Gail Sheehy: The Family Caregiver

As a cultural observer, journalist and best selling author of 15 books Gail Sheehy has changed the way millions of people look at their lives. Her original landmark work "Passages" remained on The New York Times best seller list for more than three years and was reprinted in 28 languages. A library of congress survey named "Passages" one of the ten most influential books of our time. And Gail's most recent book "Sex and the Seasoned Woman: Pursuing the Passionate Life" published last year, she reports on well, you know. In her previous bestseller such as "The Silent Passage" she broke the taboo surrounding menopause and opened a dialogue vital to maturing women's health. In New Passages and Understanding Men's Passages, she revisited the stages of adult life and mapped out a completely new frontier entitled "Second Adulthood." In 1999, she culminated a decade of Hillary-watching with the biography, Hillary's Choice, exploring the life of one of the world's most intriguing women. As a literary journalist, Gail was one of the original contributors to New York magazine. A contributing editor to Vanity Fair since 1984, she won the Washington Journalism Review Award for Best Magazine Writer in America for her in-depth character portraits of national and world leaders, including both Presidents Bush, Bill and Hillary Clinton, Newt Gingrich, Margaret Thatcher, Saddam Hussein, and Mikhail Gorbachev. Gail is a seven-time recipient of the New York Newswomen's Club Front Page Award for distinguished journalism, most recently for her Vanity Fair article "September Widows." Other honors include the National Magazine Award and the Penny-Missouri Journalism Award. The title of this morning's presentation is "The Family Care-giver", please welcome Gail Sheehy. Oh thank you and a very good morning to you. I am delighted and somewhat surprised to be among the honored guest at Chautauqua, because the President told me, confessed, after I got here that when he read Passages, it made him mad. It made a lot of people mad because, he wanted to be unique. What do you mean I am like other people? What do you mean I have passages like other people? Well, the corollary to that was you are not the only one. You are not crazy, you are not alone. Let me start with a confession, when I wrote Passages, I stopped parsing the stages of adult development at age 50 because I was in my 30s at the time and I thought, well what happens after 50 that matters. How quaint that seems now. In fact, most Americans in their 50s and 60s and 70s say, these are among the most satisfying periods of their lives. But the stages after 50 are not as predictable as those in our earlier adulthood. We really go through more life stage transitions in our 50s and 60s than at any other time of life. Well, in the last 10 years as I have been continuing to track the stages of adult life, the whole life cycle has undergone a revolution. Americans are taking longer to grow up and much, much longer to grow old. Most middle class Americans today really don't admit to being adults until about age 30, think about it you know, that's when they really begin settling down with a mate you know, settling on a life course, may be paying some or all of the bills. So as I see it, today our first adulthood runs roughly from age 30 to 50. And then a vast new territory stretches out from 50 to 70s, 80s, the fastest growing demographic in America as you know, is people a hundred and over. So you have at least 30 years, may be 40, may be 50 before the deficits of age begin creeping up. Epidemiologists have told me that if a woman reaches age 50 without any evidence of cancer or heart disease she can expect to live to the age of 92. Okay, I hear a little rumble of "Yeah", and then a little gasp. Well it's exciting but it also something of a shock. I mean who ever prepared us for the possibility we might live long enough to forget the name of our first husband. Well, my current book is titled Sex and the Seasoned Women because frankly titles are designed to get readers in to the tent. But it's about much more than sex. The subtitle really spells it out. It's about pursuing the passionate life, finding passion in your work, in your relationships, in your spiritual life, in community, finding and keeping your passion for life. The first insight I gained from interviewing groups of women over fifty all over the country is that finding your passion is the basic requirement to become a seasoned women or a seasoned man. Passion is the central motivator of all human activity and I bumped into a principle that embodied this principle literally bumped into her on my street, where I live in New York City. This was a Madeline, a neighbor, I heard her singing one evening as she was walking up the street you know swinging her arms and singing on the street where you live. Well, I was I couldn't figure it up. Madeline was a journalist in her late 50s, she has been apparently depressed and kind of in limbo for the previous few years. She had extracted herself from a marriage where both physical and emotional intimacy had languished. She had survived breast cancer without any much help. She tried out the single scene in Long Island, that didn't work. She tried living with mom in New Jersey, that really didn't work. And so I caught up with her and I said, Madeline, what happened? She said, I've started taking voice lessons. She said I always wanted to sing backup for Stevie Wonder. But her ex- husband and son had always made fun of her singing. So she had just given it up. So here she was in her 57th year, picking up and giving in to expressing her joy through music, her natural vehicle. And she said, now when I can't sleep and I get up in the middle of the night, I practice my scales. I am pretty good. She says, singing gives me a passionate thrill. I can only liken it to that feeling of when you have just met somebody special. I have a crush on singing. That's passion. For women and men who find their passion and have the courage to pursue it, the decades from 50 onward can offer the best seasons of your life. A whole second adulthood as I call it. Well, you wouldn't know it from watching most of the commercials that featured mature models, you know, silver hairs, two of them walking into the sunset together, enjoying serenity by being drugged by the pharmaceutical companies, or thrilled at finding protection from incontinence. Did you ever see as I did the other night at a dinner party a beautiful women in her late seasoned years, who buried her beloved husband about seven years ago, after years as a compassionate care giver? And who now travels with a handsome companion, a tall silver haired widower, whose wife was buried with very much same sequence as the lady's husband, so there is life after loss for care givers and that was reassuring, it's always reassuring for me to see. And it's the subject of my current research, the family caregiver. It's a term we have all heard, but it doesn't really have a familiar face. One phone call can change your life. I can tell you how it happened for me. "It's not benign", that voice belonged to my husbands oncologist. It took me a moment to find my own voice but but you know two years ago after the biopsy you said he interrupted me, the pathologist re-cut the old slides, its cancer. That exchange with my husband's oncologist plunged us into the whirlpool of fear, denial and confusion, that suddenly drafts so many of us into the wars against aging and physical decline. Over then the first few days of sharing the news with the stunned family members, googling disease sites, tracking down doctors, comparing hospitals and going dizzy with all the confusing information, conflicting opinions, it began to dawn on me that my life had also radically changed. I had a new role, family caregiver. It's a job nobody really applies for. You don't expect it. You are not trained for it. You won't be prepared. Yet the backbone of our broken healthcare system is the family caregiver. My experience is being shared today by an unpaid army of 44.5 million Americans caring for adults. Another 10 million provide care to children under 18 with mental or developmental disabilities. And of course the numbers will only grow because of our demographic direction. Care giving as a predictable crisis for adults in mid-life is a relatively new phenomenon. We keep people alive longer and longer in our hospitals but we send them home quicker and sicker to us, their loved ones, family members, who love them but who aren't trained to perform this professional job. We often feel scared and sad, alone and mad, and we have a right to. In fact somebody gave me a Caregiver Bill of Rights. I suggest you look it up on the aphasia website if you are interested. Like most new caregivers I thought the crisis would resolve itself in may be six months or a year and then we would go back to normal. That was 15 years ago. Adult children usually under estimate too the magnitude of the new role when they get the first call, "Mom's fallen and lost mobility in one of her legs", a busy San Francisco entrepreneur told me. Well, as soon as I find the right wheel chair it will be okay. But becoming a family caregiver often creeps up on you. You start helping mom, paying her bills, taking her to the doctor, but if she doesn't recover mobility or falls again and insists on remaining at home, which is the preference of well over 80 percent of Americans, the working family caregiver will need to cut back severely on her career. Studies have shown the caregiver spent on average four and a half years in this role, with needs escalating. My husband and I working together have battled three separate assaults by cancer and each time emerged victorious. These battles called upon every strength, every spiritual resource we could find and share. But meeting these assaults gave us courage and courage to risk turning our lives upside down in our 50's and 60's. But I don't want to gloss over the very real dangers and debilitating effects that long term care giving can produce. An ongoing state of crisis can be life threatening to the caregiver. The chronic stress leads to depression in 40 to 70 percent of family caregivers and depression often leads to lethargy, immobilization, isolation. In Portland, Oregon I found a program wonderful program, first of its kind in the country, may be the only one called powerful tools for caregivers. It's a six week course that teachers people in this role to pay attention to taking care of themselves, that its not selfish, its survival. Many participants say when they first start the class, "Stress? I am not stressed. I know this role, I have been taking care of my husband for 10 years and I am the only one who knows him well enough to do it." Well you can't be the only one for ever. And by the way I want to tell you something about this course, it was started by two women who had been caregivers, five years ago they saw that there was really nothing out there to help the caregiver in this role. They were part of a little program called Caregiving Services, a part of a big health system in Portland Oregon and I will tell you the end of the story later. But it later comes out in this course that caregivers like this usually have lost all contact with their friends. They have given up their work or their passion. They don't take time to exercise and they're just two worn out by mid afternoon to think about almost anything else except when they can just lie down for few minutes. May, one teacher in the class, had given up her work and her identity to care for his husband when he went in to cognitive decline. She told the group, I just have no time to take my own medications. I am always but I am very careful to give all 15 that he needs to take. Well, they said, well how long does it take you May? She, said well about four minutes. They said, "Four minutes?" She said, I don't have four minutes for myself. Well going to class she realized that she didn't know anything about dementia. She thought her gentle husband was just suddenly being mean to her. She learned that brain changes had changed his personality and she learnt not to take it personally. And she accepted the idea that if she doesn't pay attention to her own health and fight against the isolation that imprisons many caregivers in their own home, she won't survive to care for her loved one. She later admitted, I am an educated person, I have a Master's Degree Plus, but I didn't know how to breathe how to breathe. Now she said, as soon as I wake up, I take a half a dozen deep diaphragmatic breaths to start the day, and you know it starts it on an entirely different attitude. Well, I can't wait to get back and tell May about Dr. Dharma's singing meditation, right. For those of who were here yesterday, "sa ta na ma sa ta na ma" isn't it what it wonderful what it does for you. I am going to add that 12 minute meditation to my usual morning practice which is, I start by asking God to direct my thinking especially asking that it be directed away from self pity or self seeking. If I have to determine which of two courses to take in my husband's care, I ask God for inspiration and intuitive thought or a decision. And then I can relax, kind of take it easy, it's surprising how often the right answer just comes during the day, after you try this for a while and you probably know the Latin root of the word "inspiration" inspirare it means breath. And so inspiration comes to us from taking deep breaths. And by the way, I just got word that that wonderful powerful tools for caregiver's program in Portland, Oregon, the whole care giving services department was terminated by the hospital system. I want you to be outraged. I want you to call the number that you will find in Parade Magazine on September 9th and make a fuss. It's a nonprofit making department and that just reinforces the way our for-profit medical system and healthcare system is going. Well, for my next book, I am interviewing family caregivers around the country; women and men; it may surprise you to know that 40 percent of family caregivers are men. And typically men fulfill the role, sometimes at a distance even if they live in the same community, managing legal and financial issues while the hands on care and emotional support is usually carried by females in the family. Well, for the either one the care giving role often feels open ended, rollercoaster, with no clear beginning, or middle or end. So I am working I am breaking it down into stages, because each stage I am finding it brings its own rewards and its own demands. But each stage requires a shift of attitude and a new set of strategies. You know, most of us can do a sprint around the clock to save the day for somebody we love and most of us remember those sleepless nights as young parents, but children do eventually grow less needy. Care giving for an adult usually turns into a marathon. Nobody can run a marathon year in and year out without time outs and serious guilt free attention to taking care of oneself for the long haul. So stage one as I think of it, is shock and awe. Receiving the news that a family member has a life threatening illness or has suddenly lost a function that we all take for granted; throws most of us into shock and probably some denial. We don't know the medical lingo and nobody really knows how to navigate the labyrinth of medical centers and HMOs, traditional doctors versus alternative medicine approaches. In mobilizing to be a partner for my husband I learned how to interview physicians and ask the question that they are not answering again and then again. Taking notes, sometimes I even tape record it, because the care receiver is not going to be able to remember, it's too threatening what they are hearing. And the caregiver has to really remember may be too threatening for us to hear. So taking notes or taping is very helpful. We even tested an 82 year old surgeon who was slated to do radical surgery on my husband radical neck surgery. We asked for an appointment for a second consult, and we asked him, how many of these surgeries do you do in a week. Well, this is a vitally important piece of information to get when you are choosing a physician because studies show the more continuous experience in that procedure, the greater the success rates. Well, a surgeon understood exactly why we were there. He held out his hands, they were still as stones. He just held them there for almost a minute. He said, I do three or four of these surgeries a week. They take up to five hours. The only thing I ask of you he said is that you tell me at the morning of surgery, we know you are going to do a splendid operation. Well he had shown us both confidence and humility and we entered into a very human contract with him. And that morning we told him you are going to do a splendid surgery and he did. Well we learned how to focus on what was right with us rather than what was wrong with him. We did meditative breathing exercises together. I talked my husband's through calming visualizations, which helped me at the same time. He learned self-hypnosis to put his body in a receptive state before surgery, which really does promote more rapid healing. I had a bio feedback session to pinpoint my anxiety to triggers and start to learn how to counteract them. And through all of these efforts, my husband and I became connected at a much deeper level. That's the reward part. But moving from stage to stage requires profound shifts in attitude on the part of the caregiver if he or she is to remain grounded and healthy and able to live out his or her own natural life. Stage two, I call the new normal. And counter intuitive though it might sound although it may have happened to some of you, my husband slumped into depression after his first successful cancer treatment. You know once all of the mobilization all the family, the doctors, nurses, caregivers stop focusing all their attention on the patient, you are just left to wonder, is it over, is it going to come back, am I cured? Well also my husband's former life as a magazine editor and publisher was unrecoverable in many aspects and that reality it was hard to accept, for both of us. Like many who go on living with cancer you know, once all the medical interventions are completed, he became rather immobilized by uncertainty. And we found it hard to adjust to the new normal. It took another shock and awe to catapult this into making a dramatic life change, which is one of the great things that may come out of a serious life threatening condition. Two years later, we were in another doctor's office in New York hospital and he said; this is a low- grade non-Hodgkin's lymphoma, its indolent; the median survival rate at your age is 10 years. But since you have no symptoms and early treatment with any drugs doesn't improve your lifespan, I am going to leave you alone. He said my advice to you is this, "Go out and live your life, the two of you, do something wonderful that you never thought you would do before". Well we sat, stunned, this wasn't the usual seven minute physician consult with the dehumanized patient, this doctor was talking to my husband man to man, as a person of intelligence and action, who was just depressed by losing his former way of life. And he was including me, the caregiver, as a full participant in this experiment in healthy living we were about to in embark on. We walked out of that office on a cloud of reprieve. It didn't hold us up very long, you know clouds never do. We had to act, tear up the life we had spent decades building, in the densely connected world of New York publishing and strike out for some place else some new way of life that would stimulate and mobilize us. And when I say stimulate I mean actually stimulate by husband's immune system and bring him out of depression. Well, it took a community to help us find the right path. Former colleagues of my husbands wanted to help. And these were the writers and editors and artists and photographers whose career he has started or shaped or promoted over the years, they created an informal working group, a community, to brainstorm about how to get him back into action again. He at the same time had to spend a lot of time trying to uncover, "What is my passion?" And we were advised by wonderful cancer psychologist that you have to think about this everyday, like do I take an umbrella? Yes, is the answer here and argue about it, to dream about it, to discuss it with your loved one, what was it he loved most about his work stripped of title or setting. The answer took about a year in coming, but then it was clear as a bell, he loved identifying and shaping young talent and that opened to whole new venue for another career, teaching young journalists in a graduate program, by teaching them by doing making magazines. The working group then interviewed several universities and they settled on the University of California, Berkeley, as the best journalism program, but it was a long way from our home in New York but what an adventure. We moved into a faculty apartment, you know, back to the brick and board book cases and the one bathroom you know, living like graduate students, but we found a running track with the view of San Francisco Bay where you know, there are no limits to your horizons and we walked down to a side walk café every morning in the winter. We had our oat meal and coffee outside, reading The New York Times. We were young and we were in love all over again. Remember what I call the stage two the new normal. We made this our new normal. Stage three; I call Boomerang, okay just in a nice plateau, things are going along and then inevitably another surprise. It may be another diagnosis; it may be another functional loss. It's going to invade the new normal to which you would become adjusted. For us it came wrapped in that most dread word in the English language, recurrence. This time the cancer surgery being at the base of tongue was going to possibly silence my husband's voice. And he was a communicator. He was fighting the fear that he wouldn't able to resume teaching the following semester. But the night before that radical surgery one of his best friends called up and said; I will be your voice, I will come out and team teach with you for the next semester. And six weeks after that surgery, they were teaching together. I made up my mind, we weren't going to give up going out to dinner or traveling just because he now had to eat with the G- tube a gastrointestinal tube. We made an adventure of it. We went off to Paris that summer, we bought a blender in European current and I stopped into a lovely restaurant in Paris in the afternoon to meet with the chef and explain our special needs. "Quel damagae!" he exclaimed, it's unthinkable to a French Chef that a person went down to eat with out tasting a morsel of his exquisite food. So he prepared an elegant meal, blenderised it, strained it all, served it up in the silver pitcher, with a chaser two waiters to block the view, so my husband could pour it into his tube in privacy. Well, after that experience, we were fearless about eating out. If we could do it in an elegant French restaurant, we could do it anywhere. And we did. Stage four; this one I call "How long." It's one of the most haunting questions for the family caregiver and the receiver and it's impossible to answer. Carol Levine, author of "Always on Call" she is also the Director of United Hospital Funds, Families and Healthcare project, she told me, "In the first year after my husband's accident and traumatic brain injury, I stopped being a wife and started being a family caregiver". She warns the danger is that you may become so enmeshed with care giving; you will see nothing else in life. Well, so after hearing many stories like this I have come to the conclusion that the way to move through the "How long" stage is to stop asking the question. You must move on from care giver to care manager. One of the biggest problems between care givers and care receivers is communication and honesty. Many feelings that we think are unthinkable, unspeakable, unacceptable go unspoken. But they fester, and later they probably will get expressed in anger or withdrawal or guilt tripping or create a schism between people who otherwise love each other and want to help each other. Well, my passion is play writing and yesterday as I was going over my talk with my friend Beverly Camie, a film and theater producer, we just began spontaneously role playing, and the examples began to come alive. So we are going to try out a scenario for you. Now we are not actresses and we hope there aren't any theater critics in this audience. So Beverly, curtain time. This is a dramatization of a father son relationship about to implode, until the son makes the passage from full time caregiver to care manager. Kevin Burne the father lives in a long time family home in Worcester, Mass. I am Kevin. It's not near Boston or much of anything else. But Kevin loves his home he lived in it with his wife for fifty years. He is now 82 and restless; he is used to running a corrugated box company, with his name on the boxes and successful. He has a son and two daughters. He hoped that his son was coming in to business with him, but Sean was a natural whiz kid in the computer world. Sean lives three hours away in Boston. Sean -. I love my job, I work for Intel, I do searches, I have a great future. I am the kind of person who wants to know everything in advance, what I have to do, how soon do I have to do it and when it will be finished. But now I have a second job and I don't know what I am doing. My dad was having memory problems and finding it not so easy to read anymore. He probably would had had a minor stroke but he refused to see a neurologist to confirm it. Mom looked after him, boy they argued a lot, mainly about who should drive. I was perfectly capable of taking the wheel and I still am, don't you let anybody tell you differently. For Pete's sake I ran a company. This argument really came to a crisis point after mom died. Dad slipped into a depression. Then he slipped on a rainy step. His eye sight had really deteriorated, but you couldn't talk to him about it and now he really can't drive. That's what I came here today to tell him. Give me the keys, dad. What keys? The keys to your car. I don't know where they are. They are in you pocket. Damn it, I taught you how to drive. I know you did dad, and you did a great job. But you are not going to do such a great job now; you are not doing such a great job now. The last time you drove you ran over Mrs. Murphy crabapple tree. That tree was half dead and so is Mrs. Murphy. Next time I should put her out of her misery. Now dad, I know this isn't easy for you. But I will find somebody to drive you around. What, like I am some kind of invalid, these are my keys, this is my home. I don't even want to talk about this any more. You can just leave. I am not really very good at concentration. I do a lot better with computers. So I went into the garage and disconnected the battery. Then I got my two sisters on the phone. Susan lives in Florida, Ann lives in LA. Listen to me both of you, you are not hearing me. Dad can't live alone anymore. What do you mean you can't do anything? Dad could live with you Susan, part of the year; it's nice and warm in Florida. Well, and the rest of the year he can go to California where it's also nice and warm. Listen; if I have to keep taking days off to come out here, every time dad hits crabapple tree, I will lose my job and god forbid, he runs over a person. Assisted living? You know dad would never go for that. I know this is their way of dealing with their guilt. Leave my home. Forget about it, I am not budging. At this point I don't know what to do, so to clear my head I take a walk around the block. And God was looking down on me because I ran into Laura Murphy Mrs. Murphy's daughter, who is carting away the crabapple tree. You think I was having problems; she gave me an earful about trying to deal with her mother who had emphysema and wouldn't stop smoking. She had already burned down half the garage. She is just as stubborn about not leaving her home as my dad and she won't even go to live with her daughter who actually wants her. I went home, I went back to my computer and I did a search, "grow old at home", what came up was a New York Times article about a movement starting all over the country, where older residents in the same neighborhood are coming together to share the responsibility, the responsibility of maintaining their independence in their own homes. And it all started in Boston right around the corner for me, on Beacon Hill. So I immediately went and checked it out. The 400 members of the Beacon Hill community pay yearly dues to hire prescreened helpl, a carpenter, a chef, a home health aid home health aid and even a computer expert. I was going to audition for that job. And they can all grow older and stay in their own homes. I thought the kid had a hell of a good idea, as long as I could be President. I came with a name for our association, the "Slow Walker's Neighborhood Association." I am in the driver seat again. Thank you. Well we are not giving up our day jobs, but I wanted to have an illustration of a caregiver making the passage to care manager and in this case, building a community to share the management, which I think could be easily imported to Chautauqua, in neighborhood groups. I'd like to complete the stages of care giving for you, but I am not there yet, either in my research or in my own journey. My husband is in a subacute rehab in a nursing home and doing well. But we are the doctors say that he is in the stage of slow dying. But it could take a long time. I'll welcome any of your stories, any of you who have completed the journey or who are in any other stage of it, so I invite you to come to my website and share your story. If I want to interview you, you will have the option to be anonymous or identified. And I think the ushers some ushers at the top there, have my cards with my the website names, kind of difficult, its seasonedwomansnetwork.com. And the ushers will pass them out to any of you who are interested in visiting and seeing what the other people have to say, we have a message board. I want to close with one of the many hopeful stories I have gathered from caregivers who have completed the journey and found a new life. Now I think I will tell you two because we have time. One of them is about Brigita and her husband, both artists, they travel together, critiqued one another's work; they were really soul mates. Brigita was only 52 when she was told that her husband had Early- onset Alzheimer's. So the care giving role for her became all consuming within the first year. Well after three or four years she told us, I wonder how much longer I could go on doing this there were times she said, when I was too tired to read out loud to him but I did it anyway because he couldn't read anymore. It wasn't about the words that he was hearing, it was about hearing my voice. There were other times she said, when I wished it was over, honestly and sometimes I took my husband to a facility for a few days, so I could just go home and sleep. But there is no complete getting away when you are in the care giving situation. And when my husband passed away, she said, it was very peaceful and joyous and I felt I had done all that I could for him. The atmosphere that experience, she said, carried me to the memorial and it took five or six weeks before the grieving set in. She said I was exhausted at that point; I had no adrenaline left, just nothing to get me going. So she said, I got help from a naturopathic physician and I deliberately reconstructed my energy. I learned how to breathe. She said it took a year and a half; I am still not quite there. I asked how old she was now, 67, and how old do you feel, I asked. She said "I can't say that I feel old because I am thinking of things that I still want to explore. Life is still wonderful". Well I spoke to Brigita just a week or so ago; she has recently recovered her artistic inspiration after a trip to Mexico. It was her first vacation alone and she has begun painting again. The color she chooses are vibrant, her subject is the web of life. Now I want to tell you one last story, this is about a couple care giving for one another. This I this is the story I found when I was doing Sex and the Seasoned Woman. I wanted to interview centenarians. So I called the Harvard Centenarian Study which has been ongoing and talked to the director and I said, would it be possible to add a couple of questions on your protocol about love and sex? He said, well we don't ask about those things. Well, the next day he called back and said, you know I am really chagrined, because we should ask about those things, why should we assume they are no longer important. He said, I can tell you this is the Director of the Harvard Centenarian Study, but he said as a grandson, I can tell you about a 91 year old lady who is having a great love affair. I said, who? My grandmother. So he sent me to Freedom Village in Tampa, Florida. Well, I arrived at the airport, the van driver was there. He said, are you meeting someone special? I said, "Oh yes, I am meeting a 91 year old lady who has an 89 year old boy friend." And he said that's it, they always go for the younger man. So we arrive at the independent living facility, I called Catherine from a lobby, I said I am here, can you come down? We could have lunch. She said, oh I am delighted, would you mind if I bring someone special? And I said I would be delighted. So down they come, they come off the elevator, on one walker, holding hands in the middle. It was so beautiful. We walked through the corridors, everyone comes over to say hello to Catherine and she greets everyone by name, asks something personal about them, just as graceful as we could be. We sit down, we are having lunch, he has called to the podium for phone call in the middle of lunch, he goes to the podium without the walker. It's only at the end of lunch do I learn that she is functionally blind. What happened? Well, she had an operation three years before from macular degeneration, the surgeon failed to notice the medications that she was on, there was a hemorrhage and she woke from the surgery functionally blind. Now Ward is her seeing eye-man. He moves her around so that she knows exactly where she is facing and may be whispers to her or gives her a little sign as to who it is, so she is always able to greet people and interact with people as if she sees them perfectly well. And they go back up after dinner to her apartment and he narrates the news with her, discusses the news with her, that she is hearing and then he narrates the ball game. Well they had a cocktail party for me in the afternoon. They showed me all their albums, all of their children and how they had became close over the eight years that they have both been together; they were both widowed when they came into this independent living place. Now it's eight o'clock, they are going strong, I am exhausted. I finally got up the courage to ask the main question. I said, Catherine, do you and Ward still have an intimate life? She said, oh yes, she said, every night when Ward leaves he gives me a big hug and I give him a big kiss, may be two kisses. We don't have sex, she said, we are not married. So what that tells me oh, then Ward told me the real story. He said, when Catherine is a little wobbly, he said, I spend a night in the recliner in her apartment. And on nights when I sleep in my apartment, immediately beneath hers, he said, if I hear her fall out of bed and she is trying to go to the bathroom, I come upstairs and I lift her back into bed. That picture has stayed with me. It tells me that sex may be the last to go, but there is one thing that never ever needs to go and it's the only thing that survives all, including the end of life and that is, love. Thank you.