Composing a Further Life

golf or hobbies; play, which has been called the work of childhood, may now be proposed as passing the time for pleasure alone. Later many older adults find themselves in a battle of wills, insisting on their ability to hold on—to live alone, to handle their money and affairs, to drive a car—and a certain curmudgeonly stubbornness becomes an asset in resisting the need for supportive care as long as possible, relying on the strength of will learned as a two-year-old. Eventually, however, like infants, we have to entrust ourselves to the care of others, and more and more trust will be called for, along with an ultimate trust that can accept the losses of old age as well as the approach of death. Life review—remembering who we have been—offers a way of mining the past for the strengths needed in the present, a present which may seem all too grim.
    As I reflected on this, I found myself thinking of a woman I will call Helen. Helen was the eldest child and the only girl in a devout Protestant family, which meant that from very early on she was taking responsibility and caring for others. She and her husband immigrated to the United States as young adults and raised their children in a handsome house in the Midwest, where they joined an evangelical congregation. He was a successful professional, and she was always busy in their home and active in the church. Their children grew up and married, Helen’s husband retired, grandchildren came, and Helen developed osteoporosis. In her late seventies she fell, breaking her leg in two places, and she fell again in the hospital, facing a long period of rehabilitation. Helen’s husband, accustomed to a traditional division of labor, was quite unable to cope alone in their big house.
    The family conferred and moved Helen’s husband into an apartment in an assisted living facility with an attached rehabilitation and skilled nursing unit, where Helen could convalesce. Their two cars were given away, beloved items of furniture were moved into the small apartment where Helen would join her husband when she was able, and the house was sold. Meantime, Helen was forbidden to move from her bed without a professional caregiver to transfer her to a wheelchair, and the overworked nurses were often too busy to get her to the bathroom on time. She felt as if her entire life had been shut down and she was now totally dependent. The food, the care, all the circumstances of her life were unsatisfactory and decided without consulting her.
    Helen’s situation took me back to an encounter, many decades before, with my maternal grandfather, the first elderly person whose needs I had had to think about when I was a teenager. He had continued as a widower in his Philadelphia home after retirement, renting rooms to graduate students. The day came when they began to complain of faucets left running, pots burning on the stove, and doors left unlocked, and my mother asked my older cousin and me to go to Philadelphia and find a residential hotel he could move to. So Philip, who had a driver’s license, rented a car, and we set off to research possibilities.
    Bompa—my childhood name for my grandfather—was a retired professor of economics, ornery and domineering—a true curmudgeon. On a blazing hot summer day, we worked our way through a list of addresses, taking him to visit one after another, all of which he firmly turned down. We pulled up outside the last one, which had sounded good to me on the telephone, and I said, “You know, it’s just not worth it, let’s not even go in, let’s head back.” “Nonsense,” he announced, “we’re here, let’s have a look.” In we went, and I anticipated him with criticisms of everything we saw—the bedroom, the dining room, the management. “Forget it,” I said, “this won’t do.” He told me I was completely wrong, triumphantly engaged a room, and we moved him in that evening. He grinned at me as we said good-bye and quipped, “You think you’re pretty smart, don’t you?” He remained there until his death, firm in his choice.
    What I had been able to return to him, by letting him overrule me and assert his will, was his sense of agency, of being the master of his fate. This made him able to accept the help he needed even though he recognized what I was doing. Help is not always tactful, or it may move too fast, taking away all sense of choice.
    But Helen’s situation was more difficult. She told me despairingly over the phone