“Everything I’ve ever let go of has claw marks on it.” – David Foster Wallace
Our youngest daughter just graduated 8th grade, and I am really trying not to leave claw marks on her elementary school. After a total of eleven years there, I’m finding it difficult. First, I am going to miss the familiar faces, rituals and exceedingly pleasant atmosphere in the place. But more significantly, I am finding it difficult to accept that we don’t have young children anymore, and therefore, I must rewrite my inner biography.
Until recently, my narrative involved being a mother to two daughters who needed lunches made, permission slips signed and endless rides to school, soccer, chorus or social activities. I was the woman of the household, the caregiver, but also the one who might get admiring looks from strangers when I dressed up. Now, I am a supervisor who asks that my charges “check in and let me know when you get on the bus”, and when I get looks from strangers, I quickly realize they are actually looking at one of my beautiful daughters. Truth be told, this is not the first time I’ve changed my narrative, but it’s one of the times that I am not completely happy about the plot-line.
This realization has made me ponder the transitions I witness others make all the time at work. As a physician and patient advocate, I am called in when someone has gone from being someone “in perfect health” to someone with cancer, or from being an independent survivor of the Great Depression and WW2, to a person with Alzheimer’s who needs assistance with the most basic functions. These are not the narratives we want to write. In fact, I remember riding on a crowded elevator with a client who was going for her first chemotherapy session at a cancer center. Someone broke the silence: “Cancer is for the birds” they said. My client replied: “No kidding!” In that moment, her narrative changed from self-pity to solidarity, and she was able to confront her new chapter with resolve rather than resignation.
When the narrative takes on a dark or less-than-heroic turn, our defenses go up and we fight the inevitable. Sometimes it’s in the form of denial (is that why I forgot to buy tickets to the graduation or get teacher’s end-of-year gifts?) and other times it’s overt hostility. Ask any geriatrician what their least favorite task is, and two out of three will respond: “Taking the keys away”. However, with a little “creative writing”, these moments don’t always have to be so difficult. In one memorable instance, a family member conjured up a very large “repair bill” for his father’s car hoping his father’s Depression–Era frugality would trump his desire to keep driving. By allowing his Dad to “decide” to forego the repairs and find more economical ways to get around, he maintained his narrative as a practical decision maker even in the face of dementia.
Admittedly, sometimes the narrative is impossible to sugar-coat. There are some diagnoses that don’t allow for much hope or “up-side”. It is in precisely those moments that we must allow the person to salvage as much of their narrative that they can. Talking to patients early on about what’s to come and what to expect is the only way they can write their own final chapter. Without that knowledge, their story might end in the hospital when they really wanted it to be at home, or as the center of a family feud instead of the peace maker. What I’ve come to learn is that there is always the opportunity to help the dying write their narrative if we give them the chance—and even if the narrative isn’t exactly what they would otherwise choose, the ability to influence even small aspects of it is very powerful.
It is with that perspective that I face this small change in the narrative of my life and ask myself how I can turn what seems to be a bittersweet transition into a joyful one. Observing my young women engaged in the wider world is really enough to make it all right, but reconnecting with my husband who has been on the work/parenting treadmill with me for the past sixteen years is an opportunity I cannot pass by. I am determined that the three day road trip with him while the girls are off being their independent selves this summer be one funny and juicy chapter in my life story.