Grandma at Vandy

Saroja Paati (Grandma) visiting from India

and a visit to Vandy

A proud and beaming grandma at the Frist Center and outside my office space at the LASR Research Lab.

 

Happy Mother's Day

 Dedicated to the EXTRAORDINARY MOMS and DADS and PARENTS out there, 

on behalf of your extraordinary child.  

You Never Gave Up on Me

You held me in your arms, oh mother mine
When I was a mere wrinkled newborn babe
You gazed at me with love and joy
Just as all young mothers do.

I walked my first step and said my first word
With pride, you watched my every move
You expected me to walk the predictable path
Just as all young mothers do.

You watched me slip and slide away
Wondering why I didn't do what other kids do
I stopped making eye contact with you
And stopped the spoken words too

A well of sadness entered your eyes
The smile not always in place
Perplexed and puzzled
Do I know this child of mine at all?

But, you rolled up your sleeves
You never gave up on me

You took the other fork on the road
The one without the map
You struggled and searched for solutions
You fought endless battles for me

You put your fists up and took a stance
And you never gave up on me

Lost in the desert of sadness
You changed your perception of things
You summoned new strength and courage
From the unfathomable deep

You changed your whole life for me
And, you never gave up on me

You coaxed every small victory out of me
Pride overflowed from your eyes
Steps of this extraordinary child
Of quite the extraordinary mom

You do the job of a dozen people
And you never gave up on me

Exhausting is the journey you're on
Exhilarating only some of the time
I am not the typical child you thought you'd raise
New challenges lie in the path every day

To the extraordinary mom who holds my hand
And who never gave up on me.

------------------------------------------------------------------------

I wrote this poem sometime during high school. But I feel it is still so relevant even today. This poem is dedicated to all those wonderful and amazing moms and dads and parents out there who did not give up on their disabled child. Thank you for your dedication and fortitude, in rolling up your sleeves and taking on the world for us, without even knowing how to go about it.


I think back to the story of the frog who climbed to the top of the well amidst discouragement from the crowd that the task was impossible; turns out the frog was deaf so had not heard the discouragement, so made it all the way to the top.


This is what parents of the children seen as having more challenging disabilities face every day. From the get go, they are nudged to tone down expectations of their children, not to expect much. Lady Liberty did not hold up her torch of the American Dream for that child.

Over the years, I have seen many of my peers disappear one by one into the void of the system (out of sight and out of mind of society), as the once eager and enthusiastic parents reach a state of burnout and exhaustion, with this constant barragement of discouragement and lack of support. Other adult peers who have aged out of the special education system are sitting at home with their aging parents as adult day programs want “easy to manage” adults (sheep!!), even as there is a dearth of support systems for the ones with “behaviors.” It is like a battle for the classroom placements and supports during the school district years, starting all over again in adulthood for many.

Thank you to all the extra-ordinary parents out there, for your support and embrace, when the world seems to abandon us at every new stage, not just when we were children but as adults and possibly even when we are middle aged. For many with more significant disabilities, our parents and siblings are likely the only family we will ever have. I wonder who will be there as this lifelong pillar, when we are senior citizens ourselves, where we are not just battling aging issues but also the nature of our disability may mean that not all of us reach a level where we are able to take care of ourselves and have to depend on the largesse of paid staff for a decent quality of life.

Parents, Yours is truly a dedication of a lifetime. Thank you.

Samosa Chat

 

On UC Berkeley campus enjoying Samosa chat with fellow Calbear David Teplitz.

Our senior year starts next week.

Raghavan Thatha online

Came across a pic of my Raghavan Thatha (grandpa) online, in his heyday working for the UN in the pacific. There are more links of stuff he's done. Too cool.

 

Harrapa Artifact

My late Raghavan Thatha (grandpa) worked in archeology for a while. Replica of an artifact - Harappan seal from the Harappa archeology digs from the time of the Indus Valley Civilization. 2600BC-6000BC

Tongan Kava Bowl

My late Raghavan Thatha (grandpa) also spent many years in Tonga. Tonga is one of the last remaining Polynesian monarchies in the world. This is a Tongan Drum and a Tongan Kava Bowl. Thatha & Paati (grandma) have been to many traditional Kava ceremonies.

Banana Leaf Lunching

Warm delicious Paati samayal (grandma's cooking) on a freshly cut banana leaf from the garden.

Eating traditional style on an organic, eco-friendly, biodegradable plate with extra nutrition thrown in.

Extra nutrition? Polyphenols (think micronutrients in plant based foods packed with antioxidants) in the banana leaves get stimulated from the warmth of the food and get absorbed into the food along with Ascorbic Acid, Citric Acid, Ca and Carotene in Banana Leaves. 

Can I get a banana leaf every meal?

Eating with fingers? Its a natural exercise and builds dexterity for the fingers and the hand (kind of useful for someone like me actually with poor fine motor skills). It's slows down eating and brings about greater awareness of texture and taste, a.k.a mindful eating. 

And isn't seeking sensory experiences an autistic thing? LOL Using silverware actually lends to faster eating. 

Faster eating is linked to Type 2 Diabetics. Silverware actually lends to faster eating.

Ayurveda says nerve endings on the fingers stimulate digestion and improves blood circulation. Incorporating the five elements represented by the fingers - starting with thumb - space, air, fire, water, earth - is holistic eating. Somehow the Colonial legacy has meant that such indigenous cultural practices were frowned upon. That such things were "inferior" and made you "less than"

This sound familiar? - that the disabled mind-body is somehow "less than"

Image Description: Young male of South Indian origin eating food served on banana leaf. Also seated at the dining table is his grandpa with his grandma serving them food.

#PaatiSamayal #GrandmaCooking #EatingOnBananaLeaf

 

In Search of My Promised Land

An early holiday gift from my dad with this message. 

"A Gift to the Greatest Son who is finding his own Promised Land"

Can't wait to start reading. 

 

Kittu's Birthday

Attending my friend Kittu's Birthday. Was good to see him. Been a while.

Kedar's Engagement

Kedar used to volunteer with me as a high school senior at Archbishop Mitty School

Goodbye Rishi Srinivasan

Rishi the showdog

Goodbye Rishi Srinivasan

Veritable Senior Citizen.

15 dog years, 105 human years.

Golden Fur Shih Tzu.

I miss you, friend.

My 15 yr old Shih Tzu passed away on Sunday night. The house is gonna feel different without him around underfoot and acting as quite the proverbial sibling at times by competing for attention and food.

Meditating in the forest deep.

Flowing hair like a Hermit Rishi.

Expression, a thoughtful contemplation. 

Rishi Srinivasan, an appropriate name.

Rishi came to our house when I was in elementary school. Rishi had this mournful look about him and his long fur made him look like a rishi (hermit) meditating in the forest. So he was aptly named Rishi.  Rishi would accompany my mom to pick me up from Mr Tran’s class those days. My classmate Ryan asked me his name and when I responded, “Rishi,” Ryan immediately exclaimed, “Hari Srinivasan’s dog is Rishi Srinivasan.” So that’s how Rishi became Rishi Srinivasan. The name tag that hung from his collar proudly stated “Rishi Srinivasan” and had our phone number on it.

Sashaying fur like skirts around legs.

Fluffy wagging tail, a furry bouquet.

Former show dog, a handsome dude. 

Pets from strangers, a regular thing.

Tourists, “Can we take a picture with him please?”

Rishi oozed his own unique personality. Rishi had been a show dog before we got him and was a very good looking dog with his flowing hair and the fur around his legs falling like a skirt. His tail when upright looked like a fluffy furry bouquet, which would swish from side to side when he wagged his tail. 

Whenever we’d taken him out to beaches or to Yosemite, folks had always wanted to pet him. Many tourists have wanted to take photos with him. I think in his younger days, Rishi probably knew that he was good looking and was proud of it too. When anyone took a photo, Rishi would join in, give a pose and look right at the camera.  People often mistook Rishi for a girl dog as he was so pretty. I wonder if Rishi minded being called a “her” by people who wanted to pet him.

Communication via Body Language.

Angle and wagging of the tail.

Eyes sparkle or mournful to suit the mood.

His body spoke so much to you.

Rishi communicated a lot just through his body language. The position and angle of his tail itself would be an expression of his delight, his disapproval,  his disappointment or his sorrow.  His eyes too would sparkle with joy or become mournful when he needed a treat from an adult. 

Package of love in under 20 lbs.

Barks stating “I love you, Hari!”

A Happy Dance when seeing me.

Cute paw over paw greeting.

That Rishi absolutely adored me is without a doubt. He’d be camped on the front doormat the entire time I was in school - from the time I got on the school bus to the time the bus returned.  He would hear the bus at the end of the road and come to life joyfully announcing my return. As soon as I stepped in the door, he would do this cute paw over paw on the ground and then skip around in a dance; we called it Rishi’s Happy Dance. 

One time I was on the backyard swing and Rishi was running circles around me happily barking. My therapist asked me, “What is Rishi saying?” expecting me to say “Woof” or something to that effect. Instead, I instinctively responded with “I love you, Hari!”. 

Concern for me when sick.

Vigilant guard during therapy.

Message clear to therapists.

“Take good care of Hari.”

When I was sick, a very concerned Rishi would lie at the foot of my bed, till I got better.  If I said the word "bathroom," in any room in the house, Rishi would run to the nearest adult and give a sharp bark as if to say, “Go attend to Hari.” 

When therapists came over, he would keep an eye on them from his place at the door of the room, making sure they were treating me right. Therapist Cherie has even laughingly assured him, “Rishi, don’t worry, I’m taking good care of Hari.” 

I was taught to say his name in ABA therapy though I already knew his name inside my mind. During my later charter school years, Rishi was my mascot, lying under the table as I did my lessons.

Understood nuances of this extra-special kid.

Alas, the autism factor.

Love could not be stated explicitly.

The quality I think we admire most in dogs is their empathy and Rishi had that in abundance. Intuitively he understood my differences and adapted to it. He learned to work around a lot of my needs and behaviors. For instance, he had really wanted to sleep with me on the bed but I could not handle that, so he just slept in his basket. Instead, he became my music buddy, camping on the bed when I would listen to music on the headphones or during prayer when he would dutifully sit the whole time and listen. 

As a young dog, he would try to intervene when I became agitated but his small size meant he really could not do much. So he learned it was better to just keep out of the way but would come back and sit next to me later to offer comfort.  

Rishi followed me around and showed his love even though I did not always explicitly display outward affection for him. Hugging and petting a dog was not my strong suit as that is a very sensory experience and I have all sorts of sensory dysregulation. Until the very end, I had not found a real comfortable way to physically interact with him, the autism part of me puts many obstacles in the way. 

Autism often means that our behavior and body mannerisms can be contrary to our thought. But I think Rishi just totally understood that and did not demand or expect a reciprocal physical interaction with me. I think he got enough hugs and cuddling from other adults. Rishi also instinctively sensed the times I was more receptive to touching him and when I was not. My touch too has not always been regulated so Rishi just learned to wiggle out if I was a little rough. 

In a world that is filled with naysayers and doubters for us differently-abled folks, it is refreshing to experience such non-judgemental and unconditional love that dogs like Rishi bring. Every disabled child needs to have a dog sometime in their life. 

Every 2 months.

Shaggy bear to shorn sheep.

Sudden new dog in the house.

Autism mind - not reconcile.

Rishi was a hypoallergenic dog with double coated fur. His fur did not shed, rather it grew out so long that his eyes would be completely covered by fur.  So he would go to the dog groomers every couple of months to be bathed and get all his fur trimmed back. He would come back with a bandana and a bow. The transformation would throw me in the early days. A overgrown shaggy dog left at the groomers was picked up a shorn sheep. He would look so different that I would be quite scared of this new dog. I would refuse to go near this new Rishi for a few days. 

Before Grooming

After Grooming

Fruit connoisseur, a banana-loving dog.

Gnaw Carrots, his veggie bone.

Idli, pesarattu, into Indian Food.

Protest bark if not offered a piece.

Rishi loved Indian food like yogurt rice, plain dhal, idlis and salt-free pesarattu. My family is vegetarian and salt and spices were added to most dishes after keeping some aside for Rishi. He loved apples, pears, avocado, boiled potatoes, boiled beans, carrots, moong sprouts, quinoa, and cucumber. He would sit on the kitchen floor and stare mournfully and sometimes make noises of protest in different tones if he was not given a piece. If still nothing was forthcoming, his tail would be stiff and he would give a sharp bark as a reminder that he needed a share. 

He was quite the connoisseur of fruit, and banana was his all-time favorite. If he walked into the room and realized I’d eaten a banana without him (he could still smell the banana in the air), he would whimper sadly.  Rishi could probably eat a whole banana or even two bananas if we let him. A carrot was his daily vegetarian bone and he would gnaw on it all day. 

Even as he has acted like an older sibling in his concern for me, he has also acted like a younger sibling - competing with me for food and attention from my parents. At times the autism part of me has not liked this, though the logical part of my mind has reminded me that he’s just a small wholly dependent dog, and that this was no competition at all. 

Paw on keyboard.

A look that says, “Me too.”

Hari, you are getting a voice.

I want a conversation with you

I think Rishi was thrilled when I first started using AAC. He would come,  place his paw on the computer keyboard and look up as though he too wanted to type out a sentence or two. I bet if he’d been taught to type too, he’d have had a ton to say too. He totally knew the keyboard was somehow helping me. One of my earliest poems was about Rishi.

Had yoga got regard for how darling dogs are
gist of young dogs joy it fortells
joy obvious from its tail, paws, and head.

Understanding silky body moves
God-given gift just for kid
total love in just under twenty pounds.

Noisy licking just unintended
fur very elegant has total appeal
had noted fundamentals of kid.

.

Judicious desire to total caring

Its paw over paw greeting delightful

fur around legs like a skirt.

Beyond holy is his name
brother to kid he has been
forever kid's unquestioning pal.

Unfortunately Rishi started getting health issues. He got some kind of allergy and almost lost all his fur. My folks even tried alternative therapies with him like Homeopathy but he steadily lost weight. I remember saying, “Noisy licking keeps kid awake.” 

Fortunately, a new vet was identified who changed his kibble and meds. My Saroja Paati (grandma) was also visiting and she changed his diet to include lots of boiled vegetables, dhal, and curd rice. Prior to that Rishi had been primarily on wet and dry processed dog food. Rishi prospered so much that the vet asked if it was the same dog during the next visit. Rishi with his glorious fur and sparkle was back. 

Rishi in Raincoat

Alas, old age catches on.

Perpetual allergies, Ear infections.

Vision gone, Hard of hearing.

Body slows down.

Rishi’s earlier illness meant that he’d also developed lifelong allergies. He had to be gluten free, milk free and on special Kangaroo meat kibble and hypoallergenic dog treats for the rest of his life. He was at the vet a lot for some allergy related issue or ear infection and constantly on meds. As he aged, parts of his golden mane started turning grey, (yes, even dogs get grey hair). 

In the last few years, Rishi also started slowing down. He slept most of the day. His sight started deteriorating till he became almost completely blind. Apparantely Shih-Tzu's are genetically prone to eye issues. He was on eyedrops all the time so his eyes would not dry out. He knew his way around our old house so it was not that obvious. 

His sight issues became very noticeable when we moved to a new house. Poor Rishi would bump into things and not know how to navigate the steps in the backyard of our new place. His poor vision meant he would not see my sudden impulsive body moves. He no longer constantly followed me around and our interaction dwindled even more. 

Two years ago, he developed a tumor and had a toe surgically removed. He stopped barking when the front doorbell rang; perhaps he became hard of hearing. But till the last day, he would come running for food - especially if he could smell banana in the air. 

Rishi’s condition really went south last weekend. He could not even hold his neck straight. He had to be hand fed as he could not eat his hard kibble. Good thing was that he still ate his favorite banana the morning before he died.  By Sunday night he was in bad shape. My folks did their best to shield me from what was happening but I did hear two sharp cries of pain and his loud raspy breathing on Sunday night. He stopped breathing just before midnight. We took him to the vet to be cremated and will get his ashes in two weeks. 

I’m not quite sure of how I feel now. I think I’m still trying to process. I know I am sad; after all, Rishi had been a huge part of my life for 15 years. There are more emotions swimming around inside but no words for them just yet. I am gonna miss Rishi’s cute shenanigans, his unconditional love and his presence around the house. 

Rishi was a spiritual dog for he loved prayer and vibuthi. 
Go now and rest at God’s feet, Rishi Srinivasan, as your journey comes to an end.

Rishi's Ashes were immersed at East Beach under the Golden Gate Bridge

Suite Seats for the Ball Game

SF Giants vs Oakland A's at AT&T Park last Thursday. Giants won 11-2. 

What an amazing suite level seats to see the game. The view from up there is amazing.

Thank you David and his parents Linda and Gary for inviting us. 

I totally loved the experience.

Happy Father's Day

Moods from worry about my future

To elation over past accomplishments

My dad

Dives with passion into cooking

Explore hip youtube recipes

International eating, GFCF  style

My dad

Fingers fly over the qwerty keys

Searching for solutions that may help me

unendingly

My dad

We watch basketball and football heavily

Sprinkles of cricket and tennis thrown in

Warriors Champs 2017

My dad

Quite the best Bud really

Happy  Father’s Day

Plans. Dad and I will have a father-son lunch on sunday.

Only Light

My Raghavan Thatha (Grandpa) was in  ICU in Jan 2015 (and passed away on Jun 10, 2015)
A Poem for my Thatha and Paati (Grandma)

Sadagopan Raghavan

This is a paper I did for my Developmental Psychology course. The subject for my case study is my grandpa Raghavan. Unfortunately from the time this paper was written  there was significant deterioration in his health and my Raghavan Thatha passed away on Jun 10, 2015.

--------

Developmental Tasks in the Elderly

Case Study: Sadagopa Raghavan

Hari Srinivasan

Developmental Psychology

Abstract

The subject of this case study is 82 year old male, Sadagopa Raghavan, who currently resides in Chennai, India. The individual has recently been diagnosed with Parkinsonism. This paper looks at his life history and examines his current level of performance per Robert Havinghurst’s Developmental Tasks for his age group.

Method of Data Collection

Information about the subject was gathered from family members and a medical doctor familiar with his case, as well as examination of reports and lab work on his case. Since the subject is my maternal grandfather, statements are also made based on personal observation and knowledge about him over the years. The appendix contains interview questions.

Personal Reflection

My 82 year old Grandpa Raghavan had always represented someone who did not let age limit him. It seemed like he could go on forever. He successfully switched career tracks several times over the course of his life, even starting a new law career at the age of his retirement. I’ve always thought he had a most productive and interesting life. He has always been active and engaged in some activity. A few months ago he was diagnosed with Parkinsonism. Last month he collapsed and spent 10 days in the Intensive Care Unit to the considerable shock of the whole family.  

In the context of our developmental psychology course, we study the different tasks or crisis that we face in different stages of our life. Psychologist Robert Havinghurst defined the developmental task of dealing with aging parents as a crisis of middle adulthood. I feel that dealing with the crisis of aging grandparents or near family members is a developmental task that needs to be included for the younger age groups as well. As children, we assume the immortality of our grandparents, especially if all four are alive, so a potential crack in their seeming longevity comes as a shock.  

Description of Individual and Background

Sadagopa Raghavan was born on Aug 25, 1932, in Chennai, India. He was the third son in a large family, typical of that period with 4 brothers and 2 sisters. His own father had been an entrepreneur, which meant that the family fortunes fluctuated over the years depending on the state of his father’s business ventures.  The family went from extremely wealthy with cars, timber estates, mica mines, and mansions, to being economically challenged.  Thus his childhood included interesting experiences like visiting timber estates in the South western state of Kerala, where along with timber; elephants would also be captured and used for hauling logs.

Raghavan’s education was typical for boys of that socio-economic class of that era in India. My family belongs to the Brahmin caste in India, which usually places a lot of emphasis on education. He and his brothers attended Ramakrishna Mission School in Chennai and went to study at Madras Christian College.

Raghavan had an interesting family. His mother operated a small scale business of her own – raising dairy cows and selling milk to local residents and businesses. His mother even participated in the Indian Independence struggle movement, giving speeches to other local women to inspire them. One time, he spoke of his mother’s sister, a social worker who had chosen to help out the “shudra” (or untouchable community) thus becoming shunned by a number of the Brahmin community. I found it refreshingly progressive for women of that era. Another cousin of his ran a Gandhi ashram which assists and educates the poor.

It was expected that Raghavan would follow the footsteps of his older brothers and do Math in college but Raghavan took up Zoology. He had once said that he would have liked to have been like Jacques Cousteau, the marine biologist, but that would not have been an acceptable profession for a Brahmin boy. As it is, he had to do his dissection projects well away from the house, as no meat was allowed anywhere near a Brahmin home. After completing his graduate degree in entomology from Madras Christian College, he became a zoology lecturer. He often recollects the time he had taken his students on an overnight camp to watch baby turtles hatch on the beach.

Raghavan switched careers and joined the central government service based in New Delhi, India. As was the custom of that time and which prevails even today, his marriage was arranged. He had two children - a daughter (my mother) followed by a son. The government job meant that he worked in various departments such as Archeology, Music Arts and even served as Assistant District Collector in rural areas. After his second child was born, Raghavan went back to college to earn an MBA at the University of Delhi.  The business degree led to overseas opportunities and he was sent as part of the developmental aid initiative to the Kingdom of Tonga in the South Pacific.

Raghavan’s stay outside his native India was probably the most prolific period of his life. He was responsible for setting up the small-scale industries center and Tourism in Tonga amongst other things, He was a terrific speechwriter. Though it was not part of his job description, Raghavan helped write the Maritime Law for Tonga as they had none, and Japanese whaling vessels were illegally poaching whales in Tongan Waters at that time. Whaling was still legal those days and my grandpa has recounted stories of the gigantic whale bones that their dog would somehow find and bring home to chew on.

He then got an executive level position at the United Nations and traveled extensively all over the world for trade talks and industrial development. He was even a speaker at the United Nations Conference for Trade and Development. His name would be featured regularly in the New Zealand and Australian newspapers as well as in other countries of the Pacific and even in the Irish paper. Raghavan has met many world leaders including Queen Elizabeth II on her royal yacht Britannia.

At age 55, Raghavan returned to India. He resumed his Indian Government Service for few years but before retiring he again went back to the University of Delhi and got a Law degree. Thus, as soon as he officially retired at age 58, he was ready for another career. He joined some well-known Supreme Court lawyers as a junior lawyer. But given his experience and articulate writing skills, he was asked to write briefs almost immediately and started arguing Supreme Court cases within a year. 

When a consumer protection governmental commission was set up, Raghavan was asked to join. There was no formal Consumer Protection Law in India till that point, and a Commission was set up to compile existing cases and draft a comprehensive Consumer Protection Law. In a sense, Raghavan is one of the drafters of Consumer Protection Law in India. 

My grandpa is also a great admirer of Ralph Nader and would root for Nader whenever Nader stood for the U.S. Presidency. Raghavan carried on his Supreme Court Law career well into his 70s, winning a majority of his cases. He has worked on some landmark cases such as the Kaveri river water dispute case between two southern states.

He had a very intense personality and was always well-planned and meticulous in everything he did. On the other hand, he did tend to be over anxious and wanted every minute detail planned well ahead of time. 

For all his brilliance he was very poor at handling any kind of gadgets from TV remote controls to learning how to use the computer. It was my grandma who would often do all the computer related activity. Grandpa would discuss Indian temple architecture at length, probably as a result of his years in Archeology. He’d even helped secure the site for the well-known Malai Mandir temple in New Delhi. 

He loved gardening and had quite the green thumb growing all kinds of vegetables and experimenting with hybrid varieties. My grandma reports that grandpa often gave advice on plant growth to their botanist neighbor who worked in the Agriculture Department in the Pacific. Raghavan had developed some dozen varieties of eggplant for instance with different combinations of coloring and had come up with a new sugarcane variety in the Pacific. In India too, he continued his passion using pot plants on the balcony and terrace as they now lived in an apartment.

As they were aging, Raghavan and his wife decided to shift back to their native Chennai in South India, to be close to their siblings and other extended family. They made the move 4 years back. 

However, the move meant the end of the law practice as the Supreme Court is located in the capital city of New Delhi.   Suddenly Raghavan was not a busy man anymore and he had been used to being busy all his life. It was just him and his wife at home and really nothing much to do. Though both of his children visited, they lived in other countries and had their own young families to take care of.  My grandparents still attended all the weddings, other family events and rode enthusiastically on public transportation to events and temples. Mrs. Raghavan had been a homemaker all her life and she continued in that role, though a lot slower.  However, Raghavan simply was not being intellectually stimulated anymore and that is when he visibly started slowing down. 

Mrs. Raghavan reports that in the last couple of years he would just wander around the house, not really interested in anything.  He would read the newspaper and watch the occasional cricket match. Raghavan had always loved writing in his diary yet he never asked to buy a diary for the year 2014 at all. Mrs. Raghavan simply thought he had lost interest and did not think much of it.  

Small unnoticeable memory lapses followed but this was put down to age. He started eating less and became physically weaker. His memory lapses increased while his motor skills decreased. His handwriting skills declined and he became reluctant to even pick up the pen as he could no longer motor plan to write, though he would stare at the paper. 

He was diagnosed with Parkinsonism in September 2014. Some of his medications induced hallucinations and he would imagine people or situations. He would speak incessantly on some topics like court briefs but his speech would often be out of context and unclear. With physiotherapy and medication, his writing skills seemed to improve as well as his memory but the nature of the disorder means waxes and wanes.

Developmental Tasks

Developmental Psychologist, Robert Havinghurst (1968) of the University of Chicago delineated tasks that were to be carried out in each of the 5 major stages of life.  According to Havinghurst:

The developmental tasks of life are those things that constitute healthy and satisfactory growth in our society. These are the things a person must learn if he is to be judged and to judge himself as a reasonably happy and successful person… Some tasks arise from physical maturation… others arise from cultural pressure…and yet others from the personal aspirations of the individual which are part of the personality or self.

Each age group faced different developmental challenges or tasks.  For the Later Maturity stage of above age 60, Havinghurst lists six such tasks.

1.     adjusting to retirement and its reduced income

2.     adjusting to declining physical strength and health

3.     adjusting to change in the health of one’s spouse

4.     establishing an explicit affiliation with one’s age group

5.     Meeting social and civic obligations.

6.     establishing satisfactory physical living arrangements

Havinghurst’s focus is on reorganizing functions and expectations. For example, older adults who do not accept their changing physical and heath limitations and adapt may become maladapted. According to Havinghurst, the continuing refining roles and expectations to meet environmental demands accomplish the maintenance of identity. (ed. By M.S. John Pathy., 2005, pp.54-56).

Four of these tasks (1, 2, 5 and 6) are examined in the case of Sadagopa Raghavan as they seem most relevant to his case.

Task: Adjusting to Retirement and Reduced Income

Fortunately, finances are not a challenge for my grandparents in their aging years. Raghavan’s successful careers, savings and investments over his lifetime meant that they could expect to maintain a comfortable standard of living. Having retired from the Indian Government, meant that much of their medical expenses would be covered under the government medical scheme for their lifetime. So fortunately living and medical expenses are not an overriding issue at this point.

Psychologist  Robert F. Peck (1968) had identified, “Ego differentiation vs. Work Role Preoccupation,” as a conflict that arises in the elderly group. This essentially refers to, “finding ways to appreciate and identify the self without the career being the marker of success.” (ed. By M.S. John Pathy., 2005, pp.54-56). Raghavan had coped with his first retirement by plunging into another career.  It is possible that Raghavan’s behavioral apathy towards new interests in the last two years could simply have been early signs of the Parkinsonism which was yet to be diagnosed. If that health concern had not appeared, it is possible he would have developed new interests in his new environment given his self-driven personality, methodical nature and innate desire to remain active.

Task:  Adjusting to Decreasing Physical Strength and Health

In my grandparents’ house, it was my grandma’s asthma that had been the overriding medical issue. Thus my grandpa Raghavan falling ill had been unexpected. He had always maintained reasonably good health till around age 80. “The caregiver for a married elderly frail person is usually the spouse, who is also elderly.” (Berger 564). Thus suddenly there was a role reversal - “The partner who nurtured may need nurturing care; the healthy partner may have to assume new roles of banker, handyman and decision maker.” (ed. By M.S. John Pathy., 2005, pp.54-56). During one his moments of consciousness during his hospital stay, my grandpa had sadly remarked on the difficulty that my grandma now was facing. Indeed, my 76-year-old grandma now has to manage everything from handling medical claims and treatment to hiring support staff to managing finances in addition to her own fluctuating health. 

However, Raghavan had the foresight to keep his wife well educated on managing finances as a significant burden of IADL (Instrumental Activities of Daily life) has now fallen on her shoulders. IADLs include, “managing medical care, food preparation, filling out tax forms and payments, transportation, communication, maintaining a household and managing finances… IADLs are thought to be even more critical to self-sufficiency than ADLs (Activities of Daily Living)” (Berger, p. 562).  While my grandma is managing well on this front, fortunately she also has significant help from her son on these matters.   

Raghavan has a condition called Parkinsonism. The better known Parkinson’s Disease (PD) is generally associated with Lewy bodies in the brain neurons which can be addressed with dopamine replacement therapy. Parkinsonism, on the other hand, is an atypical form of PD and can include wide-ranging symptoms in addition to typical PD symptoms, and may or may not respond to dopamine replacement therapy. Related neurodegenerative disorders like Progressive Supranuclear Palsy (PSP), corticobasal degeneration (CBD), multiple system atrophy (MSA) etc., are all classified as Parkinsonism.

Raghavan had initially refused to accept that anything was wrong with him at the time of his diagnosis a few months ago. Initially, he developed mild symptoms of the condition which includes bradykinesia (slowness in the execution of movement),  pill rolling movement  (mild form), tremors and cogwheel rigidity. 

Later, he developed Parkinsonism Dementia.  This is where the patient starts losing their recent memory and they have difficulty in forming new memories. The pathology behind this is decreased dopamine production in the substantia nigra located in the basal ganglia. It has two divisions - one goes to the mesolimbic system (affects memory) and the other to the cerebellum (affects motor). So both memory and motor are impacted negatively. 

Constipation due to slowing of the bowel muscles reduced his appetite. The decreased eating and drinking along with metabolic derangement resulted in hyponatremia (drastic drop in sodium levels). He lost consciousness and had to be rushed to Intensive Care Unit. It was also thought that he may have had seizures and a mild stroke. One of the main attempts in ICU was to restore his sodium levels along with dealing with age-related issues in ICU such as respiratory infection.

After around 10 days in the ICU in November-December 2014, he was moved into the regular ward and started on slow liquid feeds and physiotherapy targeted at motor activity in order to decrease chances of disuse atrophy and stiffness. After two weeks of hospital care, semi-solid soft diet, he was discharged but will need rigorous care at home. He needs to work more on physiotherapy in order to improve his basic walking and motor skills as well as regular food and bowel movements. He needs to avoid excessive bed rest and its related consequences such as bed sores. He will likely need 24 hour case in the near future in case he tries to get up and falls before he regains his walking skills and then daytime assistance with living skills after that. He is not able to independently perform most of the tasks identified in the Activities of Daily Life (ADLs), namely eating, bathing, toileting, dressing and transferring from a bed to a chair (Berger, p.562). But in the few days since his discharge from the hospital, he is showing signs of improvement in areas of walking, eating and trying to get up from the bed on his own.

On a psychological level, there is bound to be a decrease in morale for Raghavan. This is going to be one of his major challenges ahead. He not only has to deal with recovering from a significant hospitalization setback but also needs to be dependent on other people to assist with his daily living skills. Having to wear an adult diaper can appear extremely demeaning for most adults. To get out of the hospital bed to sit or do his walking exercises, he had to wait for the twice daily visits from physiotherapists. That is bound to be a great source of annoyance for a formerly active individual. One time there had been some delay in changing his adult diaper. He had demanded to go home from the hospital, stating that he was, “being treated like a worm.”  As part of his coping mechanism he has sometimes behaved like a stubborn child, refusing to eat or refusing to cooperate with therapists, or getting angry. He had pulled out his nasal feeding tube and his IV line at the hospital and needed his hands to be restrained which further upset him. A thumb impression had to be taken in place of his usual signature for the annual life pension verification, which again upset him. His reaction is not surprising given that in countries like India, only the un-educated use thumbprint signatures.  Counseling and care from close relatives and loved ones always helps in this situation. In his case particularly, memory of the incident may not be properly established, according to my cousin and medical doctor, Dr. Madhu Parthasarthy, who has studied his case. So there maybe distortion in his reaction to it and patience is required while nursing.

Fortunately, Raghavan’s family has been very supportive in his time of need. Raghavan’s son visits often and helps guide his treatment plan. Relatives poured in to visit him at the time of his hospitalization and continue to visit him frequently. Many helped spend nights outside ICU and helped with food and moral support for my grandma. His nephew frequently comes and speaks to him of his younger days to divert his obsession with law, and my grandpa even recalled the names of the family cows and pet dogs they owned when he was a child. Both his sisters visit and talk so much that he has to tell them to stop talking. His brother calls frequently. My grandma’s siblings also offer considerable support, especially my grandma’s younger brother. The visits and calls no doubt cheer him up immensely in his time of need. He will continue to need this support going forward.

Task: Establishing satisfactory living arrangements

When Raghavan and his wife moved to Chennai, they did so with the explicit aim of being close to many of their near and dear ones in their old age. Their plan was actually well thought out, as evidenced by family support during the time of his hospitalization. The advent of Parkinsonism was an unexpected setback. That prematurely moved Raghavan from the old-old elderly to the frail-old elderly category. With physiotherapy, Raghavan is expected to regain some level of mobility, though he is likely to continue needing daytime assistance from staff for daily living skills.

Task: Meeting social and civic obligations

I feel this is one area my grandfather met very well. Throughout his work life, he had always been admired as a conscientious and trustworthy individual by all around him. He engaged in a lot of volunteer work and activity. Whatever task he undertook, he did it wholeheartedly and with great sincerity. When the Malai Mandir Temple authorities approached him a few years back, he declined the need for a public ceremonial acknowledgment for his earlier contributions via a plaque etc.  

He never engaged in corruption that is rampant in developing nations like India despite occupying positions of considerable authority and influence. Over the course of his life, he always strove to find gainful employment for many individuals he had come across of varying backgrounds with no thought of personal gain. He has often been a counselor for many family crises in the extended family circle and amongst friends.

Of course, the sudden advent of a debilitating disorder like Parkinsonism changes the game plan and he is in the process of finding ways to cope with the changed circumstance. The family around him will have to help him in this process.

Summary and Synthesis

Worldwide, the life expectancy of humans is increasing. According to a report by Muthane et al. of NIMHANS (National Institute of Mental Health and Neurosciences, Bangalore, India):

The elderly population in developing countries is predicted to increase by 200- 280% compared with a mere 30-40% in the developed nations. Of the world’s 580 million elderly (>60 yrs), 61% live in developing countries and 22% (of total) live in India. 

A corresponding increase in age-related disorders is only to be expected with this huge increase in aging population in India. The NIMHANS report further cites a study carried out amongst the elderly in Bangalore, India, showing that, “24% had Parkinsonism, with PD being the commonest (71%) followed by drug-induced Parkinsonism (2.55%).” They acknowledge that Parkinson’s and Parkinsonism has become a common neurological problem amongst the elderly in India. A major task going forward for these countries will be a establishing a system of caring for the elderly. (Muthane, 2007).

The major challenge at the individual level for 82-year-old Raghavan is coping with the realities of his chronic illness. Though Parkinsonism is understood to be degenerative in nature, the degree of progression and treatment options are not fully understood. Parkinsonism medications may also produce unpleasant side effects like hallucinations and insomnia and need to be constantly monitored and modified. Other age related conditions could add complications. 

Psychologically, Raghavan still has not come to terms with his new and possibly debilitating diagnosis. He is intelligent enough to grasp that this label is thought to be neurodegenerative and that can be very devastating for anyone to hear. He may be worrying about my grandma’s future and other family issues as well. 

The fact that he is likely to be dependent on others for his daily living skills will no doubt irk him immensely.  The possibility of loss of some of his excellent cognitive abilities and memories due to the nature of his illness may be extremely frightening for him to deal with. 

Struggling with both motor skills and memory loss is overwhelming at best. Continued support and counseling from family and friends will be critical. It will be a trying time for him and his caregivers as they attempt to journey on this new path. 

People around Raghavan will have to help him develop new interests as part of his coping mechanism. For instance, interest in spirituality is both acceptable and age appropriate for him in the context of Indian culture, as is interest in music. In addition practices like regular breathing and meditation exercises may in fact help brain functioning. He may never go back to being the dynamic active individual of old but has to remember that the end game is a decent quality of life and a good respect for the self. 

References

Berger, K.S. (2013).  Invitation to the life span (2nd ed., pp. 499-572). Macmillan Higher Education.

ed. By M.S. John Pathy. (2005). Principles and practice of geriatric medicine. (J. Morley, A. Sinclair, & M.S.J. Pathy, Eds.) (pp. 54-56). Chichester; Wiley, c2006

Havighurst, R. J. (1953). Human development and education.

Muthane, U., Ragothaman, M., & Gujuraj, G. (2007, September 10). Epidemiology of parkinson’s disease and movement disorders in india: problems and possibilities. Retrieved December 11, 2014, from http://www.japi.org/october2007/R-719.pdf