frailty: gains and losses

 Working with the elderly gives a whole new definition and many, many faces to the idea of frailty.  Old age comes to all of us, of course (unless we die of something else first), and I knew intellectually that it often and eventually involved losses - loss of independence, loss of memory, loss of strength, loss of friends or family.  But it's one thing to know it in my head and another to encounter it in patient after patient, as I do on my geriatrics rotation.

One particular patient sticks with me.  She was an older woman with Parkinson's disease.  Most patients with Parkinson's develop dementia along with the physical neuromuscular parts of the disease.  She, however, had not.  She was fully aware that her body was no longer working as it should, that her face didn't move with its former expressivity, that her limbs were harder to move out of a single location than they used to be.  She felt like she was turning into stone.  She expressed regret for having walked regularly as a younger person to have a good heart given a family history of heart disease.  At this point, she said, she wished she did not have such a good heart.  Her grief at her losses was clearly apparent, and we were helpless beyond her current medications to do much to slow further losses.  (But telling the story and her words calls to mind this vision of Aslan blowing on stone statues and seeing them turn from cold gray to warm color and then regain progressive movement and function.  Maybe that's what heaven will be like for this woman.)   

The various Alzheimer's patients also stick with me.  Often unaware of their decline, they are at least spared the humiliation and frustration of the losses they experience.  However as an outside observer, it is sobering to remember that this sort of decline could and may happen to me some day years in the future.  I, too, may not recognize my spouse who lives in the dementia unit with me.  I, too, may be blissfully unaware of the fact that I am no longer a child who lives at home with her parents and that the stuffed animal I carry is not in fact a live pet.  The encounters can make for good stories, but the sobering reality is that these older adults have lost much of what I often think makes my life worthwhile.

It is not only losses, however, that old age brings.  I am reminded of this by looking at the old people in my own life, especially my grandparents.  It also brings wisdom and perspective, a patience born of seeing God's work and faithfulness over a lifetime.  It can carry the joy of family and grandchildren, celebrations of new life and the legacy represented in one's family.  It often provides time, time for worship and prayer, time for playing games with a spouse, time for enjoying old hobbies, time for volunteering or sharing with neighbors, time to catch up with family, time to make new friends and reconnect with old ones.

The whole thing reminds me of a passage in John 21, where Jesus goes to find his disciples after his resurrection.  They have gone back to their life before meeting him, fishing (albeit unsuccessfully) on the Sea of Galilee.  He miraculously provides them with an abundant catch and then feeds them on the beach, recalling their last meal with him before his death.  Afterwards, he takes Peter aside and asks him three times (recalling Peter's three denials) whether he loves him, questioning whether in the anguished aftermath of his betrayal (cf. Lk. 22:62) Peter has learned more of what it means to love and follow Jesus.  Peter insists that he does love him, and Jesus asks him to feed and care for his sheep, adding that when he is old, "you will stretch out your hands, and someone else will dress you and lead you where you do not want to go" (v. 18b).  The writer of John comments that this was meant to indicate the type of death Peter would suffer, arms stretched out on a cross upside down and led (tied) to a cross with cords of rope.

The passage illustrates Peter's transition from an easy commitment to loyalty in following Jesus to a deeper understanding of what a life lived in service to others (feed my sheep) and full surrender to Jesus' plan may mean (including a cross and going where one may not want to go).  It seems to me that this is part of the cost of growing old as well.  Increasing frailty requires a willingness to go where one doesn't want to go (sickness, dependence on others, admitting our vulnerability and mortality).  It requires an ongoing surrender to the plan of the Father and an increasing trust as our own lack of control becomes more and more evident.  Many of the older adults in my life have shown an ability to manage the changes of age gracefully, and I think part of the secret may lie in the overlap between the spiritual life's surrender and requisite admission of need for help and direction with the changes that the slowing down and weakening of one's physical body force upon us.  

In her book Revelations of a Single Woman, Connally Gilliam speaks about her fear of ending up a withered old woman as a result of not "getting it," questioning as a celibate single the role of sexual fulfillment in keeping one alive.  She found in the midst of her fears instead that it wasn't "what someone is not getting that matters, it's what he or she is giving" [of him- or herself].  The older adults in my life who most shine with life are not necessarily the ones with the best mobility or the sharpest memory or the most independence.  They are the ones who give of themselves unselfishly, sharing their stories and lessons and God's abiding presence.  They are the ones who teach me how to live and how to age and eventually how to die.  They are the living illustrations of how losing one's life may be the very best way of finding the life which is truly life.