The lift is groaning again, a metallic shriek that echoes off the linoleum and vibrates in my teeth. It is 2:12 PM, and Mr. Henderson is refusing to budge. He is 82 years old, with skin like wet parchment and a grip that can still crush a soda can when he’s agitated. I am trying to guide his legs into the sling, but he is convinced I am a TSA agent trying to steal his shoes. I’m an advocate, a supposed expert in the dignity of aging, yet here I am, sweating through my scrubs while a mechanical arm wheezes under the weight of a man who just wants to sit in his chair until the sun goes down.
We talk about ‘care’ as if it is a quantifiable substance, something we can distribute in 12-minute increments. The industry is obsessed with the metrics of the sunset years. We measure heart rates, caloric intake, and the precise 42-milligram dosage of a mood stabilizer, but we ignore the static in the room. There is a specific kind of silence that exists in these facilities, a heavy, sterile quiet that smells of bleach and overcooked peas. It’s the sound of people waiting for a conclusion that everyone is too polite to name.
I’m not perfect at this. In fact, my brain is starting to fray at the edges. Just this morning, I was standing outside the facility when a tourist stopped me to ask for directions to the old clock tower. I pointed them three blocks east, toward the river, even though the tower is clearly two blocks west, right past the bakery. I watched them walk away with such confidence, and I didn’t even realize I’d lied until they were out of sight. My internal map is failing me. Or maybe, after 32 years of navigating these halls, the world outside has simply stopped making sense. I spent the next 22 minutes wondering if they ever found it, or if they’re still wandering by the water, looking for a landmark that isn’t there. It’s a strange feeling, being the person everyone relies on for guidance while you’re secretly losing your own North Star.
Everyone wants efficiency. The board of directors at the latest facility I consulted for-a sleek, $202 million glass-and-steel monstrosity-kept using the word ‘optimization.’ They wanted to optimize the bathing schedule. They wanted to optimize the social hour. But you cannot optimize a human being’s transition into the unknown. Efficiency is actually a form of neglect. When you make a process ‘efficient,’ you remove the margins. And the margins are where the life happens. It’s the 12 minutes spent talking about a cat that died in 1962. It’s the 22 seconds of holding a hand that feels like a bundle of dry sticks. If you optimize those away, you are left with a factory that produces nothing but breathing bodies.
[the margin is where the soul resides]
I find myself fighting for the most mundane things. The temperature is a big one. People don’t realize how much the environment dictates the behavior of a person with dementia. If a room is too cold, they don’t just feel a chill; they feel a deep, existential threat. They become combative, confused, and prone to ‘sundowning.’ We had a wing where the central air was so erratic that 12 different residents were being medicated for ‘aggression’ when they were really just cold. I spent weeks arguing that we didn’t need more pills; we needed better climate control. We needed a way to give each resident back the power to choose their own air. I remember looking into localized heating and cooling options late one night, falling down a rabbit hole of HVAC specs, and thinking about how something like Mini Splits For Less could actually be a tool for human rights. If you can’t control your own body, the least we can do is let you control your own 72-square-foot patch of the world.
It’s the little things that break you, though. It’s not the big policy failures or the 102-page regulatory reports. It’s the way Mr. Henderson looks at me when he finally realizes I’m not the TSA. He looks ashamed. He’s 82, and he’s being hoisted into the air by a woman who is 52 and struggling with her own back pain. There is no dignity in the mechanical lift, no matter how many ‘person-centered care’ stickers we put on it. We are all just pretending that this is a natural way to live. We’ve professionalized the end of life to the point where it has become a series of billable tasks.
I remember a woman named Eloise. She was 92 and had the most incredible collection of silk scarves. She didn’t know her own name most days, but she knew the texture of silk. The facility wanted to take them away because they were a ‘strangulation risk’ or a ‘sanitation issue.’ I fought them for 32 days over those scarves. I told them that if they took those scarves, they were killing her faster than the heart failure ever would. I won that battle, but I lost the one about her cat. They said a cat was a liability. So Eloise sat in a room that was exactly 72 degrees, with her scarves, but without the one thing that breathed with her. We call that ‘safety.’ I call it a slow-motion robbery.
I often think about that tourist I misled. I wonder if they’re still out there. There’s a metaphor in there somewhere, something about how we’re all giving each other the wrong directions while pretending we know exactly where we’re going. I’m an advocate, but I’m also a liar by omission. I tell families that their loved ones will be ‘comfortable’ and ‘well-cared for.’ And it’s true, in a clinical sense. They will be fed, they will be clean, and they will be safe. But they will also be profoundly lonely in a way that no 22-page brochure can ever capture.
We are a society that is terrified of the mirror. We see the elderly and we see our own future, a version of ourselves that is slow and inconvenient. So we build these ‘optimized’ silos to hide them away. We tell ourselves we’re doing it for their benefit, for their ‘level of care.’ But we’re doing it for us. We’re doing it so we don’t have to watch the slow, messy, 12-year decline of the people we love. We want the end to be a clean break, a 2:42 PM notification on our phones that everything has been handled.
I had a breakdown in the breakroom about 22 minutes ago. It wasn’t because of a tragedy. It was because I saw a list of the $112 monthly ‘activity fee’ charges on a resident’s bill. The activity was ‘balloon volleyball.’ We are charging people over a hundred dollars to bat a balloon around a room while a 19-year-old on her phone watches the clock. It felt like a joke that wasn’t funny. I threw my lukewarm coffee into the sink and just stood there, staring at the 12-cup pot until my vision blurred. I’m supposed to be the one who changes the system, but the system is so large and so cold that I feel like I’m trying to heat an entire warehouse with a single candle.
And yet, I stay. I stay because of the 32 seconds of clarity Mr. Henderson had yesterday. He looked at me, really looked at me, and said, ‘Indigo, you’re wearing two different colored socks.’ I looked down, and he was right. One was navy, one was black. We both laughed until he started coughing, and for those few moments, the facility disappeared. The lift disappeared. The 82 years of weight disappeared. We were just two people noticing a mistake. That’s the real work. The mistake is the most human part of the whole day.
I suspect we need to stop trying to fix aging. You can’t fix a sunset. You can only witness it. We need to stop looking for ‘solutions’ that involve more sensors and more automation. We need more people who are willing to be uncomfortable. We need more 22-year-olds who aren’t afraid of the smell of old age. We need to realize that a person’s value doesn’t drop to $0 just because they can no longer contribute to the GDP.
Last night, I went back to that bakery near the clock tower. I stood there for 12 minutes, watching the tourists. I saw a couple who looked exactly like the ones I’d sent toward the river. They looked tired, but they were holding hands. I wanted to go up to them and apologize, to explain that I was distracted by a man named Mr. Henderson and a Groaning Lift and the weight of 32 years of being a professional witness. But I didn’t. I just watched them buy a croissant and walk toward the tower, finally heading in the right direction.
I realized then that I’m not just an advocate for the elderly; I’m an advocate for the mess. I want the rooms to be 72 degrees, yes. I want the medicine to be right. But more than that, I want the scarves to stay. I want the cats to stay. I want the two different colored socks to be noticed. We are so busy trying to make the end of life perfect that we’ve forgotten to make it lived.
I’m going back in there now. It’s 3:32 PM, and the shift change is happening. The hallway will be full of people in 12 different colors of scrubs, all rushing to finish their charts so they can go home to their own lives. I’m going to sit with Mr. Henderson for a while. We won’t do any activities. We won’t optimize anything. We’ll just sit there in the 72-degree air and wait for the sun to hit the 112-degree angle where it reflects off the window of the building across the street. It’s a small thing, but it’s real. And in a world of $202 million facilities and optimized neglect, real is the only thing that matters anymore.