A husband and wife, let’s call them John and Joan, have 2 children.  They have had middle-income earnings and saved for their retirement.   They now live in the (big) house where they raised their children.  Their income comes from social security, and IRA, and a small amount of income from a securities account.  They are 85 and 86 years old.  

During the past few years, they have started to progressively decline mentally and physically.  This is no surprise, since they are both older than average life expectancy.  (Most people over 85 have some sort of dementia).  John and Joan meant to have estate-planning documents (wills, health care proxies, powers of attorneys, etc.) but they never got around to it. 

John and Joan cannot take care of themselves in the house.  They are barely able to pay their bills (although they have enough money to do so, and are confused about what they have and what they can afford.  They have trouble climbing the stairs.  They are both still driving (small distances, slowly), but clearly are a threat to themselves and others on the road.  (Their refusal to stop driving is a symptom of their dementia.) 

John and Joan are only able to stay in their house because of the assistance of their daughter and her husband, who are driving 480 miles every week, and taking turns staying with the parents.  They are leaving their children (young adults who live with them) at home with only one parent at a time.  The daughter and her husband are at the end of their rope.  

John and Joan want to stay in their home on some days, and on others, they want to move to an assisted living facility.  When a lawyer came with power of attorney and health care proxy papers, they decided they did not want to name anyone.   With proper organization, they could hire home health care workers during the day, and continue to stay in their home for a while.   The help they need to stay in their home wouldn’t cost very much. 

The parents are getting very close to the point where, if they do not voluntarily accept help from their children, things will spiral down, and the parents will be in danger.   Then the children will need to ask for an involuntary guardianship/conservatorship.  The children do not want to do this, because they love their parents, and know their parents will hate them for it.  It’s not a good way to end a family history. 

So, if you are in your sixties, seventies, eighties (or older), do your planning now.  See the lawyer of your choice.  Try to plan for a smooth transition between you and the ones you trust.  Make it easy for your loved ones.  Otherwise, you will sadly be leaving them as a burden, which I’m sure you don’t want to do.

 © Laurie Israel.  2011.

Many patients are now living longer with incurable diseases (such as cancer) so that it is difficult for people to accept the information from their doctors that no further options are available.  (It is also difficult for doctors to admit that they are at the end of their ability to help a patient.)  What results is a trend to pursue a cure, even though it often destroys the possibility of good quality last days, surrounded by loved ones, in complete physical comfort at end of life. 

Studies show that less aggressive end-of-life care can actually result in living a few months longer and with less depression.  But in order to have that, one must give up hope for a cure.  I have never been in that situation and don’t know whether I would opt for aggressive treatment, or if I would choose palliative care. It is a very weighty decision. 

When making end-of-life decisions, you (or your families) need to be informed of all of the medical and palliative options.   Many terminally ill patients choose comfort care after receiving realistic information about their change of survival and how difficult and painful future treatment is likely to be. 

It is good to have end-of-life conversations with your family.  I had many of these discussions with my former mother-in-law, Marian (who remained my friend after the divorce) before dementia set in.  She told me she did not want to live a life that she could not reasonably enjoy.  By the time her dementia set in, she was in no position to make arrangements to end her life.  Her loved ones cannot help – assisted suicide is considered murder in most states (although not in all countries around the world).

You could look Marina’s plight as a waste of scarce resources.  Her medical and caretaking costs are huge.  She will never get better absent a medical advance tantamount to a miracle.  This money could be used for dementia research, or for starving people in the world, or to help fix environmental problems.

What if my mother-in-law had been given a choice of ending her life 5 years ago?  Could she have made that decision and put it into effect?  It’s involves determination and set of actions very few people can accomplish.  In a way, then advanced cancer has the advantage that you will die, without having to accumulate pills to do it yourself.   That is a fortunate silver lining to having a dreaded disease such as cancer.

© 2010 Laurie Israel.  All rights reservied.

Fanny Farmer was born in 1857.  An illness (perhaps polio) during high school rendered her lame, and in those days, unmarriageable.  She turned to cooking, and became a cooking teacher, eventually forming her own cooking school, and eventually wrote her cookbook. By the time she died in 1915, 360,000 copies of her book had been sold.   It has been revised continuously throughout the years, selling millions of copies.  I remember there was a well-used copy in my home growing up.

Looking at the 1896 edition, I found some surprises.

There is a chapter for recipes “especially prepared for the sick”.  The introduction asserts that “statistics prove that two-thirds of all disease is brought about by error in diet”.  Perhaps the incorrect proportions were used, Farmer maintains, or the food was improperly cooked.  So much for germs, airborne diseases, and bacteria, not to mention cancer, strokes and heart attacks.

She emphasizes food presentation in serving the sick – select the daintiest china, finest glass, and choicest silver, making changes as often as possible, she says.   I agree with her that aesthetics are important to sick people – why just slop the food on a plastic plate just because a person is very sick.  That’s just plain unfair. 

The good foods for the sick are all of the mealy type, what we used to term as porridge in the old days.  (Remember the Three Little Bears – wasn’t there some porridge in that story?)  Flour gruel is one of the suggested dishes for sick people, made of 1 tablespoon of flour, 2 cups of milk, and some salt.  Farina gruel (which I actually remember from my childhood along with the requisite enema my mother so lovingly administered) is made out of boiling water, farina, milk, egg and salt.   For the adventurous, using Indian meal instead of flour or farina results in “Indian Gruel”.    I wondered if the food Fanny was suggesting made people sicker. 

There are also many liquid foods to offer the sick.  Barley water is highly recommended. Toast water is made with toast.  (The toast is made, of course, in the oven, not the toaster – we learned how to do this the old way back in 1958 in cooking class. )  The toast is crumbled, soaked in water, strained through cheese cloth, and seasoned.  Seasoned with what, one might ask?  Fanny is mute on this topic.

Sick people’s food gets a little more exciting as you go down the list, which includes eggnog. There are several eggnog recipes, and they all include brandy.  

Boiled beef essence is also good for sick people, she maintains.  In those days beef essence didn’t come in a cube or a carton or a can.  It is rendered by cooking steak round for 3 minutes, cutting the “bleeding” piece into 1 inch and 1 ½ inch cubes, then “gashing” each piece two or three times on each side.  After that, you express the “juice” (blood, actually) with a lemon squeezer and put it into a cup.  Finally, you set this dish in hot water – but not too hot as to actually cook the meat or “coagulate” its juices.  Sounds pretty grim. 

Have you ever heard the expression “milquetoast”?  It is refers to a weak, ineffectual or bland person (male).  The word is derived from a character in a 1924 comic strip The Timid Soul.  It probably refers to the nature of milk toast, which was an important food in 1896, based on the number of Fanny Farmer’s recipes for it.

The basic milk toast recipe is to add water to flour to make a paste, add milk and cook, and salt and butter, then dip slices of toast in it.  Remove the toast to a serving dish.  Pour the remaining sauce over the toast, and serve.  Sounds fairly unhealthy?  Maybe it was the milk toast that made people sick in those times.   

There is a robust section on donuts, but that was before Dunkin’ Donuts took away peoples’ will to make donuts at home.   People had all the time in the world I the age before multi-tasking.   They make themselves sick frying in deep fat (animal?), and if needed, refer to Fanny’s recipes for the sick afterwards.

There is an interesting chapter on soup garnishings (egg balls, noodles, flour dropped into boiling grease, etc.) and force-meats.   I have not heard mention of force-meats in at least 50 years, and was interested in learning what it was.

A force-meat is a concoction that is made as follows:  cook stale bread crumbs and milk to a paste, add egg and fish (or chicken or clam or salmon, etc.) pounded and forced through a puree strainer.  It is then shaped into small balls and plopped into to the soup to cook in it.  

There are some very interesting recipes in the book that I would like to try.  One is champagne sauce, to use on fish or meat.  You start with Espagnole sauce, which is made with what we now call “Italian” seasonings, and brown stock, itself made with beef and seasoned copiously.  Reduce it, add two tablespoons of mushroom liquor (where am I going to get this?), a half cup of champagne, and one tablespoon of powdered sugar.   

Now I know where my mother got her prune whip recipe, one of my least favorites of my mother’s fine cooking.  It’s here in the Fanny Farmer cook-book.  You add the whites of 5 eggs to prunes that are “picked over” and washed.  (What did they find on them to have to pick them over?)  Remove the stones of the prune (those are the pits — very smart move), and rub them through a strainer, adding sugar.  Then  beat in the whites of the egg until stiff, bake twenty minutes, then feed to unsuspecting children who hate the dish.  I can still recall the taste 60 years later.  (I think my siblings actually liked prune whip, which I’m sure encouraged my mother to keep making it.)

When I wasn’t getting attacked in my childhood by the prune whip (or the enemas), I could take a rest and sample the various lovely “chafing dish” recipes Farmer suggests.  Welsh Rarebit was staple in our post-World War II suburban Jewish home.   It has nothing to do with rabbit.  My mother made it just the way Fanny said to, and we all loved it.  Mother may have put a little beer in it, as is required for Fanny’s Welsh Rarebit II recipe.   Welsh Rarebit could make boring American cheese into something exciting, but was probably not that healthy.  (Cream and butter are also in the recipe.  Maybe partly explains why my siblings and I have weight problems.)

So if Fanny Farmer didn’t kill you with her food recipes, she could nurse you back to health with the dainty silverware, the gruel and the raw beef.

I hope you have enjoyed this little jaunt through earlier times.  Bon Appetite to you.