The Perils of Underestimation

Last spring my 94-year-old father nearly died. A change in his medication triggered metabolic chaos, characterized by dehydration, muscle weakness, kidney failure and disorientation. By the time he was hospitalized, his multiple falls resulted in his looking as if he had been beaten savagely with baseball bats. He was combative, hallucinatory and incapable of making decisions about his care. Even his personal physician, who had been his resident decades earlier, feared the worst. Remarkably, after five or so days, his kidney failure was reversed, his electrolytes were balanced and he was stable enough to be admitted to a rehabilitation center. The ultimate goal was to get him well enough to go to an assisted living facility; returning to the home he had shared with his recently deceased wife was out of the question.

By the time I visited him roughly a week after the onset of this disastrous downward spiral, he was in and out of rationality, experiencing episodes of muscle rigidity, and incapable of walking, eating solid food, toileting himself, or getting in or out of bed unassisted. He was the equivalent of a six foot six month old. I felt incredibly sad seeing him this way, punctuated by moments of suppressed hilarity when he earnestly told me about his having delivered twins the night before, one white and one black, or having won two thousand dollars in Vegas playing blackjack with some random mobster who then beat him and robbed him of his winnings. (That part reminded me of an imaginative six year old.)

I must admit that I was skeptical that he would ever leave the facility. I underestimated him. Twice daily physical and occupational therapy, a stubborn streak, innate athleticism and my father’s history as both a physician and a World War II veteran who spent two years in a hospital battling tuberculosis caught in the service gave him the tools he needed to regain his independence. Several weeks later he was chipper, lucid, and determined to walk again unassisted. Furtively watching him through the therapy room window work intently to lift himself from his wheelchair, or place colored plastic donuts one atop another on the equivalent of a child’s Playskool toy tower, I was moved to tears. Naturally, he became a staff favorite because of his work ethic, determination and self-deprecating sense of humor. Every day brought him closer to an honorable discharge.

Last week, just a few days after Veterans’ Day, my daughter Emily and I drove to the Chelsea Assisted Living facility where Dad is now living. He greeted us with open arms, striding to the doorway of his room on the third floor. (He admits that he sometimes forgets to use his walker). A luxurious version of a dorm room, his new abode has nice wall-to-wall carpeting and a large picture window looking out over mature trees. The kitchenette includes a sink, microwave and mini fridge containing fresh pressed cider, Jarlsburg cheese and Sam Adams beer. Upon opening the fridge Emily remarked that some things never change. Graduating from college to the old folks’ home just improves the quality of a bachelor fridge’s contents! A giant flat screen TV for watching sports and movies, a comfortable chair flanked by a floor lamp, and a side table holding his latest novel from the library and the newest issue of Scientific American attest to his having settled in. Family photos adorn the walls, including his favorite shot of his wife Ginny standing naked, looking coyly back over her shoulder, her back to the camera, on the balcony of their condo in St. Maarten. His eyes twinkled as he told us about the Jamaican woman who cleans his room asking if that was his wife. When he replied that yes it was, she retorted, “It better be!” He gave other evidence that his sense of humor is back in full swing. As we waited for the elevator to go to lunch he pointed to the sign that proclaimed in large print for the sight impaired “In case of fire take stairs.” “Like that’s going to happen,” he chortled as he tapped his walker.

In many ways my father is in better shape now than before his illness. His balance is improved, his color is rosier, his affect is warmer. As much as he hated to leave his home, I think it helped him to escape the loneliness that he experienced after Ginny’s death. He has accepted that he is in a new phase of his life, one for which he should be grateful rather than resentful, and one which includes the need to acknowledge the need for help. He is assisted in his showering three times a week, for example, because it is just too hard to hold on to the shower grab bar with one hand while washing with the other. And I think he rather enjoys the attention.

My father’s recovery, indeed his improved status overall, reminds me of the wisdom I learned from the renowned pediatrician Dr. T. Berry Brazelton, a contemporary of my dad’s at Columbia Medical School and the person responsible for whole fields of child development theory and practice, beginning with the idea that newborn babies are not blank slates, all alike, but individuals with temperaments and learning styles. Mothering my own girls, I employed his techniques for understanding them better, beginning with observing their responses to stimulation, modes of communication and approaches toward new developmental challenges.

For example, my oldest, a born perfectionist, did not attempt to walk until at about thirteen months she could stand from a sit in the middle of the room, take steps, and plop down at will. At about eight months by contrast, her younger sister, always more of a risk taker, pulled herself up, cruised around the furniture, wobbled and tentatively took a few forward steps before crashing to the floor. After literally hundreds of failed attempts, she eventually raced headlong across the room at nine months before flopping down in a giggling heap. Each baby had her own approach to a new task; one was not “better” than the other. Most babies (and people) would land somewhere between these two examples. And, as Brazelton pointed out, before each new developmental leap a child would often regress, have tantrums, changes of appetite, interrupted sleep cycles, perhaps even toilet training issues. Both my girls exhibited these despite their other differences.

Which brings me back to my father. There is no doubt that my father’s “character” assisted his recovery. But defining character as an independent variable and refusing as a society to help those whom we see as lacking it strikes me as not just a failure of understanding, but a moral failure as well. His transition from near death to helplessness to independence was not unlike that experienced by severely wounded returning soldiers, or accident victims, or on the more everyday level, each one of us who as infants learned to walk, talk, chew, and use a toilet. I am proud of my Dad, but I am also awed by the dedication of the many people who believed in him, assisted him, and continued to treat him with dignity and respect, often for minimum wages and near social invisibility. I am grateful that Medicare, Veterans benefits, Social Security and his own savings enable him to live this new phase of life in comfort. It took a village!

Inborn temperament, external resources and just plain luck determine who among us will be precocious, who will fail to thrive, who will be permanently scarred by our experiences. The process of achieving or regaining independence is not a linear one, nor is it devoid of upsetting, sometimes antisocial or aggravating behaviors –whether we are two or fifteen or forty or ninety-four. Sometimes failure, in my father’s case metabolic, but in so many cases academic or personal or social, is the predicate for growth and change. How many of our children are diagnosed and medicated rather than understood? How many helicopter parents are preventing their children from growing in their own ways and at their own rates? How many impoverished, alcoholic, drug-addicted or otherwise disabled adults among our citizenry do not have the skill set or the support system or the hope for the future that is necessary to achieve or to regain independence as my father did? How many of us have our potential for change and growth underestimated? One of the mantras of my youth speaks to the need for compassion that I sometimes fear we as a society writ large have lost: “there but for the grace of God go I.” I have a new twist to add to that now: “there with the grace of my father may I go.”

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