In my youth I dreamed of being old, evil, and rich. Around 50 I realized that rich is relative, old is inevitable, and evil is just too damn much work.
I just finished reading Atul Gawande’s Being Mortal: Medicine and What Matters in the End. Nothing like a light topic to kick off the week after Easter.
Gawande is a second-generation American. His parents came from India and were doctors for many years in the US. He himself became a surgeon. Gawande reveals a great deal about the struggle he and his mother had during his father’s illness and eventual death. He compares how these events might have played out in India versus the United States. Because of migration his family was caught between their perceptions about the old cultural script for old age and death, and the very chaotic one in the destination country. Why chaotic? Because that script is still in process in the US and in many other modern industrialized nation-states.
What Gawande understands about old age and dying in India provokes in him a nostalgia for a country he’s never lived in. What appeals to him, I think, is the certainty that comes from following a cultural script which tells us what is the right thing to do: old people are to be respected and venerated; they are to be cared for by family; dying is done at home surrounded by children and grandchildren.
In the US older people seem to prefer independence to respect. Their idea of ageing gracefully is about the freedom to live as they wish, to travel, to enjoy life without the boss, their parents, or their children telling them what to do. This poses a real dilemma when older people can no longer live by themselves.
That day will come. I had a taste of it when I was diagnosed with cancer. One of the reasons I wanted to buy our house is that it is small and almost everything is on one floor. I don’t have to climb a flight of stairs to go to bed.
I have not thought beyond that. To be honest I am not sure what the cultural script is here in France for old age and dying. I know that some older French go to retirement homes and some live with their children. There are also visiting nurses, doctors who make house calls, assisted-living retirement communities and there is hospice.
In every migrant’s mind there are times when we look back at where we came from and wonder if there is better than here. There is an “illusion of return” – the idea that one could always go back and thus staying in the host country is a choice to be considered and reconsidered over the course of one’s life.
However, if a migrant has aged in situ there comes a point where one’s choices become limited and return is revealed for the illusion it is. (Unless, of course, we are rich enough to overcome most of those limitations.) When we are old and becoming more dependent on others, it is, I think, reasonable to wonder if where we are is the very best place for us – a place where what we want is doable. To be clear, if we wait too long the decision will be out of our hands. Our children and/or a spouse will decide or, if we don’t have them, the state will do so.
It’s worth conducting a thought experiment here. Project yourself into the future, into old age (or illness) at a point where you will need assistance of some sort. Consider the options available to you based on your resources and on the country in which you live as a migrant or naturalized citizen.
Most importantly, think about what matters most to you. Is the host country still appealing if you can no longer use the public transportation, walk to the market, work in the garden, watch television, participate in neighborhood events, or manage your administrative affairs without help? Do you value your life in your own home and are there resources to make that possible as long as possible? Could you accept life in a nursing home here? If your resources are limited, what happens to the indigent elderly in this country and are you OK with that? Are you comfortable with the idea that the local government will make decisions for you if you can’t make them for yourself?
When you are dying what kind of care do you want? Can you die at home in the host country? Do you want support from family and will they have to come to you or you to them? Are you allowed to have a “living will” and to reject treatment that you understand might prolong your life but at the cost of destroying your quality of life? For some the option of “assisted dying” might be important and that is dependent on local laws.
Better to think about these things now than to have to face them (as Gawande’s family did) in a state of confusion and when one is already in a state of dependence. Gawande’s father, for example, insisted that he did not want to go to the hospital and die there. And yet, when there was a crisis, his wife and son took him there anyway because between his wishes and their doubts about what they should do and fear, fear won.
I started this post with what I used to want in my old age. Now that I am getting closer and have seen what my life might be like as I approach the end, my priorities have changed. Gawande was absolutely right when he wrote:
As people become aware of the finitude of their life, they do not ask for much. They do not seek more riches. They do not seek more power. They ask only to be permitted, insofar as possible, to keep shaping the story of their life in the world – to make choices and sustain connections to others according to their own priorities.
It does not take much these days to make me happy: a good book, the presence of my spouse, news from the Frenchlings, the garden in the springtime. Being mortal doesn’t bother me as much as it did when I was younger. And I don’t fear dependence nearly as much as I did here in France because I’ve been there and it can be a very serene place as long as there is room and respect for my wishes. There was and that is a great comfort.