My Mother, Your Mother: A Book Review

My mother died at the age of 83. She had Alzheimer’s. My father, age 88, today suffers from failing health and dementia. So I read Dennis McCullough’s new book with particular interest. It’s entitled My Mother, Your Mother: Embracing “Slow Medicine,” the Compassionate Approach to Caring for Your Aging Loved Ones. Dr. McCullough is a geriatrician whose own mother endured late-life health challenges and died while he was writing this book.

The book is designed to be a unique combination of up-to-date geriatrics, seasoned advice, and personal memoir. The combination works.

McCullough’s concept of “Slow Medicine” (he writes it with capital letters each time) is a central theme. Rather than having our elders be automatically and quickly subjected to “enduring, impersonal medical protocols in strange, disorienting surroundings,” Dr. McCullough proposes that Slow Medicine be practiced by health professionals and families together. This is a kind of care that “stands back from rushed, in-hospital interventions and slows down to balance thoughtfully the separate, multiple, and complex issues of late life.”

“Slow Medicine,” he writes, “embraces the unsung work of daily attention that is the greatest need and firmest foundation for longevity and quality of life at the farthest reach of age.”

McCullough’s book has two significant strengths. He has formulated a way of looking at the aging process that he calls “the eight stations of late life.” In individual chapters he names and describes these “stations” as if in a progression: stability, compromise, crisis, recovery, decline, prelude to dying, death, and, finally, grieving/legacy. His formulation helps the reader understand that all parts of late life are not exactly the same and there is commonly a pattern to the health challenges that many elders and their families experience.

A second important strength is the book’s emphasis on practical applications. A complete list of suggested tasks for family members makes up a major portion of each chapter, written for those caregivers who want to do their best for their elders in what can be very trying circumstances. It is clear that McCullough is familiar with what helps and what doesn’t help in these situations—he has done his own practical work of listening to and learning from both older adults and their families through the years. I found several of his suggestions to be both original and astute. In the station of compromise: “Practice witnessing rather than intervening.” In the station of crisis: “Resist overly aggressive treatment and its hazards.” In the station of decline: “Make caregivers part of the surrogate family.”

He effectively uses stories from other people’s lives, as well as from his own, in a way that instructs, validates, and normalizes.

Would I change anything about the book? I would have appreciated some introduction to the idea of the eight stations that he proposes, more than the two sentences that appear at the very end of Chapter 1. Why “stations” rather than “phases” or “stages” or “periods”? I know there is a reason, and I’d like to have his thoughts about it. Why did he choose that particular word, and what does it represent for him? How rigid is this order of the eight stations? How linear are the stations? How universal are these stations? I would like to have known more about the author’s thoughts, especially since it’s such a critical concept for him.

That said, My Mother, Your Mother is one of the best books I have read on the subject of caring for our aging loved ones, if not the best. It is helpful, honest, both understandable and understanding, and very wise. It has provided me with new insights as I deal these days with my own father.

While Dr. McCullough no longer maintains a clinical practice as a geriatrician, there is a real sense in which he has continued his practice by writing this book. I encourage you to have an appointment with the doctor by reading what he has so thoughtfully written.

Let’s Try Slow Medicine: An Interview with Dennis McCullough, M.D.

Dennis McCullough, M.D. is the author of My Mother, Your Mother: Embracing “Slow Medicine,” The Compassionate Approach to Caring for Your Aging Loved Ones. A graduate of Harvard College and Harvard Medical School, he has been a family physician and geriatrician for thirty years. Today he’s on the faculty of Dartmouth Medical School. I caught up with him in Vero Beach, Florida, where he’s temporarily based while promoting his book.

Jim: Your book My Mother, Your Mother has been out for five weeks. What’s been the response?

Dennis: Very heartening. The New York Times has reviewed it, and that review was picked up by The International Herald Tribune. I’m scheduled to be on National Public Radio. Interview requests keep coming in. I feel privileged to have so many opportunities.

Jim: Did you expect such immediate results?

Dennis: No, I thought the book would catch on by word of mouth, slowly. Instead, it may start an overdue national dialogue.

Jim: When did you begin writing it? And why?

Dennis: In 2002 I developed a painful auto-immune disease that put me on crutches for two years. I was forced to give up my clinical practice. My wife Pamela Harrison, who’s a poet, and others urged me to use that time to write. So I wrote for a year, trying to figure out what I wanted to write about. I ended up mostly writing about my experiences with elders. I composed something that would be appropriate for elders themselves to read. Later my agent and HarperCollins decided to publish my work but they wanted it written for a different audience-those 40 to 65 who are dealing with elderly family members. So I started all over again and wrote for another year or more.

Jim: Your book is terribly practical, with plenty of advice.

Dennis: That’s how we geriatricians work. We emphasize how people function, their activity levels, what they’re able to do. We pay attention to how they get along in daily life, and what can help them get along better. We concentrate on how this older person has evolved, how they have become more highly individuated as they’ve aged, believing that their lives are not defined by their diseases or by problems that may impinge. We make families an important part of the process too, if possible. Consequently, we’ve developed tools and approaches that are different from other physicians. We’re very collaborative.

Jim: Your book also has a personal dimension.

Dennis: As it happened, my own mother was going through many late-life challenges at the same time, so I was writing from the center of my life and my heart. My own story became a part of it all. I had hoped that she could see the book published, but she died last April.

Jim: I’m always intrigued about what happens when a physician gets a serious illness. What happened to you? What did you learn, both as a person and as a geriatrician?

Dennis: It was quite an experience. I learned how fast one can age, how much one can lose in the process, and how much effort it can take to return to normal living. I developed a different perspective as an ill person. I felt shrunken and vulnerable. I learned what it felt like when everyone looked wonderingly at me when I had to move in a wheelchair through a busy airport. I became more sympathetic to, and more admiring of, those who are ill, especially those who are older. I came to respect them for what they have to deal with day after day, including the psychological withering. And I never knew that rehabilitation is such hard work! It was all very eye-opening.

Jim: How did your thoughts about “Slow Medicine” come into being?

Dennis: I wanted to give older people and their families an easy way to think about a first response when healthcare issues develop. Slow down! Most problems are not emergencies. Increasingly I saw that medical centers and physician practices had become so geared toward efficiency that they neglected depth understanding of the patient and their living context and their supporters. More than that, older patients are often channeled toward medical procedures that are suited to doctors’ schedules more than patient needs. Experience teaches me that older people need time, maybe more time than normal, to absorb information about a serious illness or a major operation. They deserve the chance to share ideas and medical recommendations with those they trust rather than being automatically scheduled for testing or treatment. Rather than feeling this tremendous rush to move ahead, elders deserve to have time to ponder, to get their minds around all that’s happening. Their families need time to “drop back” too, so they can let their thoughts simmer. They all need time to talk, to process.

Jim: So when you’re dealing with a single patient, you’re dealing with more than a single patient.

Dennis: In our culture we’ve become accustomed to individual autonomy as far as healthcare. As a physician, you sit facing a person, one-to-one. You offer both individual freedom and individual responsibility. But with older patients, you have a strike a careful balance. You must respect their autonomy, but you also must realize that the whole family can be affected. Moreover, the whole family also has something to contribute. I think it’s interesting how many Italian oncologists handle a cancer diagnosis for an older person. They believe it’s unkind to subject that person to news that’s hard to bear until the family has had the opportunity to learn about it first. Then the information gradually and lovingly diffuses to the older person.

Jim: There’s a section in your book about grief and you write that your own losses as a person and as a physician “accumulate and flow together.” I was touched that you would acknowledge that as a physician.

Dennis: Up until the present, most physicians have been acculturated to move on quickly after any losses they’ve experienced. They may do that literally by leaving a room quite quickly when the news is bad. Seldom is time or importance given to debriefing one’s hurts and sadnesses or to grieving one’s inevitable losses. When that’s the case, physicians don’t get in touch with how these ungrieved losses impact both themselves and their relationships with their patients. And most physicians experience many losses through the years, one after another. In recent years I’ve tried to become more aware of my grief and to understand if a particular grief is a result of what’s happening in that moment or if it’s from an earlier loss, one that I need to separate out from this present experience with the patient in front of me.

Jim: I have to ask: do you really believe that Slow Medicine can be effectively practiced in today’s modern, fast-paced healthcare environment?

Dennis: Yes, I believe it can. That’s especially the case for frail elders today. Slow Medicine can be a win/win proposal. It can provide better care for our elders and their families, and it can also assist healthcare systems that have become clogged up with performing procedures that may not be necessary. I believe growing pressures within our healthcare system may help make this change come about.

Jim: I have two final questions. First, as a geriatrician and practitioner of Slow Medicine, if you had only one thing you could say, what would you say to today’s elders and their families?

Dennis: I’d say, others really are ready and willing to help you, so reach out and overcome any sense of isolation you may feel.

Jim: And if you had only one thing to say to today’s professional caregivers?

Dennis: I’d say, listen. Listen deeply to what you hear and also to what’s not being said. And listen anew each day, because change is always going on. Continually keep your ear open, and your heart open, to what someone wants to say.

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