These days we are talking more about advanced directives and living wills in health care. This is progress, but as a member of the sandwich generation, I am focused on the aging process. I don’t have kids, but I have parents and have the honor of watching patients struggle with aging and helping loved ones grow old — walking the long, winding and thorny road.

Patients have asked me, “Where are the golden years?” Aging is a process of loss and grief: letting go of what you can no longer do for yourself or have the energy to do, living with pain and discomfort and sorting through the could, should, would haves.

As the eldest child, I have tried to respect my parent’s autonomy to make a decision even if I don’t agree, but temper it with the realities of what Mom or Dad could and could not do. With lots of siblings, it means working to be on the same page, which is sometimes easier said than done. No surprise, there is no direction manual or easy answers. I am learning as I am doing. As a physician, I have the benefit of watching others do the same: some do it well, some do not. Someday, I’ll have more authority when I am grieving the loss of my own capabilities.

My dad was disillusioned in his final years as he came to terms with the loss of his physical strength. He did make it out to spray the weeds along the farm fence rows at 90, his goal. Doing it once at 90 was enough, although neighbors watched with their hands on the phone. However, he may have benefited from antidepressants in his final years; it might have helped him emphasize the cup half full as opposed to the half empty point of view. That said, we celebrated his 92 years of living two years ago this Christmas.

My 88-year-old mom has soldiered on without him, now alone after sixty some years of marriage. Recently she fell and broke her shoulder. Due to the nature of the break, she needed surgery. The surgery was successful, but claiming independence is tough. It’s even harder to keep your balance when you can’t use one arm. What about dressing, bathing, using the bathroom, cooking? She has reminded all her daughters what we take for granted.

Mom faced the options of assisted living or having 24-hour caregiver aides in her home. She wasn’t thrilled with either choice. With assisted living, you have more privacy but lose familiar surroundings and your own bed. With aides, you are in your own home, but you lose your privacy — the aides are always there. Because it is a low wage job, there is turnover and different lifestyles. There was the aide who went outside to smoke every 30 minutes, the one who stole money, the one with unkempt hair, tattoos and a nose ring. But there were some wonderful and caring aides as well. Big adjustments to make when you are under the weather and need help you wish you didn’t need — more grief and loss.

Of course, there is the driving issue. In our culture, where effective public transportation is a rarity, losing the keys is an affront to independence. As a physician, I have been the bad guy and taken car keys away from patients at the request of their children. Sure you can get on the senior van to go to the grocery, line-up transportation to take you to medical appointments, but you can’t come and go when and where you want. Less control and more patience. More grief and loss.

How do we make sense of these challenges? Several of George H. W. Bush’s eulogizers talked about the lubricant of his humor and how welcome it was during tough times and tough decisions. A friend’s mother with dementia was able to make fun of her forgetfulness. Some patients have the ability to laugh instead of cry at the changes and losses. Hurrah for humor!

A spiritual life helps. My aunt who played and taught the piano and guitar for years now has numbness, tingling and burning in her fingers. It seems like cruel punishment to lose the use of body parts that were not only her livelihood but also her joy. Because of her faith, she believes that through her suffering she is earning heaven. A spiritual life helps find meaning in the unpalatable, plugs us into something greater than ourselves, and provides community.

Mindfulness helps. Focusing on the smalls joys that are available to us day in and day out means celebrating the everyday lights or “de-lights” that cross our paths. But we have to watch for them. I remember James Earl Jones celebrating the morning’s sunrise at the end of a movie about the horrors of apartheid in South Africa.

Family helps. Patients that have family geographically close who are engaged with the elder, checking in, providing transportation to doctor appointments, bringing meals, engaging him/her in family activities appear to avoid loneliness and isolation. As I was arranging the 24-hour caregiving for my mother, one of the aides said to me, “Where is her family?” Shame on me, I thought, I am a product of my culture having left Ohio again. While some families in the US do venerate family connections, many do not, and children move for jobs and other opportunities. Today’s economy also requires the caregiving child, usually female, to have a job of her own. Of course, close family is not without its own complications.

Perhaps these are the lesson here. Aging is tough, not for sissies, but how we live our lives, how we celebrate the people who come and go along the way, how we celebrate the delights and avoid taking ourselves or others too seriously are the tools for coping with the grief and loss of the long, winding and thorny road of growing old.

Therese Zink is a family physician and can be reached at her self-titled site, ThereseZink.com.

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