The intriguing title of a recent article in the New York Times (2008, May 5), For the Elderly, Being Heard About Life's End, caught my attention (http://www.nytimes.com/2008/05/05/health/05slow.html?partner=rssnyt&emc=rss).
This article focuses on an approach to healthcare that slows down to balance and reflect on the individual in healthcare at life's end. This approach, termed "slow medicine," is described in a book I just read by Dr. Dennis McCullough (2008) from Dartmouth Medical School. With so many things passing before our eyes and so little time to slow down and read, I highly recommend this book for those of us caring for elders in home care and hospice as well as our families and ourselves as we grow older.
I first met Dr. Dennis McCullough when he came to Michigan's Upper Peninsula to visit his mother near the end of her life. As we passed the time waiting for a conference to begin, we shared stories of our parents and our lives. My mother had recently died after living to the good old age of 89 years with courage, wisdom, and humor but encountering a whole string of experiences that were difficult and demoralizing for her and our family. My dad had died years earlier of Alzheimer's disease, a heartbreaking and challenging end to the life of a dear, brilliant, and honorable man.
When Dr. McCullough told me he was writing a book about caring for our aging loved ones, I was immediately intrigued and made a note to search for it upon its release in the Spring of 2008. But little did I know at the time how wonderful this book would be!!
In his practical and poetic style, Dr. McCullough (2008) weaves a story of his mother's experiences, with essential information for us all, as she passed through "the eight stations of late life." He compares aging with a journey up a mountain-difficult and long and taking a lifetime to understand.
Dr. McCullough's compassion and credibility expressed in these pages are those of a physician who truly notices and understands life and death issues. He says, "Raised on welfare by my mother and grandfather in an impoverished Scandinavian American mining community in the Upper Peninsula of Michigan, I have always felt a keen allegiance to the underserved" (p. xii).
Now a family physician and geriatrician at Dartmouth Medical School, Dennis McCullough defines his mission in writing this book as "finding ways to empower elders and their families to carry out this vital work of creating high-quality care" (p. xix). Reflecting on our aging population, he states that now more than ever we need care that is "more measured and reflective, and that actually stands back from rushed in-hospital interventions and slows down to balance thoughtfully the separate, multiple, and complex issues of late life." He terms this approach "slow medicine" (p. xix).
The story of his own mother concludes with his touching words in the epilogue: "Late life journeys are surely unpredictable to the very end. The unexpected twist at the end was a gift and totally outside our plan," referring to his mother's death at Omega House, a residential hospice in Houghton, Michigan (p. 223).
This is a book that speaks to sons and daughters, doctors and lawyers, chaplains and social workers, essentially all of us who are aging or watching a loved one grow older. It offers insight and compassion for slower, older patients and their worried families bewildered by runaway situations, knowing things are not right, "unshepherded in foreign surroundings," who find they "must carry their loved one up a steepening mountain alone." Slow medicine sustains fragile patterns of well-being by truly attending or, to quote a Tibetan phrase, "making haste slowly."
The underlying message of love and respect within the "circle of concern" for late-life elders resonates throughout the book and reinforces fundamental principles such as these: "as losses accumulate, so do strengths"; "communicate well and with patience"; and "maintain an attitude of kindness no matter what."
The stations of late life that Dr. McCullough so eloquently and compassionately references are of course different for every person but include some universal stages that many encounter as they travel through the complex issues of late life. Guiding the reader through thoughts about the ups and downs of crises and hope with wisdom, he allows us to consider beforehand options and strategies for responding with confidence and skill, to learn that time and kindness often are more important and humane than exhausting medical interventions. He shows us how to practice slow medicine, the compassionate approach to caring for our aging loved ones.
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