Free Being Mortal: Medicine and What Matters in the End by Atul Gawande Page A

at all happy or adjusted. Never one to complain, she didn’t say anything angry or sad or bitter, but she was withdrawn in a way I hadn’t seen before. She remained recognizably herself, but the light had gone out from behind her eyes.
    At first I thought that this had to do with the loss of her car and the freedom that came with it. When she moved into Longwood House, she’d brought her Chevy Impala and fully intended to keep driving. But on her very first day there, when she went to take the car out for some errands, it was gone. She called the police and reported it stolen. An officer arrived, took a description, and promised an investigation. A while later, Jim arrived, and, on a hunch, looked in the Giant Food store parking lot next door. There it was. She had got confused and parked in the wrong lot without realizing it. Mortified, she gave up driving for good. In one day, she lost her car as well as her home.
    But there seemed to be more to her sense of loss and unhappiness. She had a kitchen but stopped cooking. She took her meals in the Longwood House dining room with everyone else but ate little, lost weight, and didn’t seem to like having the company. She avoided organized group activities, even the ones she might have enjoyed—a sewing circle like the one she’d had at her church, a book group, gym and fitness classes, trips to the Kennedy Center. The community offered opportunities to organize activities of your own if you didn’t like what was on offer. But she stuck to herself. We thought she was depressed. Jim and Nan took her to see a doctor, who put her on medication. It didn’t help. Somewhere along the seven-mile drive between the house she’d given up on Greencastle Street and Longwood House, her life fundamentally changed in ways she did not want but could do nothing about.
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    THE IDEA OF being unhappy in a place as comfortable as Longwood House would have seemed laughable at one time. In 1913, Mabel Nassau, a Columbia University graduate student, conducted a neighborhood study of the living conditions of one hundred elderly people in Greenwich Village—sixty-five women and thirty-five men. In this era before pensions and Social Security, all were poor. Only twenty-seven were able to support themselves—living off savings, taking in lodgers, or doing odd jobs like selling newspapers, cleaning homes, mending umbrellas. Most were too ill or debilitated to work.
    One woman, for instance, whom Nassau called Mrs. C., was a sixty-two-year-old widow who’d made just enough as a domestic servant to afford a small back room with an oil stove in a rooming house. Illness had recently ended her work, however, and she now had severe leg swelling with varicose veins that left her bedbound. Miss S. was “unusually sick” and had a seventy-two-year-old brother with diabetes who, in this era before insulin treatment, was fast becoming crippled and emaciated as the disease killed him. Mr. M. was a sixty-seven-year-old Irish former longshoreman who’d been left disabled by a paralytic stroke. A large number had become simply “feeble,” by which Nassau seemed to mean that they were too senile to manage for themselves.
    Unless family could take such people in, they had virtually no options left except a poorhouse, or almshouse, as it was often called. These institutions went back centuries in Europe and the United States. If you were elderly and in need of help but did not have a child or independent wealth to fall back on, a poorhouse was your only source of shelter. Poorhouses were grim, odious places to be incarcerated—and that was the telling term used at the time. They housed poor of all types—elderly paupers, out-of-luck immigrants, young drunks, the mentally ill—and their function was to put the “inmates” to work for their presumed intemperance and moral turpitude. Supervisors usually treated elderly paupers leniently in work assignments, but they were inmates like the rest.