Panama 2018: Reflections Post-Trip

I’m always trying to distinguish what about the Panama experience is unique to that culture — in which case I give a lot of deference — and what is common to issues like aging and diminishment and family tension regardless of where they occur. I’m deeply engaged in the story of aging myself, although with very different circumstances than those in which Minga finds herself. We’ve always learned from each other. I have a powerful sense that there is learning for me in bearing witness to what she is going through, although I’m not yet sure what that learning is.

When I am, I’ll share what I come to know.

On this trip I found myself smack dab in the middle of family tension around Minga’s treatment, her compliance with medical direction, and the issue of who gets to make the decision about where she is going forward.

I’ve taken a strong stand in supporting her right to make the decision to at least attempt to return to Rio Hato after each dialysis treatment, to the point of leaving enough cash for transportation for her and whoever accompanies her over the next three months — a reasonable trial. That has placed me in sharp conflict with almost all of her nine adult offspring, who are united in feeling that Minga must stay in the city so they can oversee what she eats and drinks.

There are two issues, I think — one specific to the culture and one not. In rural Panamanian culture, there is less independence among family members. Out of necessity, they are each other’s safety net. In our culture, people over 70 who remain cognitively able and are financially stable — through a combination of our own savings and government safety nets like Social Security and Medicare — retain the right to make decisions for ourselves. We might ask close family and friends for advice, but for the most part we have the final word. I think that is not true in rural Panamanian culture. In language that was very jarring to me, Minga’s family insisted it was their right to decide her path forward, because she is now so ill. I simply said we disagreed, that I understood what they were telling me but still maintained that Minga has lost her kidneys, not her mind, and gets to have this three month trial.

I’m not going to be there, so Minga will have to stand up for herself against hurricane force opposition.

The part that I think generalizes across cultures is that Minga’s family is far from being at peace about the fact that she will, like all of us, die — in her case, maybe sooner rather than later. They interpret her failing to maintain strict compliance with doctor’s orders for what she can eat and drink as her wanting to die. With her at my side, I tried to explain that she doesn’t want to die — no one does — but that she is trying to find a way of living every day that she can sustain, which in some cases involves a few sips of a forbidden juice or a few bites of something fried, like plantains, that she has eaten all her life. The family seems to hope that if someone hovers over her every minute of every day and minutely supervises her eating, she will live longer. I’m not so sure. Right now, that kind of attention is just making her angry.

Apart from these two issues, aging and diminishment are just plain hard in whatever form, and it takes a lot of love and inner strength to see aging through — on all sides and in all cultures.

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