System reset

On Monday evening (Dec. 8), I arrived in Madurai on an unscheduled visit after a frenetic weekend.  In the second half of last week, my father (who is 85 years and six months old) had suffered two (minor) falls and had become disoriented. His routine and that of my mother had been thrown off-gear as a result. There were no major injuries, fractures, or blow to the head. Yet, some damage has taken place. Mostly due to the age factor.

My aunt’s mother – who lived to a ripe old age – used to remark that old age was a curse. For many, it is mostly true. It is hard on them and it is hard on others. The society – especially the so-called modern society – has not evolved a proper template to deal with old age – especially ageing and passing away (or, letting them pass away) gracefully and with dignity.  The lack of template is not merely an issue of health or medical care.

For the most part, modern allopathic health care in India, especially for the aged, is insensitive and is a financial drain on caregivers. Hence, there is a need to balance the ‘need to be seen as doing something’ vs. what is optimal for the care-receiver. One has to discount the potential future scenarios too, to the present. It is not easy. That is why it makes sense to have some templates, develop some principles and concepts to deal with these issues when there is no need for them.

When things begin to go wrong, even the so-called educated, the spiritually inclined and the aware people in care-giving positions are at their wits’ end. Consequently, there is a risk that they overdraw on the ‘spiritual’ or ‘good karma’ balance in their accounts. Further, no matter how inevitable death is and especially so in ripe old age, a pall of gloom descends. The mood is a bit morbid. Emotional batteries drain little faster. One needs to be aware of it and find ways to keep charging them too.

Dan Ariely’s popular TED talk reminds us that in situation involving complex decision-making, we are unprepared. Stress, anxiety, frustration and anger are our natural responses to the complexity of the decisions involved. Obviously, they are unhelpful.

My good friend Bharath Krishna Shankar came up with an excellent social intervention initiative for teaching Life skills to high and higher secondary school students. Perhaps, he should do another programme for those who are in their forties to sixties now, as to how to grow into caregivers and care-receivers, as they age. It could be called ‘Ageing Skills’.  He called his Life Skills programme, ‘Thalir Thiran Thittam’ in Tamil and he could consider naming this, ‘Narai Thiran Thittam’. At the minimum, ‘Narai Thiran Thittam’ syllabus should deal with managing (to put it bluntly, lowering) one’s expectations from the world around us as we age.

Alternatively, there is ample merit in the proposition that, when we are lucid, we could write down a ‘manual’ or checklist for our children as to how to deal with us when we become incapable of deciding or articulating our thoughts, emotions and logic.

Most relatives want the sick, old person to be restored. But, the question is ‘Restore to what state?’ In Microsoft Windows, if a newly installed software or device malfunctions, there is an option to restore the system to the state that prevailed before the installation was attempted. The hope is that the system would be stable. With humans, it is not possible. But, emotionally, people want to try to do a ‘System Restore’. With humans, the new equilibrium will most likely be unstable and the next system crash could be more damaging to them and to the caregivers.

By no means does the previous paragraph suggest ‘abandonment’ of the old (the sick and the infirm) to their fates. Apparently, a friend of my friend had told him (my friend) that he would give his children the right to administer the ‘Pillow’ treatment to him, in seemingly irretrievable or impossible situations. I am not suggesting anything as specific as that or any other specific measure.

It is about having a clear idea of what one wishes to accomplish, of its execution, of the methods, of the resources, of the costs (material and other costs) and, more importantly, of the counterfactual. These are not easy things to do even in situations where no emotions are involved. They are doubly harder in emotional situations, especially in the Indian cultural context.

At a societal level, India with its huge numbers, is about to face an old-age epidemic. In a few Southern States, demographic trends are already comparable to those in greying Western European countries. There is both a business opportunity and a social need in providing for comfortable old age – whether healthy or not – with sensitivity and attention to detail. As it is, we are woefully ill-equipped.

A vital silver-lining in the cloud is the presence of a capable, confident and considerate nurse made available by Lifeline Nursing from Trisoor which is a not-for-profit institution. The service does not come cheap. But, it is worth it. Such a facility is needed for the benefit of the health of the remaining caregivers in the family as much as it is needed for the person being cared for. You can look them up here.

Tail-piece: About nine months ago, I wrote a blog post about Shanti Sadhan. This is the residential enclave in Madurai where my parents live. Perhaps, it is time to rename ‘Shanti Sadhan’ ‘Sulphur Sadhan’. The vehicle population has exploded. It will be interesting to take a reading of vehicular pollution inside the enclave. School buses picking up students could do so from outside the compound. But, Indian roads have no bus-bays. These buses are liberal polluters in the morning hours. In one way it is good that internet (with good connection speed) is not available. Children come out and play. But, the vehicular pollution is bad for their lungs. Behavioural science has recorded that humans are myopic. Are Indians more so?

3 thoughts on “System reset

  1. Dear Ananth,

    A very thought-provoking piece as usual. I have only a few minor comments.

    “For the most part, modern allopathic health care in India, especially for the aged, is insensitive and is a financial drain on caregivers.” You can drop “in India” — it is far worse in the USA, where “health care” is a blood-suckinng business. While Indian allopathic health care is on the same trajectory, it is many years behind the USA. Let us hope we never get to where the USA is now. When Lyndon Johnson passed the Medicare Act back in 1965 or so, he was concerned that the US health care spending had risen “alarmingly” from 3.2% of GDP to 6.5% of the GDP. Well guess what, it is now 17% of the GDP and shows no signs of slowing down in its rise! You and others have often commented on the regulatory capture by the financial sector. The regulatory capture by the healthcare sector (if it might be so called) hasn’t been commented upon to the same extent.

    “With humans, the new equilibrium will most likely be unstable and the next system crash could be more damaging to them and to the caregivers.” The same thing is true, and even more so, with Microsoft Windows operating system.

    My last comment is that we need to have a talk with our children and/or spouse when they are sufficiently mature, and we are still sufficiently in possession of our faculties. Ultimately, no matter what we tell them, and/or whatever we collectively “decide,” children/spouses will still feel the need to “do something,” and will always feel guilty that they haven’t done enough. It is almost impossible for the elderly to prescribe what is to be done, except in the case of irreversible and terminal illnesses. I find that Indian society still accepts death and its aftermath for the family as an integral part of life, whereas the USA is pretty much a “death-denying” society. We just need to build on our acceptance of death as an integral part of life and plan accordingly. This is not exactly a very profound analysis, I am afraid.

    Warm regards.

  2. Yesterday there was a,programme in Vijay TV , that they were hosting the kitchen samaras event with two popular chef, at one of the old age homes. I could see only the later part. The super singers were entertaining the inmates, they we’re give. The nice food prepared bungee chefs. More or less what you have written was passing through my mind.

    the reality of current lifestyle is challenging and certainly calls for a great adjustment , a cultivation of mindset etc. any structured programme is really a need of the time.

    rgds

    ramanathan

    Dear Mr Prabhakar

    This is a very complex subject and the discussion and outcome would invariable be complex as well. One can just say, materialism, nucleus family, children area of living, (to a great extent overseas and consequent restrictons and limitations) and so on.
    But if I recall, even fifty or fifty five years back, there were problems in parental care in different dimensions. You may recall a film by K Balachander, Bama Vijayam, a widower caught up in the midst of his three children. I have seen many such incidence, and we used to jokularly say Bama vijayam family, some under the same roof in a building partitioned as in the film, some in different locations, where the parents were to have a time table for rotation of their living with the children. But the difference perhaps could be the current generation of elders are conscious of this and looking for a solution, the children becoming desperately becoming helpful due to their comitments. Ultimately we have to learn to live with the situation and adapt to the emerging environment. Here again two categories, one is affluent, which can reasonably manage, other one is less affluent and dependents. There are many in INdia depend on children support while children too have limitations to support their parents. These are again complex.

    Rgds/Ramanathan

  3. Dear Ananth,

    It is a very important issue/subject that you have raised. Our friend Ramanathan also has appropriately commented on it. You are very right that the society has not evolved a template for it. In fact, there was a template in the previous times that was till the generation of my parents, when they were the care-givers. Let us look at that template to understand where things have changed leading to the current “no template” situation.

    Basically the issues are two fold. One is where would the old people live, at an age when they need physical and emotional support. The second is how much of “care giving” in case of huge illnesses was the order of the day.

    The previous template had simple but solidly working solutions for both. Firstly, the old people simply lived with their children (son or sons) and grand children. There was really no need for them to search a place to live. Secondly, the limited medical advancements and limited access to advanced medical infrastructure ensured that the care givers gave the traditional level of care. The psychology of medicine at those times was not to just somehow extend their life. So it was nature which ended the life as and when it was due to be ended.

    Today both have changed for the worse (in some perspectives). The families are widely separated geographically. Old people are forced to live by themselves, due to circumstances. (Not far away for people of my age group!). And hence we are in a situation where new revised templates have not yet evolved for this issue. Old age homes are but the earliest weak attempts at a possible new template for this issue.

    Coming to the second issue, that of care-giving ………….. this is a monstrous situation where on the one side medical advancements take pride in prolonging the longevity at any cost (quality of life post these surgeries/therapies are no concern of medical research) and care-givers have become very affluent relatively. And hence they carry the guilt if they think they have not given the best that their money can offer to their elders. In between these two monstrous forces the poor elders are caught., They are not sure they want their life prolonged at any cost (financial & post-quality of life). Certainly they do not want their children to pay huge hospital bills month after month.

    This triangle (Direction of Medical Science, the affluent but guilt facing care-givers and the poor elderly who want a way out without burdening their children) is a new social & emotional dynamics which has evolved over the past twenty to twenty five years. Society has to find a template to permit the dignity of the elders and allow them to pass away guilt free.

    May be, as you have said, it will be a good idea for us to write down what we want and what we do not want when we are ourselves in such circumstances (just like a will).

    A good and essential food for thought.

    Thanks

    VP

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