Vol 61: A house divided
Several years ago, a palliative nurse in Australia wrote a book detailing the top five regrets of individuals on their deathbed. In it, she revealed that there was a notable commonality among all of her patients during their last 12 weeks of life. Despite their differences in gender, cultural background, economic status and religious beliefs, they all deeply and uniformly regretted that they hadn’t fulfilled more of their dreams, not for lack of passion but out of fear. They wished they had the courage to express their feelings, worked less, stayed in touch with friends and allowed themselves to be happier.
No one staring at death, she might have noted, said, “I wish I had spent more time in the office.”
At the heart of their remorse lied a strong desire to spend more time with loved ones because no matter the circumstance, the love of family endures. Perhaps that’s why so many of us covet the prospect of having our own. Within families, there is comfort in knowing that when you grow older, you will never be alone, always supported and eternally loved.
Unfortunately, not everyone approaching old age can enjoy such ideals. In fact, globally, elder neglect appears to be on the rise, particularly in the midst and after-shock of the Covid-19 pandemic. My patient has carried the burden of his grandfather’s death for many years. He’s chosen to refer to himself as Spencer and we can all learn a lot from his story.
Spencer’s father abandoned his mother the same day he learned of her pregnancy. Rumors over the years suggest that he may have moved to the US but Spencer never wavered in his determination to forget that he existed. Instead, he was raised by his grandfather, Steven, a strong, indominable man with an incredibly kind heart. In moments of self-reflection, Spencer often recalls how safe he felt in his company. A fairly tall man, weighing 415 pounds, Steven was always smiling and he had an unforgettably deep voice with a gentle spirit. Spencer and his mother moved in with his grandfather when he was still a baby. Shortly after that his uncle fell on hard times and moved in as well.
Because of his obesity, Steven was plagued by multiple comorbidities, namely high blood pressure, high cholesterol, heart disease and Diabetes, which worsened over the years despite an extensive daily regimen of prescribed medications. His poor diet and lack of exercise was the etiology behind his diseases and his lack of self-control made it impossible for his prognosis to improve.
So, Spencer was tasked with over-seeing his care and his duties became more onerous the more his grandfather’s health deteriorated. By the time his grandfather turned 80, it fell to Spencer to accompany him to all his doctor’s appointments, bathe and dress him, tasks made that much more difficult because of his grandfather’s weight. He took him shopping for groceries and managed his finances at his grandfather’s request.
Steven’s son resented the fact that his father held such immutable fondness for his grandson, Spencer, rather than his only son. Feeling that he should be his primary caretaker and in charge of his affairs, he began to accuse Spencer of stealing. His accusations grew louder and soon spread to other members of the family. The resentment and jealousy peaked at a family dinner during a thanksgiving holiday when the mother of Steven’s son made a remark that her son was being overshadowed by a sheep in wolf’s clothing and despite, her attendance, she didn’t see the need to break bread with a depraved thief.
Steven, the only father who Spencer had ever known, said nothing to rebuke her claims, counter or in the very least challenge her statement. That hurt Spencer more than he can put into words even to this day. He broke down sharing the story, his eyes reddening, filling with tears after all these years, for the first time discussing it out loud. He told me how he moved out of the family home the same day, never thinking that would be the last time that he’d see his grandfather alive.
Shortly after Spencer moved out of the only home he’d ever known, peril struck. A Category 3 hurricane ravaged the island, destroying his grandfather’s house. The strong persistent wind coupled with rain so forceful it landed like rocks, was too much for their Sycamore tree to withstand. Defeated, it snapped in two and damaged the majority of the roof in its collapse. Though they managed to salvage most of their possessions, the house was deemed unlivable. Steven and his son moved into a small two-bedroom apartment in a nearby neighborhood but struggled to pay the rent.
Steven’s osteoarthritic knees gave out during prolonged weight bearing so he required assistance when ambulating even at home, which is a fact that his son never considered important during the years that his grandson Spencer was looking after him. In fact, at over 400 lbs., Steven was so afraid of falling and breaking a hip, he bathed less and less frequently before stopping all together. He laid in bed most of the day. After a year, he developed a bed sore in his mid-low back region that grew larger and deeper over the ensuing weeks. In time, Steven began complaining of chills, nausea and sweating with a persistent fever.
Bed sores develop when the skin is exposed to continuous pressure, cutting off blood supply to the area. As the skin breaks down, it becomes a portal of entry for bacteria as contaminants travel deeper and deeper into the bloodstream. Steven’s infection spread so deeply that his organs began to shut down. The drainage from his wound hardened and crusted cementing his wound to the bedsheets. Moving him caused the area to bleed so the sheet, now embedded in his flesh, had to be cut around the wound to free him. He was then rushed to the hospital when his breathing became laborious and the pain so overwhelming that he begged for death.
On close examination, Steven’s wound had become nearly half the size of his back. The base was yellow with an alarming peri-wound erythema that streaked far beyond the wound edge, to the center of his posterior neck. The entire back was hot to touch. With light palpation of the area, a shocking amount of pus and a parliament of crawling, flesh-eating maggots was expressed. The accompanying odor was so foul that it instantly burned your nostrils. The cultures taken of Steven’s wound while in hospital revealed that it was infected by his own feces and urine elucidating the alarming extent of his abandon. The following day, at the age of 85, he was dead.
Spencer wasn’t notified of his grandfather’s death until 24 hours later when he was asked to help pay for the funeral. At that point. Steven’s bank account was entirely empty. The family fought over which funeral home should bury him, the type and colour of the casket and the clothing he should wear. Spencer lightly put his hand over his grandfather’s heart while he lay asleep in the coffin during the family’s viewing of his body. His throat became sore from forcefully choking back the tears and his heart beat so fast it hurt, which was his only reminder to breathe.
Spencer knew that things would have been different had he stayed, but he never imagined that his absence could yield such painful consequences. Leaving the funeral home, Spencer gave Steven’s son his savings of $1000 to put towards the funeral but he never attended because he’d already said his goodbye. The family, now more than a decade later, has never reconciled.
It’s been said that a fool’s form of torture, which envelops many facing their final hours, is wondering what they’d do differently should they have an opportunity to live the same life once more. Spencer’s take home message is to forgive and forget. Families drive you crazy but if at the heart of everything, there is love, then it’s something worth fighting for. Swallow your pride, he said, and simply forgive. Spencer planned to name his own son after his grandfather but sadly the child died in utero.
The saying, once a man, twice a child, is often quoted throughout the island in reference to one’s inability to efficiently take care of themselves when the years creep forward towards an old age. Collectively, as a community, we must do more to help the older community as they navigate the loss of their independence.
Those without a close family unit or the funds to hire a caretaker are particularly vulnerable and in need of a helping hand. Hopefully, should we be fortunate enough to reach old age, we will in turn have a community that can help us during the final years of our lives, acutely content with the decisions we’ve made along the way and with no regrets to think of. Until that wistful time, we can each do our small part, even if it’s as little as helping an elderly person cross a busy street.
This is The KDK Report.
