Thanks to advances in science and medicine, our parents are living longer than ever before. But our health-care system doesn't perform as well when decline eventually sets in. We want to do our best as our loved ones face new complications—more diseases and disabilities—demanding further need for support and careful judgment, but the choices we have to make can seem overwhelming.
Family doctor and geriatrician Dennis McCullough recommends a new approach: Slow Medicine. Shaped by common sense and kindness, it advocates for careful anticipatory "attending" to an elder's changing needs rather than waiting for crises that force acute medical interventions—thereby improving the quality of elders' extended late lives without bankrupting their families financially or emotionally. This is not a plan for preparing for death; it is a plan for understanding, for caring, and for helping those you love live well during their final years.
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About the Author
Dennis McCullough, M.D., has been a family physician and geriatrician for thirty years. He is the co-author of The Little Black Book of Geriatrics, and he lives with his wife, the poet Pamela Harrison, in Norwich, Vermont.
Read an Excerpt
My Mother, Your Mother
Embracing "Slow Medicine," the Compassionate Approach to Caring for Your Aging Loved Ones
The Foundation of a New Family Understanding
Italy is where the modern idea of slowness was born. This family-centered country first conceived the Slow Food movement to counter the invasion and industrial excesses of American fast foods. By promoting regional flavors and locally grown variety, and by taking time for conversation and digestion, they reclaimed the high quality of a basic human experience, not to mention salvaging more healthful nutrition for their citizens. Later, the Italians extended the concept to their urban environments, designating Slow Cities, where automobiles were banned from central plazas, helping grandmothers to be safe and welcome on the streets.
Ive adopted this idea of slowness to benefit this special population of Late-Life elders who do not move or think as swiftly, see or hear as clearly; whose health problems and solutions are more complex; whose energy stores and resilience are less; and whose recovery takes more time than for us at middle age. Slow Medicines ultimate goal is a practical and qualitative change in care directed by a more complete respect for and fuller understanding of the particularity of each late-life elder. This practice calls for using the allotted time health professionals (and families) spend with our aging parents differently and making better, more appropriate decisions more slowly and over a more extended period of time. Doing this work well cannot be reduced to knee-jerk routines. It requires more thoughtfulevaluation and reflection, attentive listening, looking, and hands-on participation. It also demands that we ask for medical care different from what most elders are presently allowed: the fifteen-minute office call to renew prescriptions while the doctor peers into a computer screen or the answering machines advice to go to the emergency room. No sound bite distillations of information entered into a prefabricated electronic flow sheet can elicit or make sense of the complexities of an elders needs, unspoken concerns, and nuances of illness at these nether reaches of age. Focusing on blood pressure control without knowing the patient well enough or talking long enough to recognize subtle losses of cognition and strength doesnt get to the heart of the patients (or the familys) real problems. Knowing the daily burdens, emotional demands, and psychological intricacies of your mothers days in her apartment cant be undertaken by her doctor alone. Slow Medicine requires intimacy and commitment on the part of many others. The best care results when health care professionals, family members, and caregivers share information. These conversations allow discoveries and responses to percolate within a clinicians intuition and subconscious over time, leading to a deeper understanding of an older persons present situation and the future.
These balanced, mutually respectful, and supportive partnerships between doctors, nurses, and other health professionals and elder patients, their families, close friends, neighbors, and anyone else chosen to be part of what I call the Circle of Concern are at the heart of Slow Medicine. This group of people who naturally connect to a person in trouble provides steady support and insight. Although at middle age we might engage the help of such a group for a sudden crisis, for failing elders the Circle of Concern gathers for the long run. This active, extended advocacy partnership can improve our elders care by attending to both technical and human needs, and by balancing the formal care from professionals and institutions with a particular individuals physical, emotional, and financial capacities, family values, and personal philosophical or spiritual outlook. Tailoring such extended and personalized care for a former waitress will be different from tailoring care that might suit a retired college dean—neither is simply a white-haired old lady.
Slow Medicine is not really new in the annals of medicine, but it needs to be retrieved and given prominence again. Many doctors in the trenches are in mourning for the age-old practice of paying deep attention and truly attending that is being squeezed from our complex, fragmented, and technological medical system. Slow Medicine for elders in late life enacts the ancient Tibetan wisdom of making haste slowly, that is, focusing on the central issues of human caring with patience and a sense of shared humanity, forgiving one another for what cannot be changed, bending flexibly at times of need, and holding firmly to shared values and loyalties at other times. Slow Medicine is a commitment to understand, to support, to heal, and to care for those weakest among us in a way we would want to be cared for ourselves.
Over my many years of medical practice, I have identified five fundamental principles that should guide families, health professionals, caregivers, and other caring people in their efforts to enrich and support an elders life to the end.
I. We must endeavor to understand our parents and other elders deeply, in all their personal complexity, acknowledging both the losses and the newly revealed strengths that come with aging.
Shortly before her death at ninety-two, Agnes talked about closing the circle. Having grown up in the South in a prominent Georgia family, she knew and loved her family history. To Agnes, passing on was simply what a person did. You passed on from your own life, and you passed on the role you held in your family to those who came after. What a clear sense she enjoyed of how her individual life fit into a long-recorded and remembered family history! The colorful stories told after her passing made her special qualities very clear.
As we mature, our culture encourages us to become fully who we are, to realize our personal potential, and evolve as unique individuals. We also come to recognize that though our individual lives are as miraculously detailed and unique as snowflakes, they can just as easily be obscured in a blizzard of others. From birth to death, we experience our lifes passage as highly personal, but just as surely our span of years conforms to the limits and possibilities of our human species. . . .My Mother, Your Mother
Embracing "Slow Medicine," the Compassionate Approach to Caring for Your Aging Loved Ones. Copyright © by Dennis McCullough. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.
Table of ContentsPreface xi
First Things: The Foundation of a New Family Understanding 1
The Eight Stations of Late Life
Stability: "Everything is just fine, dear." -MOM 17
Compromise: "Mom's having a little problem." -DAD 35
Crisis: "I can't believe she's in the hospital." -SISTER 74
Recovery: "She'll be with us for a while." -REHABILITATION NURSE 106
Decline: "We can't expect much more." -VISITING NURSE 131
Prelude to Dying: "I sense a change in her spirit." -NURSE IN LONG-TERM CARE 170
Death: "You'd better come now." -HOSPICE NURSE 193
Grieving/Legacy: "We did the right things ..." -BROTHER 214
Slow Medicine Websites 227
Slow Medicine Reading 229
Slow Medicine Cinema 231
Most Helpful Customer Reviews
Thebook I wish I had had when my father died and I tried to help my mother, now at 78 the book I am reading, trying to accept, so I can be more helpful to my own daughter who is already worrying about taking care of me. Excellent.