The Long Goodbye

When the end of life comes later in life, the consequences are often unexpected — and often painful
Photograph by Joanne Ratajczak
Early may, 2010. Henry,* eighty-six, sits in his hot pink living room, dressed in his usual, immaculate checked shirt and tie. Piles of books cover almost every surface, and the art on the walls ranges from a fragile thirteenth-century Persian bowl to a nail “painting” by the late David Partridge. A charcoal portrait of the psychoanalyst Melanie Klein broods over the dining table, across from a pine cupboard full of Greek and Roman bowls and other ancient ceramics.

The nineteenth-century workman’s cottage in Toronto’s Cabbagetown is full to bursting with the habits and enthusiasms of two long lives, but next to the couch a wheelchair stands empty. It belongs to Henry’s wife, Anne,* who is also eighty-six. A distinguished biographer, she is paralyzed on the left side from a stroke she suffered nine years ago, and relies on Henry for everything from picking up her dropped reading glasses to help using the bathroom. Because he needs some respite, he has arranged for her to stay in a nearby long-term care centre for two weeks.

Today, after his first night alone, Henry feels ambivalent. “It certainly concentrates the mind, to do this separation thing,” he muses, thinking about all the interruptions he faces in his normal day. “On the other hand, I miss her terribly. It just feels wrong to be in this empty house without hearing ‘Henry! Henry!’”

* Henry and Anne’s names have been changed.
A year ago, at eighty-five, Henry retired, reluctantly, as executive director of Abbeyfield Canada, an organization that maintains group homes for old people. Since his wife’s stroke, he has also been engaged in a Sisyphean struggle to continue living in their house. Henry fought the good fight on two separate battlefields, working to provide homelike environments for people who can no longer live independently while labouring to keep Anne in the place she loves more than almost anything. He continues to serve as a volunteer for the local Abbeyfield chapter, and today he’s thinking aloud about a scheme that would combine elder care centres with daycares for children. “I wonder,” he says in his plummy English accent, “who could do something about that…”

Twenty minutes’ walk from their house, Anne lies in her bed in the Rekai Centre, wearing a flowered silk nightgown with a deep V-neck and a matching bed jacket. She’s spending her two weeks here reading, watching television, and receiving visitors, with a sharp ear out for spicy gossip and an eye for stylish clothes. Of a recent guest’s attire, she says, “I really lusted after that little white leather jacket she wore yesterday.” The same woman brought her a welcome gift, a sub-rosa pickle jar filled with brandy.

One of the words that describes Anne is “indomitable.” When Henry left her in this bare-walled beige space — a sad contrast with the intensely coloured rooms of her house — she told him, with her characteristic drama, “I’ll never forgive you.” But within a day of her admission, he reported, “she really was marvellous, really was lovely today,” happy for him that he was taking advantage of her absence to embark on an epic bus trip to visit his family on Long Island.

Another word for Anne is “avid.” She knows exactly what she wants from life: “Interest. I still have enormous curiosity. I still want to meet new, interesting people and see interesting places and read interesting books.” Her most pressing desire these days is to visit the Prado museum in Madrid: it contains some of her favourite paintings, and she’s never been there. As she sees it, money is the main impediment to travelling as much as she wants. “Money’s so important,” she says. “I think back on my life and think, how could I have managed my finances better? It’s nice to have money when you’re young, but boy, you need it when you’re old.” She still receives royalties, she adds (the most recent from Serbia, for The Secret Ring, her book about Freud and his circle), and she claims the cheques could partially finance a trip to Madrid.

She’s so intent on what she wants that she assumes others have enlisted themselves in her current campaign. When I visit, she asks me, “Are you making any progress?” With what? I ask, wondering if she is referring to my work. “With getting Henry to see that we can do the trip to Madrid,” she answers, as if this is self-evident.

Henry and Anne are two of the faces of old age, a stage of life that was once rare but is becoming more common. In 1900, a Canadian man could expect to live forty-seven years, and a woman fifty. By 2005, the average life expectancy for a man was seventy-eight, and that of a woman 82.7. Not only are senior citizens living longer; they make up an increasingly large segment of the population. By 2021, Canadians over sixty-five will outnumber children. In 2041, one in every four Canadians — 9.2 million — will be a senior citizen. A growing number will live to be what gerontologists call the old-old (they class people aged sixty-five to seventy-four as young-old, those aged seventy-five to eighty-four as medium-old, and those eighty-five and up as old-old).

This burgeoning population is something new under the sun. The relatively few doctors interested in them are still learning how to care for their aged bodies. Psychiatrists, psychologists, and social workers are still trying to understand their emotional and social needs. And, no doubt because old age is unwelcome and even threatening in our youth-obsessed, quick-fix culture, the not-yet-old are still averting their eyes, denying it will ever happen to them. Old age is a largely unexplored and unmapped country, obscured by prejudice and myth.

But not to those who are making their way through it. Perhaps partly because Henry devoted the past quarter century of his working life to senior citizens’ housing, and partly because he remains an old-school Brit, his attitude to age is brisk and un-euphemistic. As with most people who are successfully negotiating this last stage, old age snuck up on him when he was busy doing other things, and he realized quickly that the graceful thing to do was accept it. “I’m not a different person because I’m old,” he says. Ten or fifteen years ago, if someone offered him a seat on the streetcar, “I would have bridled, because it made me realize I looked older than I thought I was, but now I say thank you.”

Anne, too, has been in many ways unfazed by the simple fact of aging. Beginning with her two strong-willed grandmothers, she has always been drawn to old people. During the years she lived in England, she had several older women friends who impressed her as models for a thriving old age. Like her, they were blessed with an unflagging interest in life; unlike her, they had the use of their arms and legs into their nineties. After refusing for several years to accept that her paralysis was permanent, she seems to have made peace with that on some level. And although she complains that old age is tough — “I mourn for my lost energy, because I had gorgeous energy” — she can’t stop herself from noting good subjects for future biographies. Reading about the American writer Elizabeth Hardwick recently, she thought, “Oh my goodness, that would be an interesting person to write about. Then I said to myself, don’t even think about it. You’re too old to start a book.”

Not every octogenarian has as many projects on the go as Henry does, nor regularly asks family to bring the book featured on the cover of The New York Times Book Review, as Anne does, but Dr. Benoit Mulsant would see them as typical of the “old-old” in several ways. Mulsant is the physician-in-chief at Toronto’s Centre for Addiction and Mental Health, and clinical director of its geriatric mental health program. Octogenarians, he says, are physiological and psychological survivors. They’ve combined good genes with sensible habits of self-preservation. They aren’t substance abusers, who may die from lung cancer and liver disease in their fifties and sixties; nor did they die from stroke, diabetes, cardiovascular disease, or other serious conditions that can fell people in their sixties and seventies. They tend to have married, had children, and been fairly sociable — all indicators for a long and contented life. Many have some disposable income, because, unlike the boomers, they were savers.

One of the myths about old age is that the old are particularly subject to depression, a misconception Mulsant credits to the ageism of our society: we project onto the old our own conviction that old age must be miserable. On the contrary, he contends, his research shows that the old actually have lower rates of depression than the middle-aged. Those over eighty-five probably have an even lower rate than do senior citizens in general. It’s true that misfortunes (like the death of a spouse, a stroke, or a broken hip) can cause a depressive episode in 10 to 20 percent of those affected, but depression in the old is just as treatable, if not more so, than in the middle-aged.

Anxiety and panic disorders, social phobias, obsessive-compulsive disorders, and schizophrenia all tend to decrease with age. “Life is a therapy in itself,” Mulsant says. “If you have been waiting for the sky to fall on your head for fifty years, at some point you realize that it isn’t happening.” He doesn’t claim that all old people are happy and busy. With their siblings, spouses, and friends failing or dead, even those in relatively good circumstances often experience what he calls an existential loneliness. Perhaps above all, he says, the old have a remarkable capacity to adapt. They tend to be stoic, because they were raised in an era that valued a stiff upper lip and a shoulder to the grindstone.

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10 comment(s)

PaulineJanuary 31, 2011 17:06 EST

Being in my late sixties, I become more and more sensitive to ageing. This article expresses several aspects of emotions, thoughts that nourish my mind wondering what my situation will be tomorrow. The example of "Harry and Anne" is so real, so much like what happens to people I know, Although you plan the quality of your old age living, life still has control over it. It looks to me that you have to be well anchored to fondamental values in life to be able to sustain rationality when your body starts to let you go. And even then, the entourage in which you live has to be adequate and understanding. You must be so strong mentally to adapt to the consequences of loss of energy, loss of sleep, loss of appetite. Because of these losses, you become vulnerable and give way to fears and anxieties. Ageing can be beautiful and yet harmful.

Thank you for giving me the opportunety to reflect on the dignity of ageing.

Pauline

AnonymousFebruary 04, 2011 12:47 EST

If you\'re trying to protect their privacy you\'re done a poor job. Changing the names of this couple but leaving personal information would lead to easy identification for anyone with a computer and access to the internet.

Unless you weren't trying to protect their privacy. Why change the names though?

The WalrusFebruary 04, 2011 12:49 EST

We changed the names at the request of the family.

Pre "PERSON" personFebruary 10, 2011 19:03 EST

This is huge invasion of privacy unless the subjects and immediate kin were aware of implications of the material being online. Also those at the named facilities Mrs. X was at.

PattiFebruary 16, 2011 16:08 EST

This article was heart-breaking yet necessary. I am in my mid-sixties and although able-bodied and energetic wonder how long this will last. What happens if I or my husband become infirm as did Ann? Will we be able to adjust and cope as well as they have? We have savings but is it enough for 24-hour care for how many years? How long would we be able to stay in our much-loved home - albeit all on one floor. I most appreciated the comments on medical intervention and the philosophy of the geriatrician. A lot to consider.

A well-done article, in my opinion.

fujikatsFebruary 17, 2011 11:37 EST

I don't understand why this couple cannot be accommodated in a seniors' facility together. It would make life so much easier and happier for them both. The people who administer these facilities need to take a good hard look at this. No couple should be split up like this. Sadly, at some point, someone should have been a little firmer with "Anne". Her insistence on continuing to live in her own home, thus forcing "Henry" to care for her, has undoubtedly contributed to Henry's ill health. She is very lucky she didn't lose him completely. It's all well and fine to commend our elders on their determination to live their own lives, but reality discipline (the concept behind "tough love") needs to be applied sometimes.

selbotFebruary 17, 2011 11:37 EST

Positively eye-opening, thought provoking and tender. The immediacy of this issue never really hit me(I'm 27) until recently, and I appreciate this frank yet sensitive discussion of all the issues surrounding advanced aging in the 21st century. Great to see mention of the late, wonderful David Partridge, too! The choice to change the names and then include all those very specific pieces of personal info is quite a bafffling oversight though.

JanMarch 04, 2011 14:09 EST

Thanks for an excellent, thought-provoking article. When I read the comments and worries of those in their sixties, I wonder how much our anticipation of old age is influenced by what we witnessed with our own parents. My mother was fiercely independent and was able to live on her own until she was almost 92, when she died suddenly of heart failure. She never learned to drive, so she was dependent on a neighbor for groceries. But otherwise, she had no in-home care.

Physically, I look just like my mother, so I assume I have a predominance of her genes. I’ve (almost) always exercised and been a vegetarian. I’m now in my late sixties, have been blessed with a clean bill of health, and am anticipating that I’ll stay active and independent into my nineties.

AnonymousMarch 08, 2011 13:09 EST

Great article, I am currently in school to become a health care assistant and am very excited entering a career that is relatively new in its concepts and philosophy\'s of care. Many people do not recognize the important role that care aids play in society, but something tells me our voice in the coming years is going to get louder and true reform is going to come about, I have a dream one day that capacity for elder care will be met at a national level but it all starts in our community and I for one am very proud to be working at the front lines and am hopeful that one day I will be in an arena of change in wich I can affect the policy that our parents, grand parents and one day us will all fall under. Empathy has been described to me as putting yourself in somebody elses shoes, and until our health administrators come from behind their desks and spend the time needed to find out were those shoes have gone they will never posses the confidence and strength needed to bring about reform from the top down. Our industry needs more heroes who like the author of a bitter pill who will step up and give a voice to those who are seldom if ever heard.

eastcoastjudyAugust 29, 2011 10:54 EST

My mother, aged 90, died about 7 months ago.
People wonder about the cost of in home care.
Since she lived in downtown Toronto and needed 24 hr supervision and care, in her home, it cost over $365,000 for the last two years of her life. From her money, we children paid $20 per hour for a health care aide or an LPN, and we paid it to an agency. That is the only way to ensure responsible full time help that I can think of. For some time, on top of this we needed a registered nurse for about a day or two a week. This costs $50 per hour. Needless to say, few of us can afford what my mother could afford. But it seems to me this is all backward.

Why can't we get good, kindly and decent institutional care?
Why can't we treat the elderly with the respect they deserve and have quality food and drink in these nursing homes, not slop. Why can't we as a society provide for the elderly — in their homes fine, but in cooperative group care? In the next decades more than a quarter of the population will be over 65. What do we do, say that everyone should save and save and be rich enough to afford their own care, or look for a meaningful solution for all?

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