Some read­ers may be made uncom­fort­able upon read­ing this.

Tsk. Life is pain. [Your mileage will not vary.]

Until the last eigh­teen months kicked into full gray swing, like many Amer­i­cans I never really thought much about elder care, one’s per­ma­nent fail­ure of health, hos­pices, nurs­ing homes — stuff like that there. My grand­mother was in a home, and my Dad had to spend a few of his last weeks in one under hos­pice care, but as a typ­i­cal guy my age I wasn’t really involved. Old and fail­ing rel­a­tives are either peo­ple cared for by oth­ers who you visit occa­sion­ally (or rit­u­ally, as part of the often-​​maligned Hol­i­day Fam­ily Vis­its), or seem­ingly self-​​sufficient peo­ple who you talk with on the phone from a great dis­tance, who you sus­pect are bravely hid­ing much of the truth of their lives alone out there, but also respect for their spirit of tough-​​minded independence.

About a year ago, my 83-​​year-​​old Mom moved in with us (at our behest), and at the same time my wife’s par­ents became very ill and needed ²⁴⁄₇ care. My wife and I have taken this entire last year “off” to help them full time. No grad school, no work, not much in time to spend with the Old Gang.

It’s a real job. Hard to explain at school, at work, and to the Gang. To some, I recently started fram­ing it as “tak­ing a year of retire­ment now”. That is of course a very bad way of mak­ing them under­stand why we don’t have real career-​​forwarding jobs, and don’t write back right away, and don’t go out to the pub ever any more, and spend what lit­tle psy­chic energy we have left on essen­tially mind­less hob­bies. I balk at draw­ing the anal­ogy with the social change that hap­pens to cou­ples when they have kids. Valid as that may be. Suf­fice to say, it’s a large-​​scale famil­ial shift for all of us, the sick ones and the caregivers.

Any­way, this isn’t a sod­den diary entry about the self-​​imposed unem­ploy­ment or the depres­sion or the stress, or even any of the par­tic­u­lars of ill­ness and med­i­cine. It’s about culture.

I mean, who lives with their par­ents? At our age?

In a year and more of talk­ing with peo­ple in our exact demo­graphic group [con­sist­ing of service-​​sector mid­dle– and upper-​​middle-​​class folks with inde­pen­dent book-​​focused TV-​​eschewing irre­li­gious computer-​​using globe-​​trotting lives and two or more post­grad­u­ate degrees, whose par­ents tend to be Depres­sion– or WWII-​​babies, often them­selves intel­lec­tu­als], the two most com­mon responses the these aspects of my life have been, (1) “Wow, that’s remark­able; I could never stand to have my Dad/​Mom live with me, but more power to you!” and (2) “When I go, I want to go quickly so I’m not a bur­den on my kids.”

Never, “Oh, we did that, and it was the best thing…” or “We built a hand­i­capped acces­si­ble wing on just a few months back, let me give you our contractor’s num­ber,” or even, “You’re the third fam­ily I’ve met this month who’s deal­ing with that.” Not once.

Peo­ple don’t go about it this way. Not our peo­ple, at least — the ones who it strikes me can best afford it finan­cially and socially. Actively tak­ing care of par­ents is much more com­mon among poorer demo­graphic groups, and more reli­gious groups, and those whose par­ents can’t afford any sort of care at all. And they make it work, some­how. There were no Elder Care Cam­puses when my great-​​grandparents emi­grated from the moun­tains of Slo­va­kia and moved in with my grand­par­ents in their farm­house in North Roy­al­ton, Ohio. There were no mother-​​in-​​law suites, even, nor Elder­hos­tel, nor Senior Cen­ters, nor geron­tol­o­gists. Inter­est­ingly, none of the other peo­ple who do take care of their par­ents seem to take advan­tage of those resources, either, whether by choice or poverty.

Nowa­days, if they were instead in our demo­graphic group, my great-​​grandparents might get admo­ni­tions from their kids to “learn to use their email” and “let us know if they needed any­thing”. They’d have a lifestyle choice to make.

On their own.

In a way, it’s like a col­lec­tive stroke-​​induced blind­ness, so sub­tle that even the absence of atten­tion is itself missed. Older and middle-​​class? It’s up to you to finance and arrange not only your children’s edu­ca­tion, but also your long-​​term care so you don’t bother them. It’s up to you to pick a new place and arrange a move when you can no longer take care of your cur­rent house. It’s up to you to coor­di­nate the bewil­der­ing cock­tail of med­ica­tions inces­santly pre­scribed by the prop­a­gat­ing hydra-​​heads of spe­cial­ist physi­cians that pop up just when you think you’ve finally knocked one off the list. It’s up to you to go to more doc­tors, and to change doc­tors if one makes a mis­take or doesn’t lis­ten to you the way you like, and to know where to find one when you need a new one. And to fig­ure out how to retain an ounce of social life, while you’re at it.

But don’t bother your kids.

This is odd. Not least because our par­ents’ and our gen­er­a­tion have always struck me as ridicu­lously child-​​centered. A coworker once told me, not­ing that he was pass­ing along sound advice, that he doesn’t think one is a fully mature human being until one has raised kids. And that’s a good way of stat­ing a preva­lent atti­tude, if you think about it. So much fuss is made about fer­til­ity treat­ments and school choice and the insis­tence on hav­ing chil­dren. In fact, that it’s spawned the sadly amus­ing back­lash of the “child-​​free”.

We don’t really pay col­lec­tive atten­tion to ear­lier gen­er­a­tions. What atten­tion is paid, is given by only the clos­est rel­a­tives, the core fam­ily. Even where care is given, one never takes care of one’s grand­fa­ther, one’s uncle — that’s their kids’ respon­si­bil­ity. Polit­i­cal society’s focus is for­ward; for social con­ser­v­a­tives and lib­er­als alike, the fun­da­men­tal ques­tion is: will it do for the chil­dren?

So is the stereo­typed nag­ging mother right when she points out how much she’s given, and look how she’s treated and ignored in her elder years? Or is she right when she insists that she should not be a bur­den on her already over­loaded chil­dren, that she’s fine?

Both? Nei­ther?

We’ve spent about 18 months of the last two years look­ing for a new house. New con­struc­tion, recent con­struc­tion, old con­struc­tion. Plan­ning ahead, we need a prac­ti­cal first-​​floor bed­room with a rea­son­able and acces­si­ble bath­room. Which, in the houses in our price range, does not exist: You have your choice of a pala­tial tile-​​encrusted whirlpool biddy-​​drowner in a vasty Mas­ter Suite, or maybe a “study” right next to the din­ing room, which could be used as a “bed­room” with an adja­cent half-​​bath; or else it’s a rancher (“ick”), with exactly one (1) Mas­ter Suite intended for Mom and Dad, plus three or four closet-​​sized Children’s Rooms tucked in a quiet wing so it doesn’t inter­fere with the won­der­ful Great Room with Home Theater.

Leav­ing aside the fact that greige mass-​​produced devel­op­ment homes are inher­ently stu­pid, ugly, and waste­ful, and can­not in many cases even be changed to become handicapped-​​accessible … nah, don’t leave that aside. It’s still the point. So now we’re build­ing a house. Which I expect nobody will want to buy, when we move — it’ll be too weird.

We’ve spent a year deal­ing with med­ica­tions and doc­tors. Just off the cuff, let me esti­mate that our three par­ents rely on the ser­vices of about sev­en­teen doc­tors, sur­geons, and Nurse Prac­ti­tion­ers. Every one of these, even the GPs, focus in their fif­teen minute appoint­ment on treat­ing The One Com­plaint: the rea­son the patient has sought them out, the thing they’ve com­plained about just now. Indeed, they’re obliged to note one and no more rea­son for the visit on their paper­work. As a result each one inde­pen­dently pre­scribes pills for The Com­plaint, or tell the patient to drop pills pre­vi­ously pre­scribed by oth­ers, and ignores all other aspects of the patient’s state. Even though there is a dif­fer­ent GP for each par­ent — that’s three inde­pen­dent sam­ples — in no case has even one of them ever reviewed the full list of the patient’s pre­scrip­tions with an edi­to­r­ial eye. Nobody exists whose job it is to say, “Why are you still tak­ing that Zan­tu­lum, when we gave you Nexlac last month?” Nobody to say, “Who in god’s name told you to take six of these a day?! You’re on methoti­tanate! Nurse, get that moron [Name] on the phone imme­di­ately; I want her in my office in the morn­ing with an explanation!”

No Dr. House, as my Mom says. We will all need a House, she opines. I think I agree. An atten­tive advo­cate who sees and argues with all the stu­pid peo­ple, who breaks the bureau­cracy when called to do so, who makes mis­takes because doing noth­ing is an easy way to die faster, and who fights, in the end, exactly because being dead is the thing that can’t be fixed.

In mod­ern middle-​​class fam­i­lies, all these med­ical trou­bles tend to get taken care of auto­mat­i­cally, of course. In a nurs­ing home, you give up your right to chose a doc­tor, and you never see spe­cial­ists, so right there you’re back to one sane voice rear­rang­ing all your med­i­cines. (Which of course we all know has been a great model for robust, objec­tive, low-​​error man­age­ment in all kinds of sit­u­a­tions in the world.) Or maybe your meds kill you. Right there you got two easy ways out of coor­di­nat­ing all that riga­ma­role, with no result­ing social stress on the active, upwardly-​​mobile over­worked ser­vice industry-​​employed kid­dies in Far Away Town. The rest is just mop­ping up.

Speak­ing of nurs­ing homes: They are nec­es­sary, and a bless­ing in some cases. They can save your life, and your family’s life. We per­son­ally would be in a far more bleak, ruined con­di­tion than we already are, if not for them.

Care­giv­ing is a hard job, with few rewards. One you pay for, one way or the other. In the process of hav­ing a nurs­ing home help out, they will inevitably trans­form your fam­ily into a Profit Cen­ter, and treat you as generic accord­ing to their (which implies your) means: one doc­tor, one room, one sched­ule, one menu, one face­less, ever-​​burning-​​out staff, shared among the 30 or 50 or 250 patients.

What frac­tion of nurs­ing homes’ res­i­dents need to be there? Let me take a quick jaunt into Mod­est Pro­posal ter­ri­tory with that one:

At some point, we all know we’re going to have chil­dren. Every­body is well aware how busy you are in this rat-​​race of a world, and so we encour­age you to learn more now, before unex­pected events catch up with you, about your local Creche Cen­ter Asso­ci­a­tion. At a cer­ti­fied and inspected Creche Cen­ter, we’ll take care of your child for the first few years of his or her life, start­ing from the help­less, med­ically risky days right after birth, and pro­vid­ing qual­ity care for as long as your fam­ily needs us. In the friendly atmos­phere of the Creche, your child will be super­vised by our trained staff, fed and given the nec­es­sary med­ica­tions on a reg­u­lar sched­ule by our Doc­tor, will be given oppor­tu­ni­ties to par­tic­i­pate in a vari­ety of engag­ing and ther­a­peu­tic group activ­i­ties, and will be helped as nec­es­sary on their road towards that great unknown, Adult­hood. Fam­ily mem­bers are wel­come to visit their chil­dren at any time, and are encour­aged to offer input into their care as needed. Now offer­ing an enlarged Pre­mie Care wing, Taste­fully 80s-​​Decorated Child Villa is accept­ing appli­ca­tions for rooms. Ask about our easy Creche Financ­ing Pro­gram, too! We know that child­birth can be a stress­ful time for any fam­ily, so we offer com­plete coun­sel­ing ser­vices as well.

(You can call your kid, too, if you pay for them to have a phone line.)

Over­sub­scrip­tion, I’m thinking.

How’d this hap­pen, this handing-​​off of an impor­tant part of life to strangers? I can see a lot of low-​​hanging fruit: geo­graphic dis­per­sion, mod­ern medicine’s focus on mor­tal­ity instead of mor­bid­ity, the notion of a pen­sion, and even a nat­ural out­growth of the funereal-​​industrial com­plex described in the clas­sic Amer­i­can Way of Death.

Yeah, we move a lot. We talk on the phone a lot, some­times while mov­ing a lot. The major­ity of us change jobs every five years or so, on aver­age. In most cases we dis­like or despise this, but see it as a nec­es­sary aspect of a mod­ern career. Yet when we’re older, we all expect to have “set­tled down;” surely ear­lier gen­er­a­tions intended their gilded retire­ment to be cen­tered around a sin­gle Dream House. What are you going to do, ask your Mom to move to San Jose just because you got a job there? And what will your employer think of that? Surely it’s eas­ier for you to pro­vide moral sup­port; I mean, just think of the addi­tional effort involved in pick­ing not only Bren­dan and McClintie’s schools and enrich­ment activ­i­ties, but also your Mom’s doc­tors and stuff? Can you imag­ine, hav­ing to drive her around to Gar­den Club or some­thing (what­ever it is she does), and then get the kids to their soccer?

or

Yay, med­i­cine is like soooo great! It keeps you from, like dying and stuff. And, like, the infin­i­tes­i­mal vari­a­tions in the for­mu­la­tion of lead­ing lifestyle phar­ma­ceu­ti­cals can be clearly seen to trans­late directly into days of addi­tional life. Cool! And we all know they never inter­act with one another; the fact that “dizzi­ness” appears high on the side-​​effects list of eight of the fif­teen med­i­cines you’re tak­ing right now doesn’t have any­thing to do with, say, the dizzi­ness you’ve been expe­ri­enc­ing; that’s no doubt just a symp­tom of a pre­vi­ously undi­ag­nosed con­di­tion. We’ll change six of your med­i­cines, and you just be sure to tell your car­di­ol­o­gist and rheuma­tol­o­gist when you see them in a few months. Oh, no, we can’t change that pre­scrip­tion, that’s your cardiologist’s job; we just do the gen­eral stuff. See ya! So glad you’re still alive and all! Get more exer­cise, too, by the way — but try not to do any­thing that would, like, tip you over or any­thing, OK?

or

OK, now we all know that some of you will get pen­sions (I see some frowns, do I?), and that some­times a pen­sion can sup­port you in your declin­ing years. But just as new hires at a firm are inevitably offered more money than the decades-​​seasoned vet­er­ans who train them (what? more frowns?), the pen­sion you get will inevitably be smaller than your children’s salary at that time. Let alone the expense of your care at that time. Indeed, your pen­sion fund or IRA or Invest­ment Account will rather play the impor­tant role of hush money: For all your pro­duc­tive work­ing life we will say to the world that we have “given” it to you, so that you in turn may admon­ish your chil­dren not to worry, that you’re “well taken care of”, that “every­thing will be all right”. In this sim­ple and expe­di­tious man­ner, they can get on with their lives, and you with yours. As it were. Or you could invest in the stock mar­ket, if you pre­fer — we don’t care. Just rest assured that your chil­dren will not be given cause to worry. After all, it’s them we need. They will, in turn, be offered gen­er­ous pen­sions that seem­ingly dwarf yours… but let us not stray too far into a future that is, in its essence, none of your con­cern.

or

Oh dear. Ew. Well, I sup­pose you could say we all die. I sure wouldn’t — not in pub­lic, that’s for sure! Nobody who’s any­body wants to talk, let alone think about it. But still, I guess it does hap­pen. Some­times. Oh, I see! Yes! So then you’ll want to make up for the var­i­ous guilts asso­ci­ated with your years of inten­tional blind­ness by buy­ing a nice Pre­mium Cas­ket (which you may burn, if you like, or merely rent for a mod­est sum), and a won­der­ful engraved head­stone, and of course there’s embalm­ing ser­vices (which you may burn, as well, if you pre­fer). Here, come have a nice chat with our Grief Event Coor­di­na­tor.… What’s that? Oh, they’re not dying? Oh, that’s won­der­ful — I was so wor­ried. See! Not every­body dies all the time! What? Oh, no, ignore all that, that was noth­ing you need to con­cern your­self with. Nononono and tut… now then. You should instead be talk­ing with our Retire­ment Finan­cial Advi­sors, and you will want also to read some reviews on Nurs­ing Care Pro­fes­sion­als and such­like. Oh, I’m so relieved — you want Long Term Care, not Death Care. I’m so happy for you. Here, let me get you a packet.…

As I said, low-​​hanging fruit.

But nei­ther here nor there. By now I think some of you may imag­ine that I’m rant­ing about The Sys­tem, that I’m some kind of reform guy. Well, that just goes to show you’re not in the thick of this; that you’re not, as my friend might say in other cir­cum­stances, a mature human being yet. “They oughtta do some­thing” is not a ratio­nal response. Not even “you peo­ple oughtta do some­thing” works, in the end.

I would put my hand on your shoul­der now, if I could. This is just the way the world is, friend. You can do noth­ing that seems rea­son­able. You can­not peti­tion, or vote, or pray, or com­plain, or pay vast amounts of money to the Right Doc­tors, or call upon younger, lov­ing, sup­port­ing, rel­a­tives for help and expect there to be any real dif­fer­ence. You have one choice, and yet it is amaz­ingly not the choice most Amer­i­cans in our class actu­ally ever con­sider: will you par­tic­i­pate the period of life when your par­ents are aging and dying, or remove your­self from it?

[It is left as a brief, no doubt rather unim­por­tant exer­cise for the reader to explore the fact that it’s an utterly novel dif­fer­ence between our cul­ture and that of our fore­fa­thers that we even have such a choice. That we can absent our­selves from the ends of our par­ents’ lives.]

In the end we do age and decline. And before we die most of us get very sick, we lose more or less of our dig­nity, and we come to rely on the care of oth­ers. Our homes, our health, our social roles, and our abil­i­ties are all grad­u­ally tugged and yanked out from under us by uncon­trol­lable forces, until we’re either knocked to the ground by a sud­den jerk, or left stand­ing on entirely unfa­mil­iar ground.

No way it can work out well, really, not in the sense of, “Please just let it be the way it was,” or even “…the way I was expect­ing it to be”. All those things peo­ple try first? It turns out that you can­not peti­tion, vote, com­plain, pay or pray your way to a bet­ter end^†. A bet­ter path to that end?

Well, maybe. That would be something.

Here is the thought­less and blind soci­etal ill that both­ers me today, and makes me rant so: You must strive with all your might to have chil­dren. And at the same time, you must strive with all your might not to die. But your chil­dren, well, they should not be both­ered by your dying. Indeed, there is no capac­ity built into the sys­tem for such a thing.

You can­not buy a house suit­able for an extended fam­ily, except for a forward-​​extended one, with lots of kids. Your employer may balk at pay­ing to move Mom in next door when you inquire about your new job — and prob­a­bly legally, though they’re pro­hib­ited from ask­ing about your kids. You’re encour­aged to attend your kids’ vis­its to the pedi­atrist, but it is not expected that you will inter­fere in the rela­tion­ship between your par­ents and their physi­cians, no mat­ter what this new­fan­gled “part­ner­ing” bull­shit is they’re writ­ing about these days. (I mean, who is the physi­cian even sup­posed to talk to?)

It’s easy for some­body in my gen­er­a­tion to hear seeds of this in Boomers’ old “Hope I die before I get old,” and some may want to point out to Mr. Dal­trey that he is now a mem­ber of that august demo­graphic seg­ment and indeed the booze and drugs didn’t help much with the tim­ing or nature of his entry. But that’s just glib; it wasn’t the point of the line, after all, nor the atti­tude of the gen­er­a­tion (if there were such a thing). But they could as eas­ily invoke Glob­al­ism or Athe­ism or immi­nent Tech­no­log­i­cal Sin­gu­lar­i­ties, or what­ever buga­boo they dis­like most.

These things I’m com­plain­ing about — the hous­ing and the doc­tors and the nurs­ing homes and such, which are offered after all as ser­vices and improve­ments, but which are are trou­bling and wrong for us — they are all effects of a larger-​​scale change that’s hap­pen­ing. As I said, we have no choice, and as far as I can tell there is noth­ing to be done to improve even one aspect. There are vast socioe­co­nomic forces in play with lots of momen­tum and iner­tia, and social frame­works and ser­vices are being elim­i­nated with­out com­pen­sat­ing replace­ments, and frankly cul­tural norms are crys­tal­liz­ing and shift­ing so far to the right and left (same thing, many days) that other alter­na­tives aren’t even being dis­cussed any more. Regard­ing health­care, and money, and houses, and drugs, and nurs­ing homes, and health and death, you have no choice in the mat­ter at all.

Whether you’re a par­ent or a child.

The only choice we really have is how we approach these inevitabil­i­ties. It’s a choice that must be made much ear­lier in the process, and made by both par­ents and chil­dren. Together, or apart?

Nei­ther way is inher­ently bet­ter than the other. We made our deci­sion, and I’m point­ing out in my long-​​winded way that it’s a weird one, and that society’s not set up for it at all, and that trou­bles me and makes me mad and frus­trated. But if you go the nor­mal route, or the dif­fi­cult route: Some­body will end up dead, in the end, no mat­ter what. Some­body will end up griev­ing and hurt, in the end, no mat­ter what.

They’re just dif­fer­ent paths.

---

^† Those tempted to pray may jus­tify it by bring­ing up Pascal’s famous Gam­bit in try­ing to con­vince oth­ers of its impor­tance. When faced with this, I tend to respond with Tozier’s Third Response to Pascal’s Gam­bit (which is undoubt­edly many oth­ers’ as well): If you can­not really know any­thing of the after­life, and indeed are faced with a real pos­si­bil­ity that there is no such thing, then Real Life may very well be your only chance. Doesn’t it make sense there­fore to live life as if there were no after­life, and be pleas­antly sur­prised if it turns out there is? Surely this min­i­mizes the risk of dis­ap­point­ment; there is no dis­ap­point­ment if there is no after­life, and no dis­ap­point­ment if there is.

Tozier’s First Response to Pascal’s Gam­bit is typ­i­cally, “Hey, dude, check out what hap­pens when I mul­ti­ply these poly­no­mi­als! Cool, huh!?”