For millennia extended families have coexisted together in close proximity, and the shared responsibilities of caring for growing children and tending to declining elders was both a communal effort and a cultural norm. It is only in very recent times that family members have become geographically dispersed, with economic circumstances requiring two incomes to maintain the same standard of living that was enjoyed with one income in previous generations. This current cultural diaspora of family members and adult children have resulted in family systems in which aging parents have limited participation in the lives of blossoming grandchildren, and, conversely, can no longer rely on trusted communal support as eventual decline requires increased assistance.

When my mother was in her last years following a diagnosis of lung cancer, I felt a responsibility to ensure that the same level of support was available to her that I received throughout my childhood and young adult life. Living 400 miles away created the challenge of coordinating caregivers, finances, healthcare, estate planning, and, eventually, a hospice care team of professionals. While I considered this a sacred opportunity for reciprocation, this became a second full-time job amidst a busy professional and family life of my own. Being present for these last moments of relationship became complicated by daily caregiving stresses, burnout, and the conflict that naturally arises between family members trying to juggle life responsibilities with the needs a dying parent. During this time, I was unable to discover services immediately available to advocate and assist us in navigating the complexities of overseeing healthcare, dealing with financial institutions, lawyers and the intense emotions that arise as we lose a loved one.

The decline of parents presents the family with a special challenge that often reveals deeper conflicts that have long remained buried or avoided. Changing roles and responsibilities, requiring us to step forward to provide the basics of care, often revive childhood memories and surface old familial dynamics that have lied dormant with geographic distance and time. Primitive emotions often appear among siblings competing for love and for equity in estate provisions. The mess and revival of old issues, supposedly long left behind, become front and center as we navigate the constellation of early family dynamics and the irreconcilable relationships that often characterized this period of life. I imagine that it is impossible to engage this transitional time without reengaging many of the family conflicts that estrange us in earlier life. However, with all of this said, I found this time of my life to be profoundly clarifying, and an opportunity to lay to rest remnants of forgotten and unresolved issues that make relationships unworkable. I realized that my desire for my mother to have a peaceful and loving transition was mirrored in the family also arriving to some peace within our own relationship that allowed us to just be lovingly present with our mom as she took her final breaths. Within this sea of challenges, I am deeply grateful that I was able to return the gift of love that carried me through childhood, eventually making possible a life of my own.

Kenneth R Lakritz, Ph.D.