffering was taking on her, he decided to apply for MAID, Medical Assistance in Dying. Canadian law provides this option for individuals who are terminally ill or in intolerable pain.
Together, Leigh and Meredith navigated all the legal requirements and preparations and finally arrived at the day of his death. Meredith and both of their adult children gathered around his hospital bed, said their goodbyes, and expressed their love and gratefulness for each other. Medical personnel administered the necessary medications, and quietly and peacefully, Leigh went to sleep and then ceased to breathe. Meredith experienced the meticulously planned and compassionately orchestrated end as a gift of love Leigh gave to himself, her, and their daughters. Years later, she still speaks movingly of this gift and her memories of their last intimate moments together. She says Leigh was right; a horrible end would have been much more difficult for both of them to endure and for her to recover from. Instead of her beloved in agony, her last memory of him is tender and peaceful.
I did not tell the story of my mother’s death in that morning’s discussion group. In her early eighties, she was diagnosed with pancreatic cancer after a long period of ignored symptoms and then months of waiting for tests and doctors’ appointments. The specialists said that her only hope of survival was a drastic surgery in which her abdominal organs would be removed from her body to make the tumor on her pancreas accessible for excision. Then, they would replace the organs, and everyone hoped everything would work properly again. It was a risky option back then for even a younger, more fit person, but it was a long shot for someone in their early eighties. By demonstrating determination and pestering her doctors, she got them to agree to perform the surgery, even though success was extremely uncertain. She wowed them on the pre-surgery stress tests, proving that she was strong enough to withstand the operation, but as the day approached, she was anxious and irritable.
One evening, I asked her why she was willing to put herself through such trauma for perhaps just a few more years of extended life when she could not count on a full recovery or high-quality health. She responded without hesitation, as though she had already asked herself that very question and was certain of the answer. “It’s for your father,” she said. “He will be too lonely when I die. But don’t tell him.” I didn’t press her further. She and my dad did not have an overtly romantic relationship. I can’t remember her ever expressing feelings of love to anyone. On the contrary, she tossed criticism liberally in all directions. But they had been married for more than fifty years, and their lives were so intertwined that she knew her death would be his undoing.
She had the surgery. The team opened her up and saw an abdomen riddled with cancer, so they closed her and sent her to recovery. The surgeon told us the outcome and gave a prognosis of one to three months. She lived through the night and, early the next morning, experienced massive internal bleeding, was taken back to surgery, and died of heart failure. My father’s sobbing heartbreak is seared into my memory, as is the sight of his forlorn, defeated figure standing outside her empty bedroom at home that evening.
I’m not sure if my mother ever told my father that she loved him, but she knew how much he loved her, and she was willing to endure a horrendous surgery out of compassion for him—her gift of love. He lived for five lonely years after her death, making the best of each day but missing her profoundly. It was tough to watch.
Another member of the aging-and-death discussion group shared a glimpse into a recent awakening. She’s been seeking understanding of love, what it is, how it feels, how it manifests, for quite some time. Recently, she and her husband were walking during an outing. He is older than she and is slowing down slightly. She found herself dropping back to match his slower pace and wondering at the tender willingness she felt as she did so. Could this be love, she asked herself—some facet of love?
As I draw nearer to my own inevitable death—The Big Let Go—I ask myself what will be most important to me, and I know instantaneously and completely that it will be love. Everything else will fall away, and the only important activity will be loving—giving and receiving it. Knowing this, shall I start to practice now? Let go of all but love, in every moment and situation, and lean into loving—fall into it, and trust it utterly.
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.
With All Due Respect 