Longevity means we get to experience life as an onion peeled layer by layer until nothing is left but the smell. One of the layers they take away is your car.
When you're old it might be okay not to get around much anymore--to sit in your comfy chair watching your soaps, to read the obits to see how your friends are doing, to nod off all dressed up with no particular place to go--but you like to know that your 1983 Impala is sitting outside ready for when you want to be an old lady driving only on Sundays. Giving up your car, handing in your keys, surrendering your license is a frightening signifier of frailty and dependence. Your last car is as emotionally redolent to you as your first. Deeply embedded in our culture and personal
identity, the automobile is the reverse transitional object of old age. David Winnicott coined this term--transitional object--for things like Linus's blanket. Children of a certain age carry around dolls, stuffed animals, and blankets as comfort for the times when they begin to operate without their formerly all-protective mother being right there. The transitional object is the passage from all-mommy-all-the-time, to some-mommy-some-of-the-time. This transition from dependence to independence is reversed when old people lose their car--one of their final comforts. Vans, buses, taxis, dial-a-ride, catching a ride with the kids or a helpful neighbor simply won't do. After a lifetime behind the wheel, you are no more interested in public transportation than you ever were.
I had an aunt and uncle in Florida. My aunt had Alzheimer's but was physically fit. My uncle was physically unable to drive but sound of mind. They'd go out driving--Aunt Molly at the wheel. Uncle Sam telling her where to go. So be careful when you're walking or driving in West Palm Beach.
The automobile permeates everything I do too, even as I count myself out of American car culture. As a New Yorker, I rode the subway and didn't even have a license let alone a car until I was twenty-three and moving out of town.
Recently, on an excellent New York publishing adventure, after my editor had taken me to lunch at a trendy Sohorestaurant, I was standing in front of Carnegie Hall about to meet with my agent and my cell phone rings with a call from a colleague at an assisted living center. Assisted living centers are the halfway home between home and the nursing home.
"They'd like you to come in when you can to evaluate this new resident to see if she can still drive."
As an itinerant psychologist, who travels around to nursing homes, I know quite a bit about skill assessment, and loud
alarm bells went off inside my head. Imagine you are a football player. You train by running through tires on tip toes. The result? You become very good at running through tires on tip toes. How that translates into running through 300 pound linemen who can do the fifty-yard dash in 4.7 seconds is quite problematical. If you want to assess some old lady's driving skills, get the old lady behind the wheel--if you dare. My last trip with my father behind the wheel was, shall we say, hair raising for my diminishing supply of hairs.
I can tell you if someone has mild, moderate, or severe dementia. But I know for a fact, e.g., my aunt, that those with dementia can drive adequately well--even if they don't know where they are going. I don't have dementia--I think--but I can get easily lost yet not be a danger to myself or others. A couple of years ago, while trying to figure out how to get from one nursing home to another I found myself on one of the few remaining dirt roads in Connecticut--a dead-end dirt road, no less. After this, I bought a GPS device in short order.
The lady at the assisted living center also had a family divided. Some of her kids said she could drive. Others argued no. More alarms going off in my head. I told my colleague I'd be happy to do a mental status evaluation, but let others conclude whether she could drive or not. I asked: Do we want to expose ourselves to the possibility that we said it's okay and then she would get behind the wheel and mistake the accelerator for the brake?
I've said the car permeates everything I do. I'm in a profession where, theoretically, I could continue to work well into old age--as long as I can manage to sit in a chair, comprehend what my patient is saying, and respond intelligently and intelligibly. But for the particular work I do now, I too need to drive. My job bears a family resemblance to truck driver or traveling salesman. We all share the road. We're all listening to the radio, talking on the phone, doing bad nutrition--in my case drinking endless Diet Cokes in a car littered with pistachio nut shells that don't all make into the commuter cup that held my coffee earlier in the morning. I can relate to the truck driver who flipped over his rig while reaching for his donuts.
I'm surprised I drive for a living. I'm not ashamed to say I can be a bit apprehensive about driving. Although as a child I could name every car and model year--back then there were obvious cars and model years--and I always had the latest brochures around, I don't feel the DNA of the auto flowing through my veins. This NASCAR thing. I just don't get it. Cars going in circles remind me of hamsters going in circles on a treadmill. Despite the curious fact that my father worked as a driving instructor, it took me three tries to pass the driving exam. The cobbler's children have no shoes, as they say. When I drive, and I'm not thinking about how dangerous it is, I find it kind of relaxing. But I'm never far from remembering Duane Hall, Annie's brother, with Alvy Booth at his side, "I have this sudden impulse to turn the wheel quickly, head-on into the oncoming car. I can anticipate the explosion. The sound of shattering glass. The flames rising out of the gasoline." Unlike Duane I don't have the death wish of turning my wheel, but I can imagine the Duanes lurking behind every other wheel.
Despite my fear and trembling, I can cope with being a traveling psychologist because no one is relying on me to show up with a pill for the agitated old man screaming in Room 14B regardless of the weather. Since therapy is somewhat devalued in my world of work, if it's snowing, I can wait and show up later in the day or tomorrow or even next week. They may be waiting for the psychiatrist on an emergency basis, but a competency evaluation is never an emergency.
Or to put it another way: Mental health is not a medical necessity.
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My book,
Nasty, Brutish, and Long: Adventures In Eldercare (Avery/Penguin, 2009), was a Finalist for the 2010 Connecticut Book Award. Click
here to read the first chapter It provides a unique, insider's perspective on
aging in America. It is an account of my work as a psychologist in nursing homes, the story of
caregiving to my frail, elderly parents--all to the accompaniment of ruminations on my own mortality. Thomas Lynch, author of The Undertaking, calls it "A book for policy makers, caregivers, the halt and lame, the upright and unemcumbered: anyone who ever intends to get old."
My web page.
