E-card to med school professors of geriatrics and family medicine

What's the right thing to do for mom and dad as they get older?

Thanks to advances in science and medicine, more of our parents are living longer than ever before. And though we are rewarded with more time with the people we love, we are also faced with new sets of complications—more diseases, more disability, more need for support and careful judgments. Yet while our health care system may help people live to an older age, it doesn't perform so well when decline eventually sets in. We want to do the best thing but are overwhelmed with the staggering choices we face.

Geriatrician Dennis McCullough has spent his life helping families to cope with their parents' aging and eventual final passage, experiences he faced with his own mother. In this comforting and much-needed book, he recommends a new approach, which he terms "Slow Medicine."

Shaped by common sense and kindness, grounded in traditional medicine yet receptive to alternative therapies, Slow Medicine advocates for careful anticipatory "attending" to an elder's changing needs rather than waiting for crises that force acute medical interventions—an approach that improves the quality of elders' extended late lives without bankrupting their families financially or emotionally. As Dr. McCullough argues, we need to learn that time and kindness are sometimes more important and humane at these late stages than state-of-the-art medical interventions.

My Mother, Your Mother will help you learn how to:

—form an early and strong partnership with your parents and siblings;
—strategize on connecting with doctors and other care providers;
—navigate medical crises;
—create a committed Advocacy Team;
—reach out with greater empathy and awareness; and
—face the end-of-life time with confidence and skill.

Although taking care of those who have always cared for us is not an easily navigated time of life, My Mother, Your Mother will help you and your family to prepare for this complex journey. This is not a plan for getting ready to die; it is a plan for understanding, for caring, and for helping those you love live well during their final years. And the time to start is now.

My Mother, Your Mother

Embracing "Slow Medicine," the Compassionate Approach to Caring for Your Aging Loved OnesBy Dennis McCullough

HarperCollins Publishers, Inc.

Copyright ©2008 Dennis McCullough
All right reserved.
ISBN: 9780061243028

Chapter One

First Things

The Foundation of a New Family Understanding

Italy is where the modern idea of slowness was born. This family-centered country first conceived the Slow Food movement to counter the invasion and industrial excesses of American fast foods. By promoting regional flavors and locally grown variety, and by taking time for conversation and digestion, they reclaimed the high quality of a basic human experience, not to mention salvaging more healthful nutrition for their citizens. Later, the Italians extended the concept to their urban environments, designating Slow Cities, where automobiles were banned from central plazas, helping grandmothers to be safe and welcome on the streets.

I?ve adopted this idea of slowness to benefit this special population of Late-Life elders who do not move or think as swiftly, see or hear as clearly; whose health problems and solutions are more complex; whose energy stores and resilience are less; and whose recovery takes more time than for us at middle age. Slow Medicine?s ultimate goal is a practical and qualitative change in care directed by a more complete respect for and fuller understanding of the particularity of each late-life elder. This practice calls for using the allotted time health professionals (and families) spend with our aging parents differently and making better, more appropriate decisions more slowly and over a more extended period of time. Doing this work well cannot be reduced to knee-jerk routines. It requires more thoughtful evaluation and reflection, attentive listening, looking, and hands-on participation. It also demands that we ask for medical care different from what most elders are presently allowed: the fifteen-minute office call to renew prescriptions while the doctor peers into a computer screen or the answering machine?s advice to go to the emergency room. No sound bite distillations of information entered into a prefabricated electronic flow sheet can elicit or make sense of the complexities of an elder?s needs, unspoken concerns, and nuances of illness at these nether reaches of age. Focusing on blood pressure control without knowing the patient well enough or talking long enough to recognize subtle losses of cognition and strength doesn?t get to the heart of the patient?s (or the family?s) real problems. Knowing the daily burdens, emotional demands, and psychological intricacies of your mother?s days in her apartment can?t be undertaken by her doctor alone. Slow Medicine requires intimacy and commitment on the part of many others. The best care results when health care professionals, family members, and caregivers share information. These conversations allow discoveries and responses to percolate within a clinician?s intuition and subconscious over time, leading to a deeper understanding of an older person?s present situation and the future.

These balanced, mutually respectful, and supportive partnerships between doctors, nurses, and other health professionals and elder patients, their families, close friends, neighbors, and anyone else chosen to be part of what I call the Circle of Concern are at the heart of Slow Medicine. This group of people who naturally connect to a person in trouble provides steady support and insight. Although at middle age we might engage the help of such a group for a sudden crisis, for failing elders the Circle of Concern gathers for the long run. This active, extended advocacy partnership can improve our elders? care by attending to both technical and human needs, and by balancing the formal care from professionals and institutions with a particular individual?s physical, emotional, and financial capacities, family values, and personal philosophical or spiritual outlook. Tailoring such extended and personalized care for a former waitress will be different from tailoring care that might suit a retired college dean—neither is simply ?a white-haired old lady.?

Slow Medicine is not really new in the annals of medicine, but it needs to be retrieved and given prominence again. Many doctors in the trenches are in mourning for the age-old practice of paying deep attention and truly ?attending? that is being squeezed from our complex, fragmented, and technological medical system. Slow Medicine for elders in late life enacts the ancient Tibetan wisdom of ?making haste slowly,? that is, focusing on the central issues of human caring with patience and a sense of shared humanity, forgiving one another for what cannot be changed, bending flexibly at times of need, and holding firmly to shared values and loyalties at other times. Slow Medicine is a commitment to understand, to support, to heal, and to care for those weakest among us in a way we would want to be cared for ourselves.

Over my many years of medical practice, I have identified five fundamental principles that should guide families, health professionals, caregivers, and other caring people in their efforts to enrich and support an elder?s life to the end.

I. We must endeavor to understand our parents and other elders deeply, in all their personal complexity, acknowledging both the losses and the newly revealed strengths that come with aging.

Shortly before her death at ninety-two, Agnes talked about ?closing the circle.? Having grown up in the South in a prominent Georgia family, she knew and loved her family history. To Agnes, ?passing on? was simply what a person did. You passed on from your own life, and you passed on the role you held in your family to those who came after. What a clear sense she enjoyed of how her individual life fit into a long-recorded and remembered family history! The colorful stories told after her passing made her special qualities very clear.

As we mature, our culture encourages us to become fully who we are, to realize our personal potential, and evolve as unique individuals. We also come to recognize that though our individual lives are as miraculously detailed and unique as snowflakes, they can just as easily be obscured in a blizzard of others. From birth to death, we experience our life?s passage as highly personal, but just as surely our span of years conforms to the limits and possibilities of our human species. . . .

Continues...

Excerpted from My Mother, Your Motherby Dennis McCullough Copyright ©2008 by Dennis McCullough. Excerpted by permission.
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