Mom landed in the hospital (again) two nights ago. Her lungs had taken on about as much congestive fluid as they could, and she caved in. A bolus of intravenous diuretics and a dollop of nitroglycerin put her back on track, though, and she's already restless about her confinement…wants to get back home, as usual. She's really done well, considering the way she's treated herself for 84 years. The woman didn't even retire until she was well into her 70's, and she was lifting heavy boxes in a high-volume photography department right up until her doctor told her to quit. He probably saw catastrophe coming.

Since she left the workplace-actually, since Dad died a dozen years ago-Mom has really started to slide. No doubt her worn-out, fibrillating heart has had a lot to do with that. We've been pushing her to move in with us for over a decade, but she has declined the invitation every time it was offered: "We live on opposite sides of the country," she explained. Now, since our own situation is a bit tenuous, we no longer have the latitude to offer her a home. No matter. She still thinks she can make it on her own, and who knows? Perhaps she can. She has always managed in the past.

This time, I have my doubts.

It's difficult to separate my fears as my mother's child from my pragmatic concerns as a physician. I've cared for so many similarly afflicted souls over the years. I believe Mom has some time left, and some of her remaining months may even be pleasurable. But I know what her ultimate course will be, given her age and the gross limitations of modern medicine. Unfortunately, I am also keenly aware of what our society has to offer to people when we have nowhere else to turn. I've seen it too often: Mom doesn't want to burden her children, though she likes the idea of having them nearby (we're scattered across the face of the planet, by the way). She doesn't want to surrender her independence, but she may no longer be capable of living alone. Any place that offers decent care charges exorbitant fees in return, and no one in the family has the funds to get Mom established in an optimal setting. And so forth.

Ironically, we were investigating an "independent living facility" in Mom's home town just before she was hospitalized. She can't hear very well, she has trouble walking, and she is beginning to forget things-important things. She's having difficulty keeping her house, fixing her meals, and paying her bills. Mom realizes all of that. She was preparing to relocate to a new apartment where she could get help with her daily activities, but now she thinks the stress of moving kicked her over the edge. She says she'll be fine once she gets settled. We, her offspring, anticipating the worst, are scrambling.

My sister, who lives near Mom-and who was attempting to keep an eye on things-is suddenly overwhelmed by her own son's diagnosis of metastatic cancer. Another sister is disabled by multiple sclerosis. An older brother who has been watching over Mom's finances got married, moved to another town, and is buried under the demands of an impossible job. Three years ago I lost a sizable chunk of my eyesight, and a career in medicine got flushed down the hopper. I'm not sending as much money as I used to.

There's always some excuse, I suppose.

So. This morning, a breathless, frightened, confused old woman lies in a nondescript bunk in some cookie-cutter hospital in America's heartland, wondering aloud why she didn't make better plans for her final years. Her case manager, undoubtedly scurrying from one delayed disaster to the next, hasn't responded to any of my phone calls. Her doctor has come and gone, stoop-shouldered beneath a load of patients that blossoms inexorably-like water leaking through a crumbling dam-with each new admission arriving from the frantic emergency department downstairs.

I hang up the phone, thankful that I have been able to reassure my mother, hoping that she won't be terrified within the next ten minutes by someone wandering in to draw her blood, and wondering how in the world we have let things get so out of hand.

We Americans, confident that our futures will be secure and serene, maunder on endlessly about the politics of health care in a country that spends more on distant wars than it does on immunizing its children, that worries more about fashion than it does about good nutrition, that publicizes more drivel about the nonexistent morals of its leaders than it does about the real needs of its citizens.

We talk much, yet we do so little.

Mom has lived through some really tough times. Right now, most of all, she doesn't want to go to a nursing home. We'll see what we can do about that.

As for the rest of us, well, I'm afraid the rest of us have no inkling about how tough our time will be, and it's just down the road a bit, around the next corner…