Don't Ask, Do Tell

I coach Girls on the Run. For those of you who know me, that may come as a surprise, as I am about the furthest thing there is from “a runner.” Especially compared to the crazy, fit people who populate my home state of Colorado. Case in point: I chose to play goalie for my high school field hockey team so that my area of coverage would be a semicircle 35 yards in diameter rather than a 100x60-yard rectangle. That’s about… [insert math here] fewer square yards of running.

For those of you who know Girls on the Run, however, you can see why I would haul my wheezing self through the paces with these remarkable 3^rd, 4^th, and 5^th graders.  It is a fantastic program that does so much to empower girls and help them see the best in their unique identities.

Last week the girls and I were talking about choices—specifically, choosing to respect others, our community, and ourselves. One of the affirmations I gave them to ponder while running was “I make my own choices.” My own daughter heard this, laughed, and responded, “Except when you make my choices for me, Mom.”

Mic. Drop.

As a parent, I’ve spent a good part of the past thirteen years pondering the idea of empowerment and autonomy, especially when it comes to how I teach the art of good choices.  When my kids were toddlers, I practiced presenting them with either/or questions: Do you want broccoli or peas with your dinner?

Voila! Suddenly your three-year-old is empowered to make a healthy decision. Don’t get me wrong. A strong-willed kiddo still can (and probably will) answer with a resounding “NO!” But at least you tried.

I realized that I had mastered (or perhaps overused) this technique when my parents came over one evening to watch my daughter—then still in preschool. My dad asked her what they should play together.  Without a moment’s pause, she looked him straight in the eye and said in a matter-of-fact tone, “OK, Baboo, here are your options…”

Now that I’m dealing with a tween and a teen, the questions have changed and become (perhaps unsurprisingly) more guilt-infused. “Well, you can go to the movies instead of finishing your project tonight, but is that really the best choice?”

The answer, 100% of the time, is yes. But you see my point. We let them fail.
We let them face the consequences. It’s all a part of self-determination and identity.

OK, here are your options...

What I find infinitely harder (yes! harder than toddlers or tweenagers!) is how to interact with my 83-year-old father-in-law, a man who served in the Korean War, raised a son who attended Princeton undergrad and Columbia Business School (despite having gone no further than high school himself), nursed his wife through eighteen months of Stage IV uterine cancer, and now resides in an assisted living unit where he spends a great majority of every day sitting alone in his room. He says that’s all he wants to do.

My father-in-law is a quiet man by nature. If he were someone who believed in self-help books, he might have benefited from all the current literature on introverts. But even keeping to himself as much as he does, he cannot avoid all interaction, nor can he avoid all questions.

Some questions are easy for him to answer. At the anticoagulation clinic, which we visit on a weekly basis, they go through a series of routine queries that we both have memorized. He answers easily: “Has your diet changed?” (No.) “Have you consumed any alcohol this week?” (No.) “Have you felt any numbness or tingling down one side of your body?” (No.)

But ask him an unexpected question—even the simplest yes/no—and answers prove far more difficult. Leaving the clinic, I might toss out something like “Dad, do you want to get some lunch before I take you home?”

I am met with an uncomfortable silence.

While I’m waiting, I contemplate the following:

1. He isn’t wearing his hearing aids. Perhaps he didn’t hear me.
2. Perhaps he heard me but cognitively cannot work through the question.
3.  Perhaps he heard me and understood the question, but the Parkinson’s is constricting his throat and preventing him from voicing an answer.
4. Perhaps he heard and understood the question but is too depressed to respond.
5. Perhaps he heard, understood the question, and came up with an answer, but that process took so long that he then forgot he hadn’t said it aloud (or that I asked in the first place).

After a few, very long minutes, I ask if he heard me and repeat the question, this time trying the either/or tactic: “Dad, do you want to get some lunch or would you rather go straight home and eat there?” Sometimes I get an answer.  And sometimes I don’t.

And I wonder if we have reached the point of “don’t ask, do tell.”

Autonomy and empowerment are wonderful concepts, but is there a line we all one day will cross—physical, neurological, or emotional—where we can no longer make good choices for ourselves? And when a loved one crosses that line, do we as caregivers attempt to replace autonomy with beneficence? Which is more important for “aging gracefully”?

This dilemma doesn’t only come into play with the big, scary healthcare decisions. It also matters for the day-to-day, quality-of-life ones. If it is time for me, as a caregiver, to eliminate questions altogether, then I need to practice an entirely new approach:

• “Do you want to attend exercise class?” becomes “I’m taking you to the common area for exercise class.”
• “Do you want to watch the Yankees?” becomes “I’m turning on the television. The Yankees are playing.”
• And “Do you feel up for some lunch after this appointment?” becomes “Let’s go get some lunch before I take you home.” 

Admittedly, I’m suggesting what feels right to—and for—me.

At the New York Deli News, the answer to
"Do you want a reuben?" is always yes.

Sometimes I wonder if I really know what’s best. It could be that he’s reached a point where the comfort of a dim, quiet room is enough. I don’t know. But I do know, from everything I’ve read and experienced, that preserving dignity and identity are just as important as—if not more so than—preserving autonomy. And perhaps dignity and identity may be achieved as much by compelled participation in the world outside one’s room as by the opportunity to voice opinion and/or answer questions.

And he still retains the right to refuse. I hope he will. I hope he still can.

One more thought on this. I have made the commitment never to use the dreaded SH- word with him.

No, no, no. I don’t mean that SH- word. I mean SHOULD. It’s never “You should go to exercise class.” These are my choices that I’m making for him, not his choices. The difference may be semantic, but I believe it is significant.

P.S. OK, OK, OK. If I’m being completely honest, I do sometimes use the other SH- word but only in my head. For example, “$#!+. I just don’t know what to do in this situation.” If only there were a preschooler around to give me my options.