Old Age and Being Alone

“Oh and there we were all in one place

A generation lost in space

With no time left to start again.”

From Don McLean’s iconic Miss American Pie

I met her long ago, on the days when I practiced internal medicine. Her husband walked into the office without an appointment: a busy professional who was in the neighborhood on business and on the spur of the moment decided that he needed a checkup. He was accommodated. He was impressed enough that he urged his wife to do the same. As she almost always did, she followed his advice. Maybe I should call it his direction.

She was an elegant, articulate, tall and slender woman in her late fifties. She was a decade younger than her spouse. Although they never had children, his frequent travels and business demands were so hectic that she had made the decision (or was it his?) not to pursue a career. She became a combination of wife and junior executive. She often traveled with him; she kept the books; she answered many calls and blossomed in the hub of a busy social network. By the time that I met her he had decided to retire. Most of her days were spent tending to their very nice home and its grounds. The traveling continued, but exclusively for pleasure.

She was healthy, but she had a manageable list of concerns. From the very first day she made it clear that she wanted to handle her medical care her way. She agreed to listen to advice, but she insisted on keeping a small stable of specialists and therapists, many of whom I was unfamiliar with. I had told her that she did not need a cardiologist, but she continued to go to one, and to have extensive yearly testing that filled no purpose. She kept an increasingly thick folder of the results of her procedures and the content of her visits. When I told her how needless this expense was she smiled: her very charming expression that she had perfected over hundreds of contacts with business associates.

“I know. But I prefer to keep this control. I trust your opinion the most; I will always do as you suggest if there is a conflict.”

A product of her generation. A woman who was every bit as capable as her husband, but had chosen (or maybe been asked to) remain a backstage hand behind the curtains.

Many years passed. Her husband died in his late eighties. She was alone in the big house. Her slender build and light skin and eyes were accompanied by fragile bones, which did not improve on medicine. One spinal fracture resulted from lifting a heavy pot. Within a year there was a second one. She was in pain; she no longer was able to travel; her beautiful garden began to suffer.

A few years ago she called.

“It’s not about me.”

There was a young man who helped around the house. He had been a godsend. He suffered from severe back spasms, but he had no health insurance.

“Will you see him? I will pay for everything.”

Of course.

The young man was strong; bright; handsome. During our conversation I found out that he had been married to a friend of one of my acquaintances. I had heard unsavory rumors about his behavior. I decided to give him a chance. One never knows the truth even after both sides have spoken. I prescribed exercise and a small amount of pain medicine.

A couple of weeks later she came in. Her back pain had increased; she wanted to be able to take more medication. I agreed to the change in dose. Two months later she told me that she had lost a bottle of pills. They were replaced. Within a few weeks she called to say that she had lost some pills through the sink. I asked her to come in.

Talk to me.

“I’m so embarrassed. I’ve been so clumsy.”

This is so out of character for you.

“I know.” The polished, effective, convincing smile again. “I will do better.”

Back pain caused by osteoporosis can be devastating. I knew something was clearly amiss. But I could not take a chance; maybe she was telling the truth. I agreed to more pills. I thought about asking her for a urine specimen, in order to confirm that she was indeed consuming the prescribed amount. I reviewed the thirty years that we had known each other; her long history of failsafe reliability. I decided not to order the test. Somehow it felt like a violation of trust.

A few weeks later one of her friends came in for a visit.

“Did you hear about Jane?”

I did not.

“That man that was living with her…”

I did not know that he had moved in.

“Almost from day one,” she continued. “Someone called the police. He stole stuff from the house and tried to sell it. He also took all of her medicine.”

I bent my head. A wave of shame and regret came over me.

“We knew that there was something wrong, but she always denied everything. We stopped socializing for a while. Even after she knew that he was stealing she did nothing.”

The young man went to jail. I later heard that it was not the first time for him. Jane did not return my calls. A few months later she came back for an appointment. She had moved into a retirement home. She was too weak and fragile to continue to operate a household. She was not in pain. She was as bright and capable as ever, but the smile was gone. She did not discuss her victimhood with me; I decided not to push it.

Old people. A generation lost; no time for a redo. Millions of bright, kind, once vibrant souls that society has no use for. We look away from them because the poverty, neglect, often abuse that they suffer hurts too much to confront. They remind us of what lies in store for us. We prefer to think that maybe, if we’re lucky, we’ll die before our mate does, or before we lose our independence. We continue to build warehouses to store them. There is no national policy; no plan; little financial commitment. Every man and woman for him or herself.

But they have no time left to start again…