It takes action and sacrifice to include our elders in our life – but where loneliness persists, ill health follows | Ranjana Srivastava

I call my friend to chat only to find her grappling with funeral arrangements; her usually composed voice chokes and I develop a tear in my eye myself. Our friendship traverses not only our training and her stellar career but also time spent in our obstetrician’s waiting room, frantically searching the zoo for lost children and deciding which dog to get.

It’s natural to wish that no misfortune ever clouds the days of those we hold dear, but this is as unrealistic as wishing the sun never set.

Her grandmother went into hospital for a necessary procedure, but the temporary cessation of her blood-thinner caused a fatal stroke. Hours ago, my friend had dropped in to find her in good spirits, looking forward to coming home.

“Grandma” survived the Nanjing massacre of 1938; as a child she witnessed the mass destruction of her relatives and neighbours by soldiers of the Japanese imperial army who had seized her home town. The second world war followed, imposing more deprivation and hardship – she left school as a child, resolutely teaching herself the survival skills she’d one day employ to raise her own family.

I met Grandma after she moved from China to Australia, her old age defined by actuarial standards, as far as she was concerned. One evening, my friend invited us to a “casual” dinner; the table groaned with so many dishes that two surfaces had to be joined together to fit them. Interspersed among the “regular” delicacies there were several dishes that I had only read about. Nothing was ostentatious, yet the effect was that of a happy feast in a busy family home where homework peeked from corners and fridge magnets held school reminders.

“Grandma cooked tonight”, my friend smiled, and my mortification felt complete. I wondered how to hide my hastily made chocolate cake with a dusting of sugar to make up for the icing I couldn’t be bothered making. In the end, I elected to succumb to my awe at the slender nonagenarian who had spent the whole afternoon cooking for us and now beamed as we vanquished the offerings.

She ate little and said less, but her lack of English felt immaterial in an air rich with the language of love. Aside from our translated thanks, every time we tried a dish, there were no gratuitous attempts to engage her. Reverence was unspoken, and her presence enough.

I thought then of my grandparents, all of whom died young, and wished upon my friend’s children the enduring gift of great-grandparents.

When loss hurts, we hasten to normalise it. Nodding to my work as an oncologist, my friend sighs that no one ought to complain about the loss of a 97-year-old matriarch who died quickly. And yet her voice catches as she laments that it is hard to lose the young because it seems unfair, but it is also hard to lose the old because with them goes their wisdom.

This reminds me of an African proverb: the death of an elder is like a library burning down. If you ever watched Grandma turn a slab of bean curd to hair-like strands or swiftly darn socks and sew Scouts’ badges, you knew that with the right opportunities, she could have been a surgeon like her brother. If you didn’t cut corners, you could learn to cook from a master chef.

And if you stayed with her stories, you stood to be transformed by the life lessons she gently conveyed. They were lessons in frugality, humility, practicality and generosity, things that so many of us struggle to learn for ourselves and teach our children. Grandma achieved this with aplomb without once shouting at anyone to get off their screen or threatening to smash the Xbox. I tell my friend that it is utterly befitting to feel unmoored by her loss.

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A 97-year-old Grandma on a treetop walk, using the wheelchair as frame Photograph: Supplied

The hardest thing for my elderly patients is not the fear of being ill but being ill and lonely. Doctors can treat disease, but our methods exacerbate loneliness – and where loneliness persists, ill health follows. The revolving door of hospitalisation is powered by isolation.

Knowing this, Grandma’s family took pains to make her visible. On a recent treetop walk (yes), instead of assuming she was incapable or uninterested, they hired a wheelchair. But buoyed by nature, she jumped out to walk, turning wheelchair into walking frame! The journey took much longer but the photos are priceless.

My friend is a rare combination of an empathic clinician and successful researcher. She has children and PhD students. She volunteers with the Scouts and delivers keynote addresses. She and her busy husband need no excuse to stick to their own needs, yet they have made a conscious decision to widen their circle of concern. Slowing down, literally, and otherwise, to honour the elderly calls for self-awareness and consistent effort – qualities honed despite the demands of modern-day life.

I have been fortunate to watch the deliberate action and personal sacrifice it took to to get to the point where four generations saw that it was as joyful and fulfilling to give as to receive love. Now, sifting through memories, my friend wonders how best to mourn the dead. I muse that after attending many services, I have come to think that a fraction of the fanfare reserved for funerals could ease the course of a life.

I see far too many of my patients die alone, their suffering compounded by the lack of love and belonging while their relatives say they will be there “for the end”. But the best parting gift of all is to be present when we are fully alive and well, to give generously of our time and attention, knowing that the end is unpredictable.

My friend and her family kept giving this gift for decades, one meal, one story, one outing at a time. They did not need a lavish last hurrah, because every day that Grandma lived she knew that she was loved.

Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death



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