Recently, my elderly mother moved from the Northeastern to the Southeastern United States in order to live closer to my sister. A widow for several years, she is on what would be classified as a fixed income, and her medical insurance premiums and prescription drug plans eat up a great deal of her monthly budget.
When it comes to some of the more pedestrian prescription medications, co-pays can range from just several dollars to perhaps $20 or $30 per month. But heaven forbid that an American elder needs a medication that is not quite so generic in nature, and the monthly payments for such drugs can skyrocket through the roof, wreaking havoc with even the most well-planned budget.
We have all heard stories of senior citizens having to decide between groceries and medications, or turning off their heat in order to pay their health insurance premiums. These stories are not uncommon, and although many of these elders may be under the media radar, we all know that there are still millions of Americans struggling to retain their health insurance, obtain health insurance, or simply get by without any coverage whatsoever.
While the debate about the new health care reform legislation rages on, we must remember that many seniors like my mother are regularly raiding their hard-earned piggy banks in order to pony up enough money to purchase costly (and admittedly life-saving) medications. While the need for pharmaceutical companies to earn money and support new research is understandable, vulnerable Americans like my mother cannot continue to be placed economically between a rock and a hard place and simply offered a pillow of pity as compensation.
I agree that reform is contentious and painful, but so is making a choice between food and prescriptions. When a senior citizen skips a meal in order to fill a prescription or pay an insurance premium, it is once again illustrated that something is wrong with this picture. And when yet another uninsured child misses her annual physical and vaccinations, this flies in the face of the Surgeon General's message of the crucial importance of preventive medicine to the over all health of the nation and its citizens.
I don't have the answer to fixing this enormous challenge that our nation faces, but I can hear in my mother's voice over the phone that this simply has to change. The United States ranks behind many other industrialized nations when it comes to important markers of public health (like infant mortality, for example), and the fact that so many Americans continue to languish without health insurance would be laughable if it wasn't so tragically sad.
Every generation strives to leave a hopeful economic and social legacy for its offspring, and my mother's generation, who lived through the Great Depression, is no slacker in this regard. But when we see octogenarians eschewing good nutrition in order to pay for their basic health needs, we must realize that we are forgetting the sacrifices that our elders made for us in decades past. Change will come, but what cost we pay in the interim certainly remains to be seen.
Showing posts with label the elderly. Show all posts
Showing posts with label the elderly. Show all posts
Friday, April 30, 2010
Saturday, October 18, 2008
Dementia and Devotion
In the home they have owned for more than 40 years, they live their lives as they always have. The same trees are visible through the kitchen window. The grass is still green. The grandfather clock given to them by her parents for their tenth wedding anniversary still chimes in the foyer. The curtains and the sofas haven't changed in years, and the silver flatware in the breakfront drawer still evokes memories of Thanksgiving dinners, birthdays, and family gatherings galore. From the kitchen linoleum to the wood paneling in the family room, little has changed in this cozy suburban home.
While the outward appearances are relatively static, it is her dementia that has permanently changed the calculus of their relationship. It began with mild, transitory forgetfulness, only to slowly escalate into full-blown dementia as the months went by without a formal diagnosis. She would walk into a room and stand there, utterly stumped as to why she was there. He would leave her in the frozen food aisle to look for light bulbs in another part of the grocery store, and when he would return to find her, she would still be there, staring blankly at the ice cream display, apparently lost in thought but actually lost in the absence of cohesive thought.
At a certain point, it was apparent that she could not be alone. She could no longer bathe herself, toilet herself, dress herself, or make even the most rudimentary decisions. Luckily, if a plate of food is placed before her, she will still reflexively use her fork or spoon to scoop up food and bring it to her mouth. Sometimes, the fork spears nothing but air and she must be redirected to bring it down to the plate again. At other times, the food will fall back to the plate or into her lap, but she won't notice. She will bring an empty spoon to her mouth with the same motion and intention as a spoon laden with mashed potatoes. She doesn't recognize the difference, and he monitors her intake with the eyes of a loving, doting husband of 55 years.
He has refused all assistance other than skilled nursing and physical therapy. A home health aide? Never. Meals on wheels? Not a chance. Day care? Unthinkable. She is his project, his object of devotion, the love of his life and the mother of their children. His days revolve around her, and he revolves around her like a moon around a planet with a strong gravitational pull.
Her eyes seem aware, yet it is not clear what they register. She responds to some questions but not others, and it is uncertain how much of her response is reflexive rather than real. Her shuffling gait, her blank gaze, her apparent lack of interest in anything happening around her---these are hallmarks of her state of mind, and he must long for the days of lively conversation and verbal interplay. How lonely he must be, prematurely bereft of his friend, his lover, his bride.
"You see how her hair is set?" he asks. "Friday is Hair Day," he explains. "I wash it, set it, dry it, and then brush it out and spray it. Just like she used to do. We make her beautiful for the weekend when the kids and grandkids come to visit." He smiles proudly.
Sitting in the chair, her hands passively resting in her lap, she stares at me, smiles, and almost looks through me. I hold her hand, tell her I would like to take her blood pressure, and she raises her arm and places it on the table. I thank her for her assistance. She smiles again.
Placing the tools of my trade in my bag after making some final notes, I shake her hand and get up to leave. Her husband walks me to the door and we shake hands warmly.
"You're the model husband, and I can see that she's receiving the best possible care here at home," I say as we shake hands.
"Thank you," he replies. "I try my best. She's all I have, and I want her here with me."
"Let us know if you need more help," I say as I enter the breezeway between the kitchen and the garage. "You're doing a wonderful job and she looks so well-cared for. Take care, and her primary nurse will be back on Tuesday to check that elbow."
"Bye bye, and thanks for coming over." He waves and closes the door.
What other slow and silent human dramas are occurring in the other well-kept homes on this quiet street? How many other spouses are devoting their every minute to the care of a beloved who is no longer quite as healthy and vibrant as they used to be?
Devotion and love are the engines that drive relationships and lead us to selflessly focus our energies on the human objects of that love. Here was a stellar example of how that type of deep, lifelong connection manifests in real life. Despite the sadness and loss that underlie such a situation, the human manifestation of that devotion and love is truly an inspiring sight to behold and an honor to witness.
While the outward appearances are relatively static, it is her dementia that has permanently changed the calculus of their relationship. It began with mild, transitory forgetfulness, only to slowly escalate into full-blown dementia as the months went by without a formal diagnosis. She would walk into a room and stand there, utterly stumped as to why she was there. He would leave her in the frozen food aisle to look for light bulbs in another part of the grocery store, and when he would return to find her, she would still be there, staring blankly at the ice cream display, apparently lost in thought but actually lost in the absence of cohesive thought.
At a certain point, it was apparent that she could not be alone. She could no longer bathe herself, toilet herself, dress herself, or make even the most rudimentary decisions. Luckily, if a plate of food is placed before her, she will still reflexively use her fork or spoon to scoop up food and bring it to her mouth. Sometimes, the fork spears nothing but air and she must be redirected to bring it down to the plate again. At other times, the food will fall back to the plate or into her lap, but she won't notice. She will bring an empty spoon to her mouth with the same motion and intention as a spoon laden with mashed potatoes. She doesn't recognize the difference, and he monitors her intake with the eyes of a loving, doting husband of 55 years.
He has refused all assistance other than skilled nursing and physical therapy. A home health aide? Never. Meals on wheels? Not a chance. Day care? Unthinkable. She is his project, his object of devotion, the love of his life and the mother of their children. His days revolve around her, and he revolves around her like a moon around a planet with a strong gravitational pull.
Her eyes seem aware, yet it is not clear what they register. She responds to some questions but not others, and it is uncertain how much of her response is reflexive rather than real. Her shuffling gait, her blank gaze, her apparent lack of interest in anything happening around her---these are hallmarks of her state of mind, and he must long for the days of lively conversation and verbal interplay. How lonely he must be, prematurely bereft of his friend, his lover, his bride.
"You see how her hair is set?" he asks. "Friday is Hair Day," he explains. "I wash it, set it, dry it, and then brush it out and spray it. Just like she used to do. We make her beautiful for the weekend when the kids and grandkids come to visit." He smiles proudly.
Sitting in the chair, her hands passively resting in her lap, she stares at me, smiles, and almost looks through me. I hold her hand, tell her I would like to take her blood pressure, and she raises her arm and places it on the table. I thank her for her assistance. She smiles again.
Placing the tools of my trade in my bag after making some final notes, I shake her hand and get up to leave. Her husband walks me to the door and we shake hands warmly.
"You're the model husband, and I can see that she's receiving the best possible care here at home," I say as we shake hands.
"Thank you," he replies. "I try my best. She's all I have, and I want her here with me."
"Let us know if you need more help," I say as I enter the breezeway between the kitchen and the garage. "You're doing a wonderful job and she looks so well-cared for. Take care, and her primary nurse will be back on Tuesday to check that elbow."
"Bye bye, and thanks for coming over." He waves and closes the door.
What other slow and silent human dramas are occurring in the other well-kept homes on this quiet street? How many other spouses are devoting their every minute to the care of a beloved who is no longer quite as healthy and vibrant as they used to be?
Devotion and love are the engines that drive relationships and lead us to selflessly focus our energies on the human objects of that love. Here was a stellar example of how that type of deep, lifelong connection manifests in real life. Despite the sadness and loss that underlie such a situation, the human manifestation of that devotion and love is truly an inspiring sight to behold and an honor to witness.
Sunday, September 28, 2008
Economics and the Elderly
(Note: This is my eighth post under the auspices of the nurse blogger scholarship which I recently received from Value Care, Value Nurses.)
So, as the bad news splashes across the headlines and the denizens of Wall Street throw up their hands to ward off the falling sky (that they themselves created), the elderly here in the United States are facing some tough economic times of their own as we turn the corner to 2009.
Reports now tell us that premiums for drug coverage under Medicare Part D will rise an average of 31% in the coming year. For some seniors, most of whom are on fixed incomes, a monthly increase of $50 to $100 could spell economic disaster, especially when one considers the simultaneous (and often astronomical) rise in the cost of food, gas, general healthcare costs, home heating, and other necessities.
As I recently reported in an article on Nurse Linkup, Bloomberg, The Associated Press, medical websites, and other independent news outlets are all reporting the inevitability of these increases, the writing already being on the proverbial wall.
To add insult to injury, changing Medicare rules may make some seniors' lives a living hell as they attempt to navigate the shifting sands of Medicare Part D.
And just as the economic climate intensifies with bad news and dire forecasts, American seniors also face the daunting task of negotiating the spending caps created under the Medicare Part D regulations. These rules limit annual reimbursements for medications to $2,510. When this magic number is reached, Medicare recipients must then be on their own purchasing medications until they have spent a total of $5,726, whereby Medicare will begin paying for medications once again. Confused? You should be. If some fortunate seniors are able to purchase expensive "gap coverage" for this period of time, they may break even or come out slightly ahead. For those unable (or too confused or intimidated) to do so, their economic peril may await.
So, what does this say about our country? Who are we? What are we doing to our seniors and disabled citizens? When pharmaceutical lobbyists have more influence than seniors (and their advocates) in the writing of the Medicare Part D regulations, we all know who loses.
Senior citizens are vulnerable members of our society, many of whom have worked all their lives, diligently paid their taxes, and now must struggle to make ends meet in the Autumn and Winter of their lives. Sure, the global economic crisis has indeed cast its pall on almost everyone, but even as the U.S. Congress holds midnight meetings to rescue Wall Street from its excesses and errant ways, no one is talking about how to rescue vulnerable and sick seniors as they fall down their own financial rabbit hole.
No doubt, even as the "rescue" ensues, some CEOs and others in power will somehow come out ahead, making off with money that is not rightfully theirs at a time when that money should be trickling down rather than up.
When I think of the cold months of winter ahead, I think of middle class and working class senior citizens who honestly don't know how they'll make ends meet. Meanwhile, in the halls of Power, there's money to be traded----and made.
So, as the bad news splashes across the headlines and the denizens of Wall Street throw up their hands to ward off the falling sky (that they themselves created), the elderly here in the United States are facing some tough economic times of their own as we turn the corner to 2009.
Reports now tell us that premiums for drug coverage under Medicare Part D will rise an average of 31% in the coming year. For some seniors, most of whom are on fixed incomes, a monthly increase of $50 to $100 could spell economic disaster, especially when one considers the simultaneous (and often astronomical) rise in the cost of food, gas, general healthcare costs, home heating, and other necessities.
As I recently reported in an article on Nurse Linkup, Bloomberg, The Associated Press, medical websites, and other independent news outlets are all reporting the inevitability of these increases, the writing already being on the proverbial wall.
To add insult to injury, changing Medicare rules may make some seniors' lives a living hell as they attempt to navigate the shifting sands of Medicare Part D.
And just as the economic climate intensifies with bad news and dire forecasts, American seniors also face the daunting task of negotiating the spending caps created under the Medicare Part D regulations. These rules limit annual reimbursements for medications to $2,510. When this magic number is reached, Medicare recipients must then be on their own purchasing medications until they have spent a total of $5,726, whereby Medicare will begin paying for medications once again. Confused? You should be. If some fortunate seniors are able to purchase expensive "gap coverage" for this period of time, they may break even or come out slightly ahead. For those unable (or too confused or intimidated) to do so, their economic peril may await.
So, what does this say about our country? Who are we? What are we doing to our seniors and disabled citizens? When pharmaceutical lobbyists have more influence than seniors (and their advocates) in the writing of the Medicare Part D regulations, we all know who loses.
Senior citizens are vulnerable members of our society, many of whom have worked all their lives, diligently paid their taxes, and now must struggle to make ends meet in the Autumn and Winter of their lives. Sure, the global economic crisis has indeed cast its pall on almost everyone, but even as the U.S. Congress holds midnight meetings to rescue Wall Street from its excesses and errant ways, no one is talking about how to rescue vulnerable and sick seniors as they fall down their own financial rabbit hole.
No doubt, even as the "rescue" ensues, some CEOs and others in power will somehow come out ahead, making off with money that is not rightfully theirs at a time when that money should be trickling down rather than up.
When I think of the cold months of winter ahead, I think of middle class and working class senior citizens who honestly don't know how they'll make ends meet. Meanwhile, in the halls of Power, there's money to be traded----and made.
Tuesday, August 05, 2008
The Aging World
(Note: This is my third post under the auspices of the nurse blogger scholarship which I recently received from Value Care, Value Nurses.)
The predictions are in. The number of Americans over age 65 will double by the year 2050, and this demographic shift is occurring on almost every continent.
Personally, although I am not a member of the Baby Boom generation that accounts for the majority of this projected statistical growth, I will turn 65 in 2029, putting me squarely in the midst of the burgeoning data pool.
So what does this mean? What does such a huge demographic population shift portend? How are we to prepare for such a tilt of the generational scales?
First, it seems apparent that governmental bodies must prepare as massive numbers of older adults begin to retire and collect government benefits (to which they are justifiably entitled). Medicare and Social Security here in the U.S. must be protected from bankruptcy, and there seems to be little actually being done about it from this lay-person's perspective. How will these programs survive the onslaught without further government intervention?
And as these scores of hopeful retirees begin to navigate their "post-career" world, many of them are already discovering that making ends meet at a time of astronomical increases in the cost of living is not merely a challenge, it is a matter of basic survival.
How many seniors are now competing with teenagers for entry-level jobs at checkout counters and convenience stores? How many elderly citizens are having to make painful and difficult choices between food, prescriptions, and home heating oil? Which seniors are choosing to sell their beloved family homes for which they have worked so hard for so long, moving to low-income housing to reduce costs and make ends meet? These are hard times, and for many newly-retired seniors, the times may get even harder.
Back in the day, a nest egg was amassed over time with a combination of diligent saving and the promise of life-long company pensions (now mostly a relic of the past). After World War II, many former soldiers went to college for free, pursued vocational training, or bought homes under the GI Bill, securing economic keys to a bright future promised by a grateful post-war government.
Today, families face a different set of economic circumstances. The cost of college has risen exponentially, and many families go into considerable debt to educate their children (or for middle-aged parents to pursue new careers in the face of a changing workforce). Relatively speaking, housing costs have also risen astronomically, with middle-class families struggling to manage mortgage payments, a substantial number sadly ending up in foreclosure. Add to this the cost of healthcare (with rising insurance premiums and out-of-pocket expenses), the price of oil, and the concurrent rise in food prices, and a recipe for economic suffering is securely in place.
So, within this cultural milieu, the newly retired, the elderly and the very old balance on a financial and societal precipice. With working families less able to assist elderly family members economically, and with elders living longer due to advances in medicine and medical technology, how will we as a society care for our elders who cannot care for themselves? Will we warehouse those who cannot afford tony apartments in bourgeois assisted living facilities, spiriting them away to less-than-adequate nursing homes for the economically challenged? Will the working class elderly have to fend for themselves as the Social Security pie is divided beyond recognition, unable to keep pace with the rising cost of living?
As a society, we truly need to think deeply about how we will make adjustments to care for, house, feed, and provide for a growing geriatric population that is projected to continue to expand for the next forty years. It is apparent to this writer that controlling the rising costs of healthcare, food, and energy are three keys to the potential success of any attempted economic rescue of our---or any other---society. I am no economist or demographer, but I can see the writing on the wall, and elders who are unable to pay for medicine, healthcare, heat, and food are elders who are at great risk on many levels of their lives.
With families around the world struggling to make ends meet, and the economic barometer anything but reassuring, it isn't only the elderly who are in need of succor. Still, like children, the elderly are a vulnerable population requiring stewardship and thoughtful oversight by both the powers that be and the citizenry at large. And how we care for our elders and our children is a good indication of the overall humanity of our collective moral compass.
The predictions are in. The number of Americans over age 65 will double by the year 2050, and this demographic shift is occurring on almost every continent.
Personally, although I am not a member of the Baby Boom generation that accounts for the majority of this projected statistical growth, I will turn 65 in 2029, putting me squarely in the midst of the burgeoning data pool.
So what does this mean? What does such a huge demographic population shift portend? How are we to prepare for such a tilt of the generational scales?
First, it seems apparent that governmental bodies must prepare as massive numbers of older adults begin to retire and collect government benefits (to which they are justifiably entitled). Medicare and Social Security here in the U.S. must be protected from bankruptcy, and there seems to be little actually being done about it from this lay-person's perspective. How will these programs survive the onslaught without further government intervention?
And as these scores of hopeful retirees begin to navigate their "post-career" world, many of them are already discovering that making ends meet at a time of astronomical increases in the cost of living is not merely a challenge, it is a matter of basic survival.
How many seniors are now competing with teenagers for entry-level jobs at checkout counters and convenience stores? How many elderly citizens are having to make painful and difficult choices between food, prescriptions, and home heating oil? Which seniors are choosing to sell their beloved family homes for which they have worked so hard for so long, moving to low-income housing to reduce costs and make ends meet? These are hard times, and for many newly-retired seniors, the times may get even harder.
Back in the day, a nest egg was amassed over time with a combination of diligent saving and the promise of life-long company pensions (now mostly a relic of the past). After World War II, many former soldiers went to college for free, pursued vocational training, or bought homes under the GI Bill, securing economic keys to a bright future promised by a grateful post-war government.
Today, families face a different set of economic circumstances. The cost of college has risen exponentially, and many families go into considerable debt to educate their children (or for middle-aged parents to pursue new careers in the face of a changing workforce). Relatively speaking, housing costs have also risen astronomically, with middle-class families struggling to manage mortgage payments, a substantial number sadly ending up in foreclosure. Add to this the cost of healthcare (with rising insurance premiums and out-of-pocket expenses), the price of oil, and the concurrent rise in food prices, and a recipe for economic suffering is securely in place.
So, within this cultural milieu, the newly retired, the elderly and the very old balance on a financial and societal precipice. With working families less able to assist elderly family members economically, and with elders living longer due to advances in medicine and medical technology, how will we as a society care for our elders who cannot care for themselves? Will we warehouse those who cannot afford tony apartments in bourgeois assisted living facilities, spiriting them away to less-than-adequate nursing homes for the economically challenged? Will the working class elderly have to fend for themselves as the Social Security pie is divided beyond recognition, unable to keep pace with the rising cost of living?
As a society, we truly need to think deeply about how we will make adjustments to care for, house, feed, and provide for a growing geriatric population that is projected to continue to expand for the next forty years. It is apparent to this writer that controlling the rising costs of healthcare, food, and energy are three keys to the potential success of any attempted economic rescue of our---or any other---society. I am no economist or demographer, but I can see the writing on the wall, and elders who are unable to pay for medicine, healthcare, heat, and food are elders who are at great risk on many levels of their lives.
With families around the world struggling to make ends meet, and the economic barometer anything but reassuring, it isn't only the elderly who are in need of succor. Still, like children, the elderly are a vulnerable population requiring stewardship and thoughtful oversight by both the powers that be and the citizenry at large. And how we care for our elders and our children is a good indication of the overall humanity of our collective moral compass.
Friday, April 27, 2007
A Birthday Story
I recently paid a visit to an elderly woman for whom I served as a visiting nurse some years ago. We are still friendly and I check in on her from time to time.
Sitting on the side of her bed, I learned that her 74th birthday was only days away. I wished her well and I was somewhat surprised by her response.
"I hope that this will be my final birthday."
"Your final birthday?" I placed my hand on hers.
"Yes. I hope Jesus will take me. I'm ready to go. It's been a hard life." She crossed herself and fingered her rosary that never leaves her thin and fragile neck.
Of course, I could have responded like many people would, especially those for whom death is a failure, a sign of weakness. But instead I chose to meet her where she was.
"If that's what you truly want, I'll hope that for you, as well. But I would really miss you."
She grabbed my hand and pulled me close to her. Then we sat in silence, looking at the shrine in her room: the Virgin Mary, several crucifixes, a incongruous plastic dog and toy car, and other Catholic items of worship and devotion.
"Do you feel you've had a good life?" I asked.
"No," she replied. "It has been a life of misery, suffering, and hard work. Now, I'm too sick to even enjoy my years of rest." She folded her hands in her lap in resignation.
"Don't you enjoy your children and grandchildren?"
"Not really,"she replied. "I'm just in too much pain. I'm ready to go. I've almost died a few times but He always sends me back. I've had enough."
We hug goodbye. I kiss her on the cheek and playfully touch the end of her nose with my index finger. She smiles and girlishly wrinkles her nose and eyes. I note to myself that she will turn 74 this week, the same age as my vibrant and healthy mother. Oh, the ravages of poverty and deprivation on the human body and spirit!
Getting into my car and returning to the clinic, I'm glad that I didn't try to talk her out of her feelings or deny her desire to "finish up" and move on. At her age, after all she has been through, she deserves to welcome death if she so desires. Is it geriatric depression? Likely so. Is it treatable with antidepressants? Possibly. Should she be treated? It is debatable on many levels, and she would probably decline treatment anyway. A tough sell, at best.
So, happy birthday to my little friend, even as she hopes for an end to the succession of the years. Perhaps her wish will come true, or perhaps her Jesus has other plans. At any rate, when she finally gets to meet her maker, I'll rejoice for her and send her blessings on that joyous journey home. Until then, may her days be brightened by the small things which can mean so much: a smile, a kind word, a caring touch, a shoulder upon which to rest her weary head.
Sitting on the side of her bed, I learned that her 74th birthday was only days away. I wished her well and I was somewhat surprised by her response.
"I hope that this will be my final birthday."
"Your final birthday?" I placed my hand on hers.
"Yes. I hope Jesus will take me. I'm ready to go. It's been a hard life." She crossed herself and fingered her rosary that never leaves her thin and fragile neck.
Of course, I could have responded like many people would, especially those for whom death is a failure, a sign of weakness. But instead I chose to meet her where she was.
"If that's what you truly want, I'll hope that for you, as well. But I would really miss you."
She grabbed my hand and pulled me close to her. Then we sat in silence, looking at the shrine in her room: the Virgin Mary, several crucifixes, a incongruous plastic dog and toy car, and other Catholic items of worship and devotion.
"Do you feel you've had a good life?" I asked.
"No," she replied. "It has been a life of misery, suffering, and hard work. Now, I'm too sick to even enjoy my years of rest." She folded her hands in her lap in resignation.
"Don't you enjoy your children and grandchildren?"
"Not really,"she replied. "I'm just in too much pain. I'm ready to go. I've almost died a few times but He always sends me back. I've had enough."
We hug goodbye. I kiss her on the cheek and playfully touch the end of her nose with my index finger. She smiles and girlishly wrinkles her nose and eyes. I note to myself that she will turn 74 this week, the same age as my vibrant and healthy mother. Oh, the ravages of poverty and deprivation on the human body and spirit!
Getting into my car and returning to the clinic, I'm glad that I didn't try to talk her out of her feelings or deny her desire to "finish up" and move on. At her age, after all she has been through, she deserves to welcome death if she so desires. Is it geriatric depression? Likely so. Is it treatable with antidepressants? Possibly. Should she be treated? It is debatable on many levels, and she would probably decline treatment anyway. A tough sell, at best.
So, happy birthday to my little friend, even as she hopes for an end to the succession of the years. Perhaps her wish will come true, or perhaps her Jesus has other plans. At any rate, when she finally gets to meet her maker, I'll rejoice for her and send her blessings on that joyous journey home. Until then, may her days be brightened by the small things which can mean so much: a smile, a kind word, a caring touch, a shoulder upon which to rest her weary head.
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