step one

It was imperative that I get my father to a doctor.  And as if we weren’t facing challenging enough circumstances, this is where things got more difficult. 

Florida, Arizona, the South Carolina low country and Northern California wine country – all places retirees are commonly found.  They leave their chillier climes for promises of sunshine and bliss and often spend years enjoying just that.  But as our parents age and their needs become greater, they often find themselves returning to familiar towns and cities, drawn to adult children or long-time friends.  It’s called reverse migration and while it was not my particular set of circumstances, this moving of the aging from one place to another can get muddy.

My father did not have a primary care physician.  Ever.  He was a ‘wait it out’ kind of guy who used urgent care when it was, well, urgent.  Arriving on my doorstep without so much as a referral from another doctor meant that we had to find him someone who would see him, and for those of Medicare age, that is no easy task. More and more physicians are not accepting new patients if they are on Medicare because of the lower rate (78%) the government pays the doctors.  When doctors compare patients with private health insurance to those on Medicare, the payment is greater and thus, more appealing – which is appalling, but I get it.  What it means, however, is that the common practice – and let’s face it, need – of reverse migration, brings with it circumstances that an already stressed family must face.

The advice from the medical community is to work with an aging parent’s primary care physician prior to the move.  Allowing the doctor to use his or her network to help find a new doctor is advantageous not only in that you are, in effect, getting a referral, but with any luck, the doctor will take into account the needs and particulars of their patient, someone who, presumably, they have had a working relationship for quite some time.

I called several places in my area, none of whom would accept a new patient on Medicare.  I hadn’t wanted to blur the line between patient/doctor and daughter of a patient/doctor, but as a last resort I called my doctor. He was not accepting new Medicare patients accept for those affiliated with the practice already – as in, I am a patient, he is my dad, the doctor would see him.  Phew.  I was nothing but lucky on that one.

the ingredients

I did my best to fulfill my assigned role in the family: calm, rational, level-headed, and above all, unemotional.  I tried, like a younger sibling chasing after the older, smarter, cooler child, knowing full well I’d never catch up.  I attempted to be what was expected of me, and I may have succeeded on the surface, but internally my emotional cup runneth over.  Worry, anger, sadness, love, longing, fear, pity, hopelessness, defeat, outrage, concern, vulnerability all swirled around, encompassing me as I stood before this man I hardly recognized.  And the sludge at the bottom of the cup? That constant?  That was panic.

What was I going to do?  Where was he going to go?  Was this a permanent move or was he going back?  How did he get here?  How did this happen? What is wrong with him? How did I not see this coming? How can I fix it?

If I knew then what I know now I would have caught my breath.  I would have forced myself to do a better job of being who everyone thought I was, that calm, capable person who functions from a place of intellect, not emotion.  What I didn’t allow him to do, despite his best efforts, was walk away.  He planned to leave, intended to continue his journey, to where I don’t think I’ll ever know.  But I got him to stay.

What I haven’t  mentioned yet, what makes me part of the sandwich generation, is that I have three boys.  So while facing this person, my father  who three months prior looked healthy, happy and aware when we saw him in his home state, I couldn’t help but wonder how the appearance of this new person, this man  who resembled little of the grandfather they knew, was going to impact my boys. And would it shame him to have them see him like this? It became, in that instant, my job to protect them all, individually, collectively, and, heart-breakingly, from each other. 

Welcome to the sandwich. 

the beginning

A year and a half ago I was moving along through life as a mom, a wife, a friend, a mere foot or so on the path that is my forties and thinking, even with the day to day stresses that face us all, it wasn’t so hard, this thing called life.  My oldest son was just starting his sophomore year of high school, the two that followed behind were enjoying elementary school, and the future, their future, seemed far enough out of reach that it was easy to keep it there. 

Long divorced and both remaining single, my parents lived over a thousand miles away from us, each living relatively healthy, productive lives.  After retiring, my mom decided to volunteer to keep herself active and engaged and my dad, with a life-long love affair with the road, continued solo travel to places new and old.  Our frequent chats on the phone informed me of their lives, but I rarely gave a thought about their future or their aging process, as they were, in my mind, still young and doing fine.

But all of that changed one day. 

My father arrived uninvited and unannounced.  When I saw him approach, I noticed first the graying of his skin, a pallor reserved for the unhealthy.  Then I noticed his small, leather duffel bag – a long-time companion on his many journeys had been carelessly packed for this, an unplanned, trip.  But what struck me most were his eyes.  At seven I watched my father divorce my mother. At seventeen I saw him bury his father. All of my life I have looked at him as he told stories of his mother, a woman who died in childbirth when he was just nine, and in all of my years of knowing my dad, in witnessing his life’s pain, I had never seen such a heartbreaking sadness in those eyes.  He looked at me, tears on the verge of spilling down his face, and said, “Kathleen, what have I done?”

It was with those words that I knew something was critically wrong and that my life, that life that I had determined was not so difficult, was about to be upended like a tree in a storm, exposed roots and all.  I was on the verge of being the caregiver not only to my children, but to an aging parent.  I was about to become a member of the sandwich generation.