True Solitude

In his book New Seeds of Contemplation, Trappist monk Thomas Merton wrote of the spiritual benefits of solitude. He notes, though, that not everything that looks like solitude is genuine:

“There is not true solitude except interior solitude.”

Just getting away from others and spending time alone may not qualify as genuine solitude, not if our inner spirit isn’t at peace. Merton’s next sentence explains one barrier to true solitude:

“And interior solitude is not possible for anyone who does not accept his right place in relation to other men.”

So Merton thinks that solitude, seemingly the most isolated of activities, is only possible in the context of relationship. In particular, our capacity for solitude depends on our attitudes concerning who we are in relationship to others. Merton explains this further:

“There is not true peace possible for the man who still imagines that some accident of talent or grace or virtue segregates him from other men and places him above them. Solitude is not separation.”

Early in life, each of us tried to distinguish ourselves from others. One personality theorist believed that as young children we all had a sense of inadequacy or inferiority, and we compensated by striving for superiority. That striving could be benign, a striving to overcome difficulties. It could also become an exaggerated belief in our own importance, often accompanied by denigration of others. It’s hard to give up the tendency to elevate ourselves above others in some way, whether this be by virtue of “talent or grace or virtue,” as Merton noted. He is suggesting that as long as we do this we won’t achieve the inner solitude that makes us receptive to God’s presence.

The older I get, the more I realize that overcoming the tendency to elevate myself above others is a lifelong project. There was a time when I liked to dwell on the traits I thought distinguished me from others. I thought that I was smart, I was hard-working, I was insightful, I was kind. Did these traits really set me apart from others, though? Granted, for each trait I could find people who seemed deficient compared to me. Unfortunately, in each case I also knew people who possessed more of the trait than I did. Maybe I wasn’t so special after all!

There was a part of me–the part that Merton labels the false self–that kept on trying to prove to myself that I really was better than others–maybe not better than everyone, but better than most people. That voice saying “you have a better understanding of that than he did” or “she didn’t do that as well as you could have” still shows up. More and more, though, I’m recognizing that this voice separates me from others and from God. It also leads me away from reality. As Merton says,

“My false and private self is the one who wants to exist outside of the reach of God’s will and God’s love–outside of reality and outside of life. And such a self cannot help but be an illusion.”

So I’m getting better at recognizing that the temporary rush that comes from imagining myself smarter or better or wiser than others is worthless–or, even more, it’s pernicious. When I start going down that path, I try to turn back as quickly as I can. The delights of self-exaltation quickly turn sour. Those of true solitude and genuine fellowship with others and God never lose their sweetness.

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Mom on the Mend

My mom, who is 91 years old, fell a couple weeks ago. She was in the bathroom, heading for the toilet in the middle of the night when her feet flew out from under her. She normally takes her time and is careful, but that wasn’t the case this time. She landed hard on her rear and hit her head on the door. She was able to get back up, but had quite a bit of pain. Her doctor arranged for an in-home X-ray, which didn’t show any fractures.

I was out of town at the time she fell but came back five days later. She still was having considerable difficulty getting around. I tried to get her physician to order more tests, but only succeeded in leaving lots of messages and getting annoyed. When, a few days later, she had a great deal of difficulty taking care of herself in the morning, I decided it was time for her to go to the emergency room. A CT scan showed a compression fracture in her lower back, and she was admitted to the hospital. After three and a half days, she was transferred to a rehabilitation facility to regain some of what she had lost in strength, balance, and functionality. I visited her a number of times in the hospital and transported her to rehab. Here are a few observations, some about treatment but mostly about going through this sort of challenge at age 91:

  • Emergency rooms are just as difficult to negotiate as ever. Mom was there about eight hours before being admitted. She hadn’t had her medications or anything to eat that day, but the ER staff didn’t address that issue at all.
  • Despite not eating all day, mom had no appetite even when the pain was manageable. I wonder if that is because as we get older we can’t focus well on more than one thing at a time.
  • It takes approximately forever for doctors called in for consultation (in her case, neurology and orthopedics) to render their opinions. ER staff seem content to wait however long that takes.
  • Though mom is still sharp for her age, she had considerable difficulty telling everyone concerned a complete story of what happened. When I was there, I often had to add or explain details.
  • Mom knew where she was most of the time, but she was prone to become disoriented. One morning she woke up knowing she was in the hospital but thinking she could get up and walk out of the room to find the closet containing the robe she wanted to put on. When I came to visit a few hours later, she told me she knew at the time that the closet was at home. Somehow, hospital and home were conjoined in whatever mental map she was consulting.
  • Mom had a number of visitors in the hospital, and appreciated all of them. What impressed her the most, though, was that the head pastor of her church came to visit. She belongs to a large church and visitation is usually handled by one of the assistant pastors. When she saw me, she exclaimed, “You’ll never guess who came to see me!” She described Pastor Jonker’s visit with as much enthusiasm as might have been expected for a visit by royalty.
  • She has had longstanding difficulties swallowing as a result of bulbar polio when she was young and a stroke nine years ago. All her food needs to be pureed, and even then she has trouble getting anything down. I didn’t think she would be able to eat hardly anything while hospitalized. She did much better than I expected. I underestimated her ability to adapt.
  • She was given a swallowing test in the hospital and did rather poorly. The staff looked at her results from a couple years earlier, saw they were the same, and decided that, since she had been managing on her own just fine, she could be relied on to decide what she could and couldn’t eat while she was there. I was surprised by the common sense displayed in this matter.
  • I had expected it would take a while for her to be in good enough shape to sit, stand, and walk without excessive discomfort, but she reached that point in just a few days.
  • The nursing staff did a good job helping her. They were respectful, caring, and encouraging. They treated her the way any of us would hope our elderly mother (or grandmother) would be treated.
  • When she was discharged from the hospital her nurse told me that, if he lives to 91, he hopes he is in as good a shape as she is. Nice to hear.
  • The move from the hospital to rehab was harder for her than I expected. When brought to her room she had trouble settling in. The rehab room seemed similar to the hospital room, just with less medical equipment, but she found the two settings different enough that she had trouble coping.
  • Part of her trouble coping was probably because she wasn’t sleeping well at night. Besides discomfort and the unfamiliar environment, some of her difficulty sleeping was that both at the hospital and in rehab she had a roommate who was making noise when she was trying to sleep. She complained to me about her hospital roommate, who was chatting on the phone with her sister until after midnight. She hadn’t said anything to the roommate about this, though.
  • Mom’s coping seems more like an on-off switch than a rheostat. She deals with things up to a point, then is overwhelmed and doesn’t cope at all. That happened the morning we went to the ER and again her second day in rehab.

I had to leave town again her third day in rehab so I wasn’t able to visit her all week. Talking on the phone, it seems as if her adjustment has been up and down. I’m back in town and briefly stopped by this evening to say hello. It’s been interesting to watch her go through the initial stages of this journey, wondering how well I would do if I was 91 and faced the same challenges.

Mom leaving the hospital

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Among the Stones (Far from the Madding Crowd)

It’s been a contemplative summer. I read a book on Centering Prayer, a contemplative form of Christian prayer, and have tried to incorporate aspects of it into my spiritual practice. I’ve been slowly working my way through New Seeds of Contemplation by mid-twentieth-century Trappist monk Thomas Merton. I’ve been trying to devote less attention to what’s going on elsewhere–political developments, the financial markets, sports, social media posts–so I can notice more of what’s happening where I am, in my immediate surroundings. And I’ve also been sitting among piles of stones.

The latter is the result of a project at my mom’s house. Many years ago, she and my dad had a stone border about six feet wide and fifty feet long installed alongside their driveway. Workers dug up the grass, laid down landscape paper, then dumped a few thousand pounds of small stones on top. The border looked very good for many years. With time, though, dirt and organic matter fell or were blown into the stones. Some of this material eventually sifted down to rest on the landscape paper, and eventually there was enough soil that weeds started growing up through the stones. Each year, it takes more effort to clear away the weeds. This spring, grasses, dandelions, violets, and various and sundry other types of plant sprung up everywhere in the border. I decided that it would be best to remove the stones a section at a time, pull up the weeds, put down new landscape paper on top of the dirt, and put the stones back on top.

I soon discovered that I couldn’t get the stones up with a shovel, meaning I would have to remove them with a trowel and my hands. It took hours to remove the stones from just a few square feet. I piled up stones in large stacks. The stones were dirty, so before I put them back on the new landscape paper I had to wash them off in buckets of water. So far, I’ve spent about 40 hours on the project, thirty minutes or so at a time, and have only completed an area about six feet square. I’m not going to get the project completed by the end of summer.

At first it bothered me that I was making so little progress. Then I discovered that digging in the stones was an excellent way to flush from my mind the concerns that usually accumulate there. I like looking at the stones, each different in size or shape or color from the next. I like their feel, their heft and smoothness, and the gritty feel of the dirt covering some of them. I sometimes listen to sermon podcasts on an MP3 player while I work, the better to meditate on matters of the spirit. I vary recorded sermons with a recorded novel; fittingly, I’m listening to a Librivox recording of Thomas Hardy’s Far from the Madding Crowd. Sometimes I pray as I dig with my trowel. I might repeat the Jesus Prayer again and again. Or I imagine each stone to be someone who needs divine intervention and picture God taking each person in his hands just as I take the stones in my hands. When I am done working on the stones for the day, I am calmer and more at peace than when I had started.

Thomas Merton wrote this about the place where contemplative prayer can best be practiced:

“There should be at least a room, or some corner where no one will find you and disturb you or notice you. You should be able to untether yourself from the world and set yourself free, loosing all the fine strings and strands of tension that bind you by sight, by sound, by thought, to the presence of other men.” New Seeds of Contemplation, p. 81

This summer, my mother’s stone border has been the corner where no one disturbs or notices me. I’m careful not to take my cell phone outside with me; any calls or messages will have to wait. For a little while, I’m untethered from the world, loosed from those strands of tension that normally hold me as tenaciously as a spider’s web holds a fly. I’m privileged to have such a place where whenever I want I can contemplate the divine.

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The Older I Get, The More Versions Of Me There Are

Rachel McAlpine, who blogs at Write Into Life, recently posted about the challenge of adjusting her identity as she ages. She writes,

“I’ve been searching for an inherent personal coherence, consonance, or harmony. But this is not straightforward, because right now life is rapidly changing my outside. Grey hair, wrinkles and all that cranky stuff that shrieks ‘Old lady! Old lady!’”

We typically achieve some sense of identity in adolescence, but we continue to work on the project of constructing an identity throughout life. New experiences–completing school, starting a career, choosing a life partner–impact our sense of who we are, so we are constantly tweaking the identity we built, twisting knobs as if we were an old-time radio that needs constant adjustment to get a clear signal. We just get the station tuned in, then something else happens and we start the process all over again. As Rachel mentions, the grey hair and wrinkles that show up when we look in the mirror are among the things that call for identity recalibration. Another is retirement. Still another is some body part or system suddenly balking rather than proceeding through its paces as we’re accustomed to it doing. So our previous self description–“youthful-looking,” “worker,” “healthy”–no longer fits, and we have to figure out again who we are.

It’s me looking in the mirror, but there’s an old guy looking out.

It’s common for people past midlife to have trouble reconciling their advancing chronological age or their timeworn appearance with an inner feeling that they ae still youthful. Rachel is no exception to this:

“Like you (I presume) I have moments of feeling like a 6- or 26- or 36- or 56-year-old, which are all a big mis-match with my chronological age.”

I’ve had the same disparity. Reflecting on her post, I realized that this discrepancy between my subjective sense of my age and my objective chronological age isn’t always present, but comes and goes. Sometimes I feel much younger than my age–like a teenager or even a child, for instance. Other times I feel every bit the 69-year-old I am.

Thinking about this fluctuation further, it seems to me that what has happened is not that I discarded previous identities when I adjusted to new realities in my life, but instead that I shuffled them further down in the deck. They are still there, ready to be dealt again as circumstances warrant. Thus, when I went to my high school reunion last year, the card that I played was my adolescent self. When I build Legos with my grandkids or have an ice cream cone on a hot summer day, the child in me comes out. When I read a reference book or scholarly article, I’m a college student again, thirsty for knowledge. The young adult wanting to make a mark on the world is still there, as is the thirty-something who was confident in his abilities and the middle-aged man who lost his way for a few years.

Somehow, all these different versions of me dovetail together. Confusing as it can sometimes be, on the whole it has been an improvement to have my community of selves grow larger and larger. I wouldn’t want to be just the limited self I was as an adolescent, proud as I was back then in the identity I had built.

So don’t be concerned when you don’t feel your age or lament when your old identity no longer fits who you are becoming. Instead, appreciate the opportunity to add another self to your collection. Welcome the new you to the family!

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“Touch Me”

Image from

There’s an interesting incident near the end of David Foster Wallace’s magnum opus Infinite Jest that says a lot about how humans treat each other. It’s the story of Barry Loach, the head trainer at Enfield Tennis Academy. Earlier, Barry’s older brother had felt called to be a priest and was studying at a Jesuit seminary. However, near the end of his studies the brother “suffered at age twenty-five a sudden and dire spiritual decline in which his basic faith in the innate indwelling goodness of men like spontaneously combusted and disappeared.” He stopped going to classes and sat all day in his room.

Barry tried to talk his brother out of his malaise, which stemmed from the ingratitude of the homeless and drug addicted people he had served during his practicum in downtown Boston and from the lack of compassion for the homeless on the part of the general population. Finally, the despondent seminary student challenged Barry “to not shower or change clothes for a while and make himself look homeless and disreputable and louse-ridden and clearly in need of basic human charity, and to stand out in front of the Park Street T-station on the edge of the Boston Common…and for Barry Loach to hold out his unclean hand and instead of stemming change simply ask passersby to touch him.”

Barry accepts the challenge and soon is standing with the panhandlers, asking passerby, “Touch me, just touch me, please.” Day after day, no one is willing to make skin-to-skin contact, though they do toss money his way. In fact, asking for human contact proves fairly lucrative, though those who drop change in his hand do so with “spastic delicacy…and they rarely broke stride or even made eye-contact as they tossed alms B.L.’s way, much less ever getting their hand anywhere close to contact with B.L.’s disreputable hand.”

I won’t describe what eventually rescues Barry from this challenge gone awry. I’d like to reflect on it a bit, though; it seems to be a parable for our times. It’s not that disgust is unique to modern societies–at least some researchers regard it as one of the basic human emotions and have explored both its neural foundations and adaptive significance (see for example the Wikipedia article on the topic). Barry deliberately made himself repulsive, so it’s not surprising that people shied away. What made this a story of modern times is that the situation could continue week after week, month after month, with no one offering anything more than monetary assistance.

In most traditional societies, the community would have some way to identify the problem troubling the person (whether it is called illness, demon possession, witchcraft, or whatever) and some strategy to offer an appropriate remedy. Though such mechanisms are present in modern societies, we’ve become so isolated from each other, so preoccupied with our own concerns, and so respectful of individual choice that it’s become easy for hundreds of people a day to walk past a troubled person with no one offering more than pocket change by way of assistance.

What can change this? I’d like to suggest that we older adults can be the ones to start turning things around. Most of us have more time on our hands than average, and I’d like to believe that we are also more observant than most about what is happening around us and more concerned about the welfare of others. Most of us are probably aware of somebody–maybe many somebodies–who are like Barry, just wanting to be noticed and treated like they are of worth. What would it be like if we made eye contact with someone like that when we had an opportunity? What if we smiled at them or greeted them or stopped and chatted with them?  I’m not suggesting that anybody risks personal safety to do so. In my experience, though, the worst that happens when I do this is that I become a little uncomfortable, am asked for money, or I spend more time with the person than I anticipated doing. What’s so bad about any of those?

We older adults have the opportunity to affirm the humanity and dignity of those who have been treated as worthless for so long that many of them have started to believe it. Let’s make a difference to the least and lost in the communities where we live. Let’s treat all God’s children as precious.

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“You Don’t Really Start Getting Old Until You Stop Learning”

In the June 5 issue of Time magazine, Bill Gates was interviewed about the books that have influenced him. I was struck by one of his comments: “You don’t really start getting old until you stop learning.”

Is that true? Do we stay young in mind and spirit, though not in body, as long as we continue to learn new things? I agreed with the quote at first, but, as I thought more, it seemed to me that the statement could be accurate or not, depending on how the term “old” is used.

Merriam-Webster lists several uses of the world ‘old’. Gates probably isn’t using it to refer to being “advanced in years or age” but instead in the sense of “showing the characteristics of age.” Some of the characteristics commonly associated with age are negative, such as inflexibility, cantankerousness, and tediousness. Having stopped learning probably does contribute to becoming old in this sense. Curmudgeons not only are disinterested in learning the latest ideas and practices, but actively erect defenses against anything new, believing instead that the old ways were always better. This type of old person prefers reruns of the Andy Griffith Show or Happy Days (which were nostalgic even when they were new) to more recent shows; oldies music to contemporary songs; Turner Classic Movies to the latest Oscar nominees. Before they know anything about what’s new, they know they don’t like it. Their insulation from new knowledge–from learning–is also insulation from ever having their assumptions challenged. They are in a time capsule, a bubble insulating them from the world around them.

But obstinacy and close-mindedness are not the only characteristics associated with advancing age. Many people become wiser as they age, humbler and less certain they have all the answers. Recently I talked to a woman in her early 70s who said, “The older I get, the more I realize how little I know. Much of the things I used to be sure about I am not so sure about anymore.”  She has become less dogmatic as she aged, more open to possibilities and more curious about views that differ from hers. She says, “I used to always have something to say. Now I’m more willing to listen, or just to sit in silence.”

Her perspective is definitely something she acquired as she aged–it’s rare to hear such thoughts expressed by the young. Her way of being old doesn’t result from having stopped learning. If anything, the opposite is true: the more she learned, the more she saw the complexities of life and the more dissatisfied she became with facile or one-sided answers. Here’s an interesting thought: perhaps her way of being old is not only consistent with continuing to learn new things, but actually requires lifelong learning in order to develop. The paradox of learning over a lifetime is that, past a certain point, the more one learns the more one is aware of how much more there is to know and the less one speaks in absolutes or with certitude.

So, perhaps Bill Gates’ assertion that growing old is the result of no longer learning is true or not, depending on what sort of growing old he’s talking about. If we stop learning, we are likely to show such negative features of aging as inflexibility and intolerance. However, there’s another way of growing old–characterized by increased curiosity, openness, appreciation, and wisdom–and those who stop learning will never age in this manner.  

It seems I learn something new almost every day. For example, recently I learned the difference between the yoga poses cobra and upward facing dog, and that older coffee drinkers are less likely to progress from mild cognitive impairment to full-blown dementia. Some of what I learn is trivial, some profound. By itself, continuing to learn doesn’t guarantee wisdom or maturity. That’s not why I keep learning things, though. I learn because the world around me and the people in it are fascinating and I’m enriched by knowing about them. If I receive additional benefits, that’s a nice bonus!

Cobra and Upward Facing Dog. Image From

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The Effects of Childhood Trauma


A 2016 article by Emily Guron, Health and Caregiving Editor for Next Avenue, described the longstanding effects of childhood trauma. As Gurnon summarized, these effects range from physical problems to emotional problems, substance abuse, and risky behaviors:

“Research has shown that childhood trauma, ranging from parents’ divorce to alcoholism in the home, increases the odds of heart disease, stroke, depression, suicide, diabetes, lung diseases, alcoholism and liver disease later in life. It also increases risky health behaviors like smoking and having a large number of sexual partners. And it contributes to ‘low life potential,’ according to the U.S. Centers for Disease Control.”

Many adults who are survivors of childhood trauma have never told anyone. Gurnon discussed this phenomenon with Michael Barnes, a program manager at an addictions treatment center in Colorado. Barnes indicates that those over 50 are less likely to tell others about their experience of trauma than are younger adults. Men are less likely than women to tell others. Gender roles seem to have something to do with men’s reluctance to convey such information, in that men are more likely to think they should be stoic about their suffering and able to get over the effects of past trauma on their own.

In my years working as a clinical psychologist, I didn’t specialize in providing therapy for those who had childhood trauma, so clients didn’t seek me out specifically for help with that problem. Nevertheless, over the years I had hundreds of clients tell me of some form of trauma they had sustained during childhood. Physical abuse was common, as was parental alcoholism, substance abuse, or erratic behavior. Sexual molestation also occurred frequently, with the perpetrator usually being someone the child knew, often someone within the family. I would estimate that at least a third of the time the person had never talked to anyone previously about what had happened.  Usually this wasn’t a result of forgetting or not thinking about the trauma; often, the person thought about it every day, but couldn’t overcome the discomfort, shame, or fear of blame associated with letting someone else know.

For the most part, telling someone about a past trauma is helpful. I say “for the most part” because sometimes the person becomes too absorbed in the telling and is re-traumatized, or is so detached from the memory that talking about it has no more significance to them than does telling what he or she had for breakfast. Talking about the memory is most helpful if the person can experience the emotions associated with it–fear, hurt, shame, sadness, anger, and a variety of others–but at the same time stay in contact with the present rather than being swallowed up by the past. Therapists who are knowledgeable about working with trauma sufferers can help the trauma survivor maintain this balance. Therapists can also help with the development of skills for dealing with the effects of the trauma and can help the person make sense of what happened to them.

So, for those who have kept memories of childhood trauma hidden away for many decades, I encourage you to tell someone. If the effects of the trauma remain strong, consider psychotherapy. Childhood trauma has profound effects, but, for those who seek help, there is hope for recovery!

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Finding Immortality

How long do you want to live? It’s not that we can determine how many years we will be on this earth, not exactly. We do have something to do with it, though. Most obviously, we can take care of ourselves–eat healthy foods, exercise, not smoke or drive too fast or drink too much.

As medical science learns more and more about longevity, it’s starting to look as if more can be done to extend our span of healthy years. Some researchers even think our lives can be extended indefinitely. A recent article by staff writer Tad Friend in the New Yorker distinguishes between longevity scientists who are “healthspanners” and those who are “immortalists.” The former group, who constitute the majority, aim to provide us with longer lives in which we will remain healthy until the last year or two. The latter group hope to reverse aging itself, so that anyone able to afford whatever treatments are developed could live indefinitely. Friend describes a recent symposium on longevity held in Norman Lear’s living room and attended by scientists, Hollywood stars, and wealthy investors. One of the speakers, Martine Rothblatt (founder of the biotech firm United Therapeutics) promised, “Clearly, it is possible, though technology, to make death optional.”

Even in that gathering there were scientists who disagreed. They are among the healthspanners, and they don’t expect a holy grail–some incredible discovery that will put an end to aging. They are looking to do more of what’s been done over the past hundred years or so, a period in which the average life span has increased by thirty years. Eric Verdin, CEO of the Buck Institute for Aging, told Friend that recently the median life expectancy for people living in developed nations has been increasing at a rate of about two and a half years a decade. He added, “If we can keep that pace up for the next two hundred years, and increase our life spans by forty years, that would be incredible.” That would give our great-great-great-great grandchildren life expectancies of about a hundred and twenty years. If they are vigorous and healthy during those years, that would amount to quite an accomplishment. Living 120 years isn’t anything near to living forever, though.

Friend nicely summarizes the biological process of aging and what has come of past claims that that process can be arrested:

“For us, aging is the creeping and then catastrophic dysfunction of everything, all at once. Our mitochondria sputter, our endocrine system sags, our DNA snaps. Our sight and hearing and strength diminish, our arteries clog, our brains fog, and we falter, seize, and fail. Every research breakthrough, every announcement of a master key that we can turn to reverse all that, has been followed by setbacks and confusion.”

Will the master key to aging eventually be found? Some very wealthy people are putting significant resources into the search. The story of Adam and Eve in the book of Genesis tells of “the tree of life” found in the center of the garden of Eden. Once Adam and Eve have sinned by eating of the tree of good and evil, God decides not to let them “take also from the tree of life and eat, and live forever.” (Gen. 3:22). In order to keep them away from that tree, he expels them from the garden.

Throughout the ages, humans have dreamed about putting an end to aging, but had no viable way to do this. Now the immortalists hope that modern science will allow them to break back into the garden and eat from the tree of life. We’ll see how that goes. The Bible offers another route to immortality, namely by way of death and resurrection. The Apostle Paul explains that “Christ has been raised from the dead, the firstfruits of those who have fallen asleep.” (I Cor. 15:20) As a result, everyone will return to life: “For the trumpet will sound, and the dead will be raised imperishable, and we will be changed.” (v. 52) Some may put their hope in scientific discovery; I’m counting instead on the promised Day of the Lord.

Fountain of Eternal Life, Cleveland, Ohio. By Daderot [CC0 or CC0], via Wikimedia Commons

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Healthcare Decisions for Our Parents and Us

In a recent New York Times article, Dr. Mikkael A. Sekeres, a cancer specialist. told of his first meeting with a 97 year-old patient. The elderly man had recently moved into an assisted living facility in Cleveland in order to be near his son and daughter-in-law, who had come with him to the appointment.  He was being seen for abnormal blood counts requiring periodic transfusions. As of yet his condition hadn’t been diagnosed.

“I don’t know if I’m looking forward to being 98,” the man confided. When Dr. Sekeres asked him to explain, he said, “I don’t want to end up . . . you know, blotto,” simultaneously leaning to the side and opening his mouth to imitate advanced senescence. Dr. Sekeres suspected that the man’s blood abnormalities were the result of a cancer that kept the bone marrow from producing enough healthy blood cells. The diagnosis could be confirmed by a bone marrow biopsy.

Did it make sense to do the procedure, though? The condition didn’t seem to be worsening, and treatment wouldn’t cure it. Plus, the man’s fear of becoming “blotto” didn’t stem just from his illness. He thought he might end up worse off “Because of my medical condition, or whatever you’re going to recommend I treat it with.”  Medical interventions don’t always make things better. As the saying goes, “sometimes the cure is worse than the disease.” The older and more decrepit we get, the more this is likely to be the case.

Dr. Sekeres brought up the biopsy, but the man immediately rejected the idea. Dr. Sekeres indicated that it didn’t have to be done; the procedure would be painful and wouldn’t offer the man any foreseeable benefit. Hearing his father’s comment and the doctor’s reply, the man’s son quickly assented. Too often, children question their elderly parents’ decisions, often to the point of treating the parent like a child who isn’t capable of making choices. Certainly there are situations where the parent isn’t capable or hasn’t thought through the implications of a decision. However, Sederes’ patient clearly had his wits about him and had thought about what sort of medical care he wanted. Fortunately, the son knew his father well enough to take his dissent seriously.

During the past few years I’ve been in the son’s position; I’ve taken my mom to doctor’s appointments during which treatment options were discussed. Most recently, it was an appointment at a gastroenterology clinic to review her difficulties with swallowing. She has had a variety of treatments in the past, resulting in no more than slight, temporary improvement. She has to puree her food and even then isn’t getting enough calories to maintain her weight. During the appointment, the physician’s assistant reviewed treatment options, recommending against some but leaving others as possibilities. None is likely to make a significant difference. A feeding tube will probably be necessary at some point, but there are no clear indicators as to when it would be best to take that step. When the PA paused, mom turned to me and asked, “What do you think I should do?”

I could have told her what I thought was best, but, if I did and she deferred to me, it would be my decision, not hers. Since she would have to live with whatever was decided, it was important for her to think about her preferences. So rather than offering a firm opinion, I mostly just highlighted what I thought were the most important points the PA had made. I mentioned the risks of having her throat muscles stretched again. The PA had said she might have an infection in her throat that was adding to her difficulties; it would be possible to treat any possible infection without further testing. This might or might not help, but had little downside, so mom agreed to take an antibiotic for this purpose. We discussed the pros and cons of a feeding tube. Having one would be especially advisable if mom lost more weight; the PA suggested 120 pounds as the weight below which a feeding tube would definitely be needed. Mom agreed. The plan came together a little at a time. Mom didn’t want to make the decision by herself, but she did want a say in the decision, and that’s what happened.

I realize that not all elderly patients have either a logical, well-thought out position from which to make health care decisions (like Dr. Sedekes’ patient) or the ability to collaborate with family members and health care professionals to make such decisions (like my mom). Yet an awfully lot do, if given the chance. It certainly works best if sons, daughters, and other family members provide that chance rather than diminishing the elderly patient by hijacking the discussion of options. Many children don’t even know what quality of life the parent is (and is not) willing to sacrifice in order to increase longevity. Those of us with elderly parents need to listen and avoid making assumptions; parents whose adult children are helping them get health care need to communicate their wishes as clearly as they can. Everyone facing medical problems during the last few decades of life should be heard and have their wishes treated with respect and caring.


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Relocating to a Retirement Community: A New Life

I wrote recently about the first part of Richard L. Morgan’s book Settling In: My First Year in a Retirement Community. Morgan was initially enthusiastic about moving to a retirement community near his daughter, but after a month or so doubts crept in. He wrote, “The initial euphoria had worn off, and I felt suspended in a limbo between a life I loved and a life yet to come.”

I had a similar experience of having lost my old life and yearning for a new life when I moved back to my hometown in 2012 to help my parents. A move such as Morgan’s or mine is just one of many events common to older adulthood that can take us away from the life we’ve been living without supplying a new one. Retirement can have this effect, as can losing one’s mate or deteriorating health. It’s instructive to look at how Morgan responded to being in limbo.

Morgan indicates that the first step in finding his new life was a process of discernment. He explains:

“Discernment is another part of detachment. We consider our life from a critical distance and then take the next step.” (p. 91)

Morgan describes his process of discernment as taking place “through endless walks around the community and long night struggles.” What came of this?

“I discerned that God was calling me to use all the experiences and gifts of my former ministry in this place. This place? Yes, right here where people at all stages of aging need comfort and support.” (p. 92)

Morgan’s “experiences and gifts” were as a chaplain and counselor. He began volunteering to provide pastoral care. The retirement home where he resides has a variety of levels, from independent living to assisted living to nursing care to a dementia unit. He had a particular passion for working with those who had dementia. He considers ministering to them a spiritual calling:

“I am sure that today Christ can be found in the haunting, blank faces of those souls who sit behind closed doors covered with the wounds of a terrible disease of the brain…. [A]s Christians we are to go outside the camp and minister to those who are ‘outside their minds.'” (p. 143)

Morgan describes a number of interactions in which those whose memory was deeply impaired still revealed their spirituality and humanity. With time, he noticed that residents in independent living tended to avoid those from the assisted living and memory care units. One of his main goals became breaking down the dividing wall between the different categories of residents. He came to recognize that the avoidance by those in independent living stemmed from fear; higher-functioning residents were evading thoughts about their own aging and what they might become. He eventually succeeded in connecting the groups, doing so mostly through music. He started a sing-along for the dementia residents using songs from the 1930s and 1940s. He discovered that some who seemed lost to dementia were able to sing the songs of their youth. Soon, independent living residents began to attend the sing-along. Music worked magic for them as well, helping them overcome their fears. Morgan describes the scene:

“We were at last the blessed community, where all are loved and accepted. Some bent to shake the hand or hug dementia residents who had formerly lived independently. Others sat next to dementia residents and helped them follow along with the words.” (p. 154)

Through serving residents of the retirement home, helping them become a healthy, loving community, Morgan found the life for which he was looking. Service was the means by which the “life to come” that he initially longed for became his reality. All of us who have lost or will lose the life that we’ve had can benefit from his story. We, too, can enter into a process of discernment, listening for our call. As with Morgan, that call will, likely as not, entail doing something for someone else. Reaching out to that person or group will not only help them; it is the pathway to the new life that is waiting for us.

Redstone Highlands, the Retirement Community Where Richard Morgan Lives.

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