It’s a Beautiful Thing?

It’s a Beautiful Thing?

We recently accompanied an elderly client and her family through assisted living, nursing and then hospice care.  When I first met Mary (not the real name of our 80-something client), I thought her an attractive and vibrant woman, full of fun and just a bit of flirtatiousness.  I liked her when I met her and her oldest son, Frank (not his real name) at the assisted living facility, but Frank seemed embarrassed by his mother’s friendly behavior.  After spending a few minutes with Mary, I could see the familiar signs of early dementia that brought her to this facility.  Prior to her admission, Mary lived independently for several years after her husband died, supported by a cadre of friends.   Mary shopped, traveled, played cards and hung-out with a group that had been together for years. But, as her behavioral problems increased, the group became less able to support her.

Mary had a second, younger son.  Bobby (not his name) was mom’s favorite but lived a few hundred miles away.   Frank, on the other hand, lived nearby but was not emotionally close to his mother.   He was his dad’s favorite.   The alignment of the parents’ affections seemed somewhat reversed – Mary was fun-loving and passionate but favored Bobby who was actually serious-minded and pragmatic.   Her late husband, similar to Bobby, favored Frank who was much more like his mom.   I surmised that the parents were attracted to the qualities in their sons that they liked in each other.  Needless to say, these alignments did not make for smooth caregiving.

By the time Mary went to assisted living her sons were her only support.  Bobby was away but she wanted him nearby.  Mary could occasionally force a visit by complaining about Frank’s lack of interest.   Frank actually visited fairly often and called even more often but had a difficult time watching his mother’s deterioration.   Mary’s behavior seemed to hit a nerve and Frank found it hard to sit with her.   Bobby would make the drive while getting more and more upset of the perceived lack of caring and support from his brother for his mother.  Old relationship wounds emerged.  Every decision was questioned and argued.   Finally, they could not be in the same room together.   Mary was clearly affected by this feuding and was often brought into the arguments.   She became more detached and eventually refused to eat or speak.  The doctors, perhaps wanting to stay out of the arguments, suggested it was just the dementia.

I decided to try a little soft intervention.   I talked to the sons and asked them to put aside their divisions and try to work together.  I suggested that if mom saw them getting along it might help her feel more secure.  They might be able to talk to her about things that really mattered.  To my surprise, the sons listened to me and met at the facility.  They talked for hours about “everything” – even things that happened years ago.   They both felt better.  They thanked me.  They thought it was really a great start to fixing their relationship – and beginning to help their mother.   I, of course, felt like a genius. It was a beautiful thing!

My time of genius was only to last 12 hours before they were angrier than ever.  I was disappointed.  What was I really trying to accomplish?  This was a family in transition like so many other families we work with.   Could they repair the fact that dad had passed and mom was failing?   Of course not, but did there have to be all the blame and anger?   It seemed to me that each son had the potential for intimacy.   During dad’s final illness, Frank was able to spend hours with dad and got him to eat when no one else could.   Frank, however, found it impossible to spend an hour with his mom.  Who knows, maybe he saw himself in her and could not bring himself to face it.  The fact that he didn’t feel especially close to mom may have made it more difficult.

Bobby was angry at Frank through the entire process.   Bobby believed Frank was “responsible” for his mother’s deterioration.  Bobby argued that when he was in town, mom did better.  At one point, Bobby decided that he would take mom with him to his home three states away to live in a facility near him and his fiancée.  His mom never made it.   More quickly than anyone imagined, came hospice, withdrawal of care and the end of her life.   Mary died peacefully with Bobby by her side.   The funeral planning was not peaceful and new arguments arose which were likely the final straw for these brothers and this family.

After the services were over, each son went back to his own life.  Bobby could move on to a marriage and perhaps children of his own.  Frank could focus on his own son and stop the dreaded drama with Bobby.  Neither seemed to have closure.  What was the lesson here? Separation is difficult? You can only help someone you are close to?   Blaming the wrong people doesn’t help with grief?   Maybe the lesson is that at some point people have to discuss what was actually happening in front of them with the person it is happening to.  That is why living wills are important; they are supposed to encourage conversation about end of life issues.   In this case, maybe it was easier to fight than to accept the inevitable end of their family and their primary identities.  They would no longer be “sons.”  They would no longer have a mother.  The sad thing is that they shared this loss and could have helped each other with it and maybe helped mom a bit as well.  If they had only been able to get to the real issues perhaps it could have been a beautiful thing.