Being Mortals, What Matters in the End?

Death notice, The Star, and North Carolina Gazette, 29 July 1825:

DIED

At the residence of James Rainey, Esq. in Caswell County,

on the 19th instant, Mrs. Anne Samuel, aged 89 years, leaving

behind her near a hundred descendants.¹

Have you read the book, Being Mortal: Medicine and What Matters in the Endby Atul Gawande? Dr. Gawande is an American physician who has seen from inside the medical system, and from the patient viewpoint, how aging and death is perceived and dealt with in America. He tells us that doctors are not at all prepared to talk with patients and families about illness or dying. Americans are conditioned to think in terms of getting oldsters in “safe” places, following the accepted way in our times.  The aging person, the focus of this “move to safety” does not ask the right questions, or effectively voice their wishes. Families and patients alike defer to the medical system for the answer of ‘what to do with Mom.’ But, in fact, medical intervention, often extends the suffering and mental agony of end of life for the patient and their families.

Dr. Gawande gives us hope in his book. Innovative changes in concepts for institutional living for the aged or infirm (otherwise known as assisted living, nursing homes, or senior communities) place individual autonomy, quality of daily life over simply giving care to the end. “Safe” isn’t the only criteria, but what has meaning for the individual. Other options exist for seniors such as Intentional Communities, cooperative groups for seniors in neighborhoods to make needed services more accessible to those remaining in their homes.

What struck me in reading Being Mortalis that we, the elders need to do some hard thinking, planning and talking  long before one falls and breaks the hip and the kids, who live far away, come rushing in to put Mom in a “safe” place. Without the communication before the emergency, without  planning (whether the kids are willing to communicate or not), one faces a hurry-up decision most likely not to your liking! The responsibility is ours, so is our future. There are options and possibilities to explore. It does matter.

As a genealogist, over and over I’ve seen the family as the caregiver either for an elder or a young invalid or “defective” child (as the 1880 census labeled). Families lived in close proximity or even in the same household. They often worked the farm or small business together. Grandparents helped with children. If help was needed, family was there, friends and neighbors too. As I examine the Census records, it is clear that family members intentionally live close to one another in rural areas, and in towns too. Living in close proximity quite often made it possible for elders to remain in their homes with help close if needed.  Census and other documents also show the elderly living in a household, which may not be a parent living in a son or daughter’s home, but instead with cousins  or other relatives. Sure there were probably some issues with the aged or sick or invalid in the household, but that was then the accepted way. “Heaven’s Gate Nursing Home” wasn’t yet open for business.

Now back to Anne Samuel who died 19 July 1825 at the home of her daughter, Nancy Samuel Rainey in Caswell County, North Carolina. Anne had lived with the Raineys for at least twenty years. She was likely a productive part of the household. She had been widowed in 1777, then went on to run a sizable farm, provide food and materials to the Revolutionary War troops and raise ten children.

One of Anne Samuel’s daughters, Sally, ran her own farm as a widow for about 25 years, with two adult children (widowers themselves) living in her home. When Sally died in 1849, the adult children, now themselves elderly, went to live with a cousin, helping on his farm.

John and Margaret Samuel sold their farm in Kansas in 1885 and moved to be close to their daughter in Bourbon County, Kansas. John was 67, quite frail, was no longer able to farm his land. Margaret, age 63, was losing her sight. When John, a Civil War veteran, died in 1996 at age 79, their widowed daughter, Mattie, moved in with her now blind Mother. Years earlier, John and Margaret had taken in Mattie and her husband in their time of need.

James Gillan, who had lived in many years in McLean County, Illinois, close to his children and other relatives, was taken in by his daughter after suffering a stroke in 1906. He died at age 84 in 1907 at his daughter’s home. James Gillan, himself an Irish immigrant, also helped many relatives come to America and find work in the mid 1800’s.

My father remembered his grandparents, Frank and Abbie McCoy, well as they came to live with his family when they were very old and infirm, cared for to the end by his mother, Lola. Lola’s parents had taken in her young cousin when his widowed mother died. Frank and Abbie had also helped care for their terminally ill grandson.

These are just a few of my kinfolk who lived to the end of their lives in the accepted way of the times. For the most part, families, friends and neighbors were there to help and in turn were helped as well in their later years without the  barriers to quality of life by the medical system and institutions in place now and accepted as the way in our times.

  1. Death notice for Anne Samuel, The Star, and North Carolina Gazette, Raleigh, North Carolina, 29 July 1825, V.X.VI. ReelRaNCS, w-3, North Carolina State Archives.