The Poignancy of Aging Alongside Spouses, Partners, and Siblings

I recently found myself as the “loving” companion to my brother and husband for two separate medical procedures. I’m happy to say there has been a long hiatus for this kind of caretaking, because the first episode, about five years ago, was quite an eye opener. At that time, I was more focused on surviving the quirky US healthcare system and locating the best offerings in my local area. The emphasis was on finding quality treatment for my husband’s scary, unsuspected illness. I shared my suggestions for navigating this rocky sea in a post on Agebuzz.com entitled, The Initiation: Managing the First Serious Illness.

Being the point person for my brother and my husband in two very short hospital procedures was entirely another matter. Of course I would be the natural choice to accompany my spouse. For my brother, who is now a widower in an LAT (live apart together) relationship, that responsibility was not so clear.

Background Events for Caretaking

Because there is no rulebook for deciding who stands guard in the waiting room and does the hospital drop off and pick up, caretakers’ feelings about these matters are probably colored by past events. For me, these experiences spanned the gamut! For the last 10 years of my nonagenarian parents’ lives, I felt incredible anguish at their lack of preparation for old age, and I noticed scarce gratitude for the many hours I clocked at hospitals and nursing homes. Going to the ER for a minor event with one of them would mean a full day lost, with both parents displaying anger for their situation, and a general lack of cooperation. Being in the waiting rooms both times recently revived these unpleasant memories.

Taking care of my husband, on the other hand, was a far different experience. He is ever appreciative of my efforts on his behalf, the initiator of fun meals surrounding medical appointments, and he managed to create beautiful playlists, when he required a lymphatic massage from me every night.

I was glad to help my brother, but I wasn’t sure how his companion wanted to be involved. Ahead of time, we worked out that I would take him to the hospital and wait during the procedure and she would pick him up the next day. Oddly enough, she became a grandmother for the first time a week before the procedure. While I had counted on her to look after him post-surgery, when he returned home, she left town for the beach with her family and the new baby – surprising, but understandable! My brother had an empty refrigerator, and I hadn’t checked ahead of time.

Couples and Illness

There are many factors related to illness which can throw a couple off balance. These are things one doesn’t think of at an earlier age, because they are so outside the daily experiences of navigating the world of work and family.

It is very common, especially if there is a big age gap or serious illness, for one partner to age at a different rate. Physical decline, illness, memory loss, mobility and fatigue can all work to mismatch energy levels of the pair. There are also role changes: one might become a caregiver to the other who must learn to receive such kindnesses.

If the marital scenario running in the background has been generally positive, caretaking might be somewhat easier. In the alternative, even if the marriage has been challenging, there is still a need to develop the same skills of compassion: listening deeply; being patient, communicative and respectful; and setting gentle boundaries to balance one’s own needs.

Dr. Susan Lehman, Director of John’s Hopkins Geriatric Psychiatric Clinic offers additional suggestions: the supportive spouse should be as informed as possible about the illness or procedure; he/she should accompany the patient to appointments with a pre-made list of questions, and where possible, pleasant home routines should continue.

Unmarried Partners

Like my brother, 3-7% of seniors in the US and UK are Living Apart Together. According to Paula Span’s post on Agewisecolorado.org, the quality of the relationships of these couples is very similar to married couples. The big difference when it comes to illness is this group is less likely to have prepared advanced directives, Healthcare Proxies, and Powers of Attorney. Unfortunately, these issues tend to come up in a crisis situation (or before or after a simple hospital procedure), and they can cause friction with adult children and others in the family because the role of the partner is not spelled out.

Besides acquiring the necessary end-of-life legal documents, both partners need to spell out how committed they are to the caretaking of the other, and let family members know their wishes. Since there is not a binding marriage contract, each partner is free to determine his/her level of autonomy, and this was probably a reason for the LAT relationship in the first place.

Siblings

Until very recently, I never really thought about being my widowed brother’s caretaker as he ages. After all, he has two adult children and a partner. Recent events have edited my thinking. Once again, there is a scenario running in the background similar to the marital version – this time it is the historic sibling version.

According to Deborah Gold who created a Sibling Typology Scale in 1989, sibling relationships occur in five specific categories: intimate, congenial, loyal, apathetic, and hostile. I would characterize my relationship with my brother through the years as apathetic, a lack of interest in a deep relationship (really just on his part). I would now categorize it as loyal: support during a crisis, but infrequent contact.

Surprisingly, I feel very committed to being the organizer for any of his medical issues that may arise in the future. Although our relationship was distant, it was definitely not hostile, and when we get together with his partner and/or children, the experience is always satisfying.

These positive feelings probably stem from the unique qualities siblings naturally enjoy. This is the longest lasting relationship in most people’s lives, even longer than the parent child relationship. There is a common cultural background, shared family history and the similarities derived from a shared gene pool. Being together creates feelings of continuity across the life span, and a sense of security.

The Poignancy of Caretaking

Because of our long history with our siblings, caretaking responsibilities in later life can easily be compassionate, especially if the historic relationship has not been hostile. It is common for siblings to grow closer at the end of life, and the inevitable illnesses are new avenues for intimacy.

Unmarried partners because of their choice of non-binding status can feel free to engage in caretaking at their level of comfort. The only caveat is that the wishes of both parties should be clear to other family members who might need to step in during a serious illness or at the end of life. Specific legal documents would be helpful if a partner is desired as a Health Proxy or Power or Attorney.

Married couples’ attitudes towards caretaking seem to be highly reflective of their relationships through the years. My parents never really gave up their ingrained perceptions of the other: the burdensome invalid and the uncaring caregiver.

When my husband’s deteriorating knee began impacting our favorite routine of walking the local trails, I was initially taken aback. I pictured myself staying in the passing lane of life as he slowed down. Such has not been the case in our mid-70’s. I have had my own physical challenges, and we have grown closer in this new era, understanding how unpredictable the future can be, physically and otherwise. He has a barely noticeable speech impediment from that first serious illness involving oral surgery. The knee is headed towards a replacement. The poignancy of it all seems to endear him to me more!

Let’s Share Our Experiences:

Have you stood by and taken care of a sibling, spouse or partner as they underwent a medical procedure? How did you handle it? What have been your thoughts and ruminations about that episode?