Who would get a tattoo on their chest saying, “Do Not Resuscitate” or “No CPR”? Apparently, a lot of people, and it’s creating controversy in the medical world.
Bio-Ethicist Tom Tomlinson argues that DNR tattoos have benefits. They don’t get lost; they go wherever you go. That’s unlike written advance directives, which are seldom in the emergency room when you get there, often not presented upon admission and hard to get into the medical record even when you have one. If you show up unconscious in the Emergency Room and your Advance Directive’s in a file at home, how will doctors know what you want? This concern is what has spurred the growing interest in DNR tattoos.
If you want to be in control of what happens to you at end of life, however, don’t count on your tattoo, because it’s unlikely your wishes will be followed.
According to the American College of Emergency Physicians (ACEP), tattoos are not legal advance directives, in part because they do not include a witness or notary. That’s bad news for this person who thought he had his bases covered.
ACEP says that for a DNR to be legal, informed decision-making must be presumed, and tattoos don’t prove you have a clear understanding of what DNR status means. ACEP also says tattoos don’t provide enough information: Does the tattoo mean no chest compressions, no intubation, no vasopressors? Written documents include information to help patients understand the meaning of various procedures, and to help medical professionals understand what is and is not included.
What about initials? ACEP asks. “Do Not Resuscitate” tattoos are commonly abbreviated DNR. This could mean grim news if your name is David Neil Rosen, or Deborah Nan Ryan.
Plus, end of life preferences change, says ACEP, based on factors like age, health status, prognosis and advances in treatment. Documents are changed easily; tattoos, not so much.
Then ACEP discussed tattoo regret, stating that more than 50% of individuals regret getting their tattoos. I found this hard to believe. Today, most tattoos are the culmination of long planning, not the unintended result of a night of intoxication. Yes, there are stories of people who got DNR tattoos because they were drunk or lost a poker bet, but to suggest that this is the majority or even a significant portion of today’s DNR tattoos, ignores thousands of people who take their DNR tattoos quite seriously.
For all these reasons, ACEP suggests that emergency physicians ignore DNR tattoos and should initiate life-saving interventions, since these can always be withdrawn if more information (i.e. a written advance directive) is obtained. However, discontinuing life support is different from not starting it.
The bottom line is, if you want a tattoo, go for it. You’ll be joining thousands of folks over 65 who are getting their first tattoos. But if you are doing it to tell paramedics and doctors about your end of life preferences, you will need more than a tattoo, you’ll need a properly executed advance directive as well.
Oh, to be young again…Really? Recently, a friend sent me letters I had written to her during our first year in college. In one letter, I wrote: “I went to a meeting last night that will change my life forever. I learned about institutional racism: we are all racists.” The following week I wrote, “I am done with that, but a really cute boy sat next to me in art history.” Was I really that shallow and self-absorbed? I guess so. In another letter, I said, “We should start a French-speaking commune. We could grow our own food, speak only French and at night we could show Truffaut movies.”
In one letter, my friend wrote that she was depressed. Ever the competitive Girls High girl, I wrote back that I was more depressed than she was depressed. I was competing about depression? Clearly, my empathy skills were not yet highly developed.
I was a college freshman during some of the most pivotal events of the 21st century: the Vietnam draft lottery, man walking on the moon, Woodstock, educational bastions like Yale admitting women, the DNC convention in Chicago, the first ATM, founding of PBS, the first withdrawal of troops from Vietnam, invention of the first micro-processor. Amidst all of this, I wrote about how many calories I had consumed that day, obsessed over my GPA and worried about course selection. As I looked at what was important to my 19-year old self, I was disappointed in my values, shocked at how mercurial I was, and struck by the fact that I didn’t seem happy. Being young was way harder than I remembered.
I realized that I am happier now than I was when I was young, and it turns out, I am not alone. In a study by the Journal of Clinical Psychiatry, researchers found that young people report the highest levels of depression, anxiety and stress, and the lowest level of happiness, satisfaction and well-being. In spite of stiffening joints, weakening muscles, fading eyesight, clouded memory and the modern world’s contempt of aging, old people are surprisingly the happiest. Across countries and cultures, research results are remarkably similar: older adults are happier than younger people. The increased happiness and greater sense of well-being, moreover, are not the result of external circumstances, but of internal changes.
It seems that older people are better at controlling their emotions, accepting misfortune and are less prone to anger. In one study, subjects were asked to listen to recordings of people saying disparaging things about them. They found that older people were less angry, often taking the view, “You can’t please all the people all the time.” This resonates with me. Years ago, I would have been devastated if someone didn’t like me. Now, I think: “Lots of people don’t like me; get in line.”
Do I want to be young again? No. Like essayist/screenwriter Nora Ephron, I do feel bad about my neck, but it is what it is. Perhaps acceptance of aging is itself a source of relief. As William James observed, “How pleasant is the day when we give up striving to be young, or slender.”
“Are you still working?” I hear this question more and more, sometimes from people my age, sometimes from folks who are younger. It bothers me, because it feels as if there is more than curiosity behind the question; it feels like judgment.
Society seems to have preconceived notions of what we should be doing at a certain age, and I don’t like being pigeon-holed into someone else’s stereotype. As a young woman, I was supposed to be a teacher or a nurse, because they were “good jobs for women.” I was supposed to live in an apartment until I got married. I was supposed to get satisfaction from cleaning, cooking, and running a household. The problem with stereotypes is they assume all people are alike because of their gender, their age, or for any reason.
Personally, I don’t play tennis or mahjong. I am not part of a book group. I hate all things domestic. I don’t think I will do well at retirement, as it is currently defined. Some articles suggest taking time — from several months to several years — to find your retirement purpose. Others say, don’t retire from something, retire to something. This has appeal. I like being driven. I could find something new to be driven by. But why should I find something else to put my time and energy into, when I can put my time and energy into what I already do?
Actually, I am not just driven, I am purpose-driven. That’s why Encore.org speaks to me. Encore.org was founded in 1998 by social entrepreneur Marc Freedman. Its goal was to redefine later life and shift the idea of retirement as freedom from work, to freedom to work and contribute in new ways and to new ends.
Encore focuses on the role of purpose in later life, and in 2005 created The Purpose Prize. The Purpose Prize honors social entrepreneurs over 60 who combine experience, purpose, and passion to make a difference in their communities and the world. “It’s not a lifetime achievement award,” says Encore. “These folks are just getting started.”
Now THAT’S a view of later life that appeals to me. As I read the stories of each honoree, I was humbled by the passion, determination and accomplishment of so many people who refused to accept the prevailing view of what later life is supposed to look like. There is a Chinese proverb: “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.” These honorees did more than contribute their individual time; they created organizations and programs that empower others to work for a better good.
I’ve decided to join the Encore Network: “Show your leadership and get in on the ground-floor as we build the encore movement.” I’ve come to realize that I am a ground-floor kind of person. I was in on the ground-floor of the women’s movement. I was in on the ground-floor of Senior Move Management. The ground-floor is a really exciting place to be.
I’ve had a lot of surgery in my life, and I’ve had a lot of colds. No doubt about it. I’d rather have surgery than a cold.
With surgery, you have a pretty good idea of what to expect. You’ll have some rough days initially, and then every day will be a little better than the one before. With a cold, the future is unknown. You could be better in a week, or the cold could linger. It might look like it’s leaving, and then resurface with a vengeance or morph into an infection. With surgery, you’re given antibiotics to keep you from getting an infection. With a cold, you have to prove you have an infection before you’re given antibiotics, and by then you feel awful.
With surgery, people are very sympathetic. They express concern; they visit you in the hospital or at home. They may even bring you a gift! With a cold, people avoid you. They may even disinvite you to an event (“I’d rather you didn’t come if you’re sick”). A cold is very isolating.
With surgery, people are complimentary. “You look great” (when they see you) or “You sound great!” (on the phone). With a cold, people are brutally honest: “You look awful” (in person) or “You sound terrible” (on the phone). Really, would you ever say those things to anyone if they didn’t have a cold?
With surgery, people expect you to take time off, and you allow yourself this luxury as well. With a cold, you soldier through (although you feel awful), because after all, it’s just a cold.
With surgery, the only one whose health is impacted is you. With a cold, you bear the burden of possibly infecting someone else. Colds are riddled with guilt — before hand, in case you infect someone, and afterward, when you have infected someone. The loving spouse who nursed you tenderly now glares at you. “It’s not your fault,” he says, but means the exact opposite: “You did this to me.”
Unlike surgeries, colds don’t leave a scar… at least not one you can see. But I think they humble our soul. We are felled by something so common and seemingly mundane. When we are finally better, we luxuriate in simply feeling well again and our spirits soar.
Someone cut in front of me, so I honked at him. It wasn’t much of a honk, more like a honklette. So I said to myself, “You honk like a girl.” “Like a girl”! Where did that come from? I thought about the video I had seen, “Always #LikeAGirl” and was ashamed of how sexist I sounded.
I grew up in the 50s, when negative stereotypes about girls were rampant. Here are a few of the sayings I, and women of my generation, grew up with:
Don’t be too smart, boys won’t like you.
Be a teacher or a nurse, they are good jobs for a girl.
Don’t go to law school; you’ll take the place of a man who needs to support his wife.
Do they give mortgages to women?
Girls aren’t good at math.
Girls aren’t supposed to have muscles.
Don’t sleep around. Why should they buy the cow when they can get the milk for free?
You’re too pretty to be smart.
You have expensive tastes — you better marry a rich man.
Although I grew up hearing these phrases, I came of age during a sexual revolution. Negative messages about women were being rejected. “Not us, not our future,” we said. We seized opportunities, defied stereotypes, broke glass ceilings and succeeded in not passing these negative stereotypes to our children. This was tremendous social change, and it happened in my lifetime.
This made me think about the other negative stereotypes I grew up with — ageism. As a young women, I refused to accept limiting visions of who I was and who I could become. Now I am once again coming of age during a revolution, except this time it is a revolution about aging. Perhaps we boomer men and women can reject negative stereotypes about aging, saying once again “Not us, not our future.” And perhaps this change too will happen during my lifetime. I am reminded of Victor Hugo’s prophetic quote, “Nothing is more powerful than an idea whose time has come.” Maybe it does start with me. This will not be me, this is not my future.
We had a wintry mix last week, and as I put on my boots, I thought, “I don’t want to fall.” “You sound old,” I said to myself. And then I thought, “Why does not wanting to fall make me old? I think it makes me smart.”
Risk-taking is highest in adolescents and tends to decrease as we age. Is that because older adults are more fearful, or because they are more experienced? Being cautious and prudent should make me wise, so why did I see it as “being old?” Because I am ageist.
The term “ageism” was coined in 1969 by physician/gerontologist Robert Neil Butler, who was the first Director of the National Institute on Aging. Butler defined “ageism” as:
1) Prejudicial attitudes towards older people, old age, and the aging process,
2) Discriminatory practices toward older people, and
3) Institutional practices and policies that perpetuate negative stereotypes about older adults.
Unlike more obvious forms of stereotyping, such as racism and sexism, ageist stereotypes are seldom corrected, so individuals grow up believing them, even as they themselves become older. Ageism is so commonplace in today’s society that we don’t even realize the stereotypes implicit in many things we say and feel.
All of this sounds theoretical, but in fact, it’s quite personal. Studies show that older adults who equate aging with becoming useless, helpless and devalued, die earlier, are less likely to seek preventive medical care, and are more likely to suffer memory loss and poor physical functioning.
When stereotypes are positive, however, when older adults view aging as a time of wisdom, self-realization and satisfaction, the opposite is true. In fact, people with positive age stereotypes live 7.5 years longer than those with negative stereotypes. That is a bigger benefit than not smoking!
So what does this mean for me? If I want to thrive as I age, I’ll need to be mindful of negative stereotypes in my thoughts, feelings and views on aging. I’ll need to change the paradigm. My boots are a good start. Being cautious about falling is not being old, it’s being wise.
What makes a great ad, great? This Polish Christmas ad hits it out of the ballpark. You hardly realize it’s for Allegro, an online auction platform. You’re busy smiling and crying at the same time. So why has this ad resonated with over four million people? Yes, there’s a cute dog, but that’s not it. In a world where advertising repeatedly marginalizes and stereotypes older adults, this ad stands out precisely because it is not ageist.
The elderly man shops online, learns new skills, travels independently, makes plans and implements them. This is what older adults do throughout the world, but it’s not how they are often portrayed. Instead, they’re stereotyped, made fun of, diminished. Why do so many people love this ad? Because it is respectful, it is truthful, it is funny, it is sweet. If you haven’t seen it, sit back and enjoy. If you have seen it, think of someone and share it.
In “The Year of Magical Thinking,” Joan Didion eloquently describes how grief distorts thinking and creates thoughts that defy logic. She describes this process as “magical thinking.” I think some people approach moving with magical thinking as well.
In psychology, magical thinking refers to the belief that one’s thoughts can make things happen, or that thinking something is the same as doing it.
In moving, magical thinking is the conviction that I want these things to fit in my new home — so they will, or I will hand carry everything to my new home, or downsizing will be fast and easy. I can see why people prefer to think magically. Moving creates stress and feelings of loss of control. This is especially true for older adults who may be leaving the family home, starting a new lifestyle, experiencing health issues or the loss of loved ones. Magical thinking relieves anxiety and restores a sense of control. Is it any wonder clients are reluctant to let go of magical thinking?
In comes the Senior Move Manager, with floor plans and reality checks to demonstrate why our thinking is correct, and our client’s is not. Do we really “win” by telling someone their furniture won’t fit, their move plan won’t work or that unpacking 100 cartons by themselves will be overwhelming? Surely, we don’t build trust or reduce anxiety — two of our goals — by telling clients they are wrong. I’ve been thinking about this, and perhaps the solution to magical thinking lies in storytelling.
Storytelling is an ancient art, but in recent years it has been recognized for its unique value in assisting discovery and enhancing learning. Stories help us connect factual information to feelings, and make sense of abstract concepts by providing tangible, concrete examples. If stories bypass linear thinking to assist with whole brain learning, perhaps they can bypass magical thinking, also.
Instead of “Your things won’t fit,” perhaps we should say “Let me tell you about a client who moved recently…”. The protagonist of our stories should not be ourselves, but our clients — competent people who create an image of how things will work because they want and need it to be that way. These magical thoughts serve our clients well by reducing their anxiety and making them feel in control. Our stories need to show real people who faced challenges and overcame them. Clients don’t demand that moves be perfect. They demand that they emerge from the move experience feeling intact and whole. Stories can be the bridge that helps this happen.
Am I certain this approach will work? There is no guarantee that storytelling will successfully combat magical thinking, but there is plenty of evidence that telling people they’re wrong does not work. Instead, let’s provide a platform where clients can relate to the emotions of moving and through the experience of others, arrive at better decisions for themselves. If we learn how to help clients better plan and prepare for their move, or better accept the consequences when moves that are less than perfect, that would indeed be magical.
At the nail salon, I saw an 80+ year old woman getting her nails done. Her hands were wrinkled and veined, her knuckles were enlarged, but her nails — each a different color — were spectacular. I was startled that a woman her age would want nail art, and then thought, “Why am I assuming that fancy nails are for young people only?”
Liquid nail polish was invented in 1907, and tastes have evolved ever since. The French manicure came from Paris in the mid 70s. Nail art emerged in the 80s. Today, women use nail art for fun and self-expression. I guess I figured elderly women didn’t crave fun and self-expression. I wasn’t just ageist; I was wrong.
Last spring, NAILS Magazine, an industry publication for nail technicians, featured a number of women aged 55 and over who indulge in nail art at the salon. One of them is 87-year old Prat Messer. Introduced to nail art this spring, she began “hanging out” in the lobby of her retirement community much more than she used to. “People were noticing my nails even in the elevator!” she said. Apparently, nail art is more than self-expression; it increases opportunities for social interaction.
Naomi Koshkin Friedman, 95, says that getting her nails done makes her feel young and alive again. “Everyone in the retirement community is envious… they don’t have the guts to express their inner artistic side like me. Where I live, they talk about me. Let them talk.”
Elderly women aren’t supposed to be adventurous, spontaneous, frivolous or outrageous. They’re supposed to be invisible. Nail art makes them visible again.
Nail art combats boredom — one of the greatest challenges of Long Term Care. It’s simple and low cost. It seems perfect for inter-generational programs. So why isn’t nail art commonplace in Long Term Care settings? Probably because people like me assume that 80 and 90-year olds want boring nails.
The National Center for Creative Aging and organizations like it are dedicated to “fostering an understanding of the vital relationship between creative expression and quality of life of older people.” Creative expression doesn’t require that individuals have exceptional talent or physical prowess. It doesn’t require expensive programs. Creative expression as we age is within everyone’s reach. It’s at the tip of your fingers.
Photos courtesy NAILS Magazine; nail designs by Athena Elliot, SPAthena Salon, Houston, TX.
Top photo is from Facebook/Angela Cooke via Love What Matters
I ordered a book on BookBub that I vaguely remembered as a comedy starring Hugh Grant — Four Weddings and a Funeral. Instead, however, I ordered a book titled Four Funerals and a Wedding. It was very different from what I expected. Which just goes to show that sometimes you don’t get what you want, but you get what you need.
Four Funerals and a Wedding, by Jill Smolowe, is a book about resilience. A fifty something woman talks about the deaths of her husband, sister, mother-in-law, and mother — all of which occurred in a 15-month time frame. God willing, most of us won’t go through this much loss in so short a time, but most of us will go through this much loss over time.
If you’re a baby boomer, chances are you’ll be burying your parents (if they are still with you), your aunts and uncles, and sometimes, your friends. We don’t want to talk about it, although while we are in the midst of the experience, it’s often all we do talk about.
In spite of its title, Four Funerals and a Wedding is not about dying. It’s about living through loss, and developing your unique perspective on how to deal with your grief, because there is no set formula on how to behave.
One story that stayed with me begins when Jill sees an acquaintance she knows to be recently widowed. Jill avoids her, not because she wants to, but because she doesn’t know what to say. Three years later, Jill is “that woman” — the widow — and she wonders if friends are avoiding her because they too don’t know what to say.
She also talks about how people react when you share bad news. Some give advice. Some insist on addressing issues that may not be your priorities. Most don’t know what to say. But some, and these were the ones Jill especially valued, asked simply how could they help.
Four Funerals and a Wedding is not maudlin or tragic or heroic or inspiring. It is one person’s journey through grief, and the operative word here is “through.” When Jill remarries four years after her husband’s death, she is clear that you don’t stop loving or grieving for someone who died just because you learn to love someone else.
I wasn’t sure what I thought about this book when I finished it, but when a friend wrote recently that tests showed several ominous “hot spots,” I asked simply, “How can I help?”
Sometimes, you get a book that is not what you want, but is what you need.