I just finished reading “My Mother, Your Mother: Embracing “Slow Medicine”, the Compassionate Approach to Caring for Your Aging Loved Ones” by geriatrician Dennis McCullough, MD.

Although there have been a host of books about “death & dying” and “end-of-life” care as well as “how-to” books about financial trusts and living wills, this is the first book I’ve seen that tenderly encapsulates the beauty and pathos of what he calls “late life.”

The book is chock full of practical tips which may have read as a “do as I say” text were it not for the fact that he begins every chapter with a tender accounting of his own mother’s end-of-life journey and what it meant to him and his family. The forging of memoir with solid advice has produced a very strong, practical, humble and wise treatise.

.McCullough takes us through the “eight stations of late life”: Stability, Compromise, Crisis, Recovery, Decline, Prelude to Dying, Death, and finally Grieving and Legacy. We’ve all been schooled in Kubler-Ross’ 5 stages of death and dying (“the grief cycle”), but what about the 10-20 years preceding the final passage? In this book, which I have honored with the pet name “Deep Geriatrics”, McCullough shares profound insights about caring for the elderly in their last years.

The book seemed to crawl along at a snail’s pace which evoked a feeling that in addition to “Slow Medicine” I was also experiencing “Slow Literature”. But in concert with that reaction was my awareness of a great deal of poetry in the prose, which made the slowness not just tolerable but pleasurable. I later read in the acknowledgments that McCullough’s poet-wife was responsible for some of the lyricism. The slowness of the way the book read became a metaphor for the ‘slow’ movements-- a “stop and smell the roses” effect. As I meandered from station to station, (chapter to chapter), I may have disembarked sooner were it not for the fact that I am currently caring for my 96 year old father and needed all the advice I could get.

The advice came in the form of a prescription for “Slow Medicine”. For example in the Station of Stability he warns us to be wary of our denial and instead “anticipate the onset of interdependency” an elegant way of saying “get ready, your parents are going to need you more now.” Sounds simple but by forming a partnership with your parent or patient early on while they are still stable you can potentially circumvent 30% of future ED visits according to McCullough.

In the “Station of Compromise” McCullough educates us about the nuts and bolts of senior independence. The goal of course is to delay institutionalization as long as possible. As nurses we’re all familiar with ADLs (Activities of Daily Living) but I was not familiar with the terms IADL (Intermediate Activities of Daily Living), nor AADL (Advanced Activities of Daily Living). The AADLs are activities that allow an elder to still be active in the community and the IADLs are ones that render a senior able to live alone with some assistance. The basic ADLs are tasks that a person can perform with a caretaker or family member nearby. These distinctions make all the difference and help in assessing our patients and parents in order to know how to best help them.

McCullough also urges us to separate “aging, disease, and illness” in order not to allow the labeling of our seniors which may cause overly aggressive treatment. This labeling may also result in ignoring the restoration of health after an illness by not paying attention to the restoration of healthy habits.

I won’t go into all of the eight“Stations” but I do highly recommend this book for nurses and everyone who is concerned about their aging patients, parents, relatives, friends or neighbors. Although sometimes repetitive from chapter to chapter I trusted that McCullough’s guidelines and reminders were worth bearing in mind.

You can read my blog posting about “Slow Medicine” at this link: http://forums.nurse.com/blog.php?b=227

“My Mother, Your Mother: “Embracing “Slow Medicine” the Compassionate Approach to Caring for Your Aging Loved Ones.” By Dennis McCullough, MD
Published by HarperCollins Publishers 2008, ISBN:978-0-06-124302-8