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Last week, my wife, my daughters, and I drove to Washington, DC to spend time with my mother as her health continues to decline. While her condition has been worsening steadily over the past several years -- complicated by COPD, heart failure, cancer, and now treatment-resistant pneumonia -- this latest hospitalization has been the longest and the most serious.
What has struck me most is that while her body has steadily surrendered to age and illness, her personality has refused to yield an inch.
There she lies, surrounded by oxygen tubing, IV lines, cardiac monitors, and the incessant traffic of physicians, nurses, respiratory therapists, and specialists moving in and out of her ICU room. Physically, she has become extraordinarily frail. Psychologically, however, she remains exactly who she has always been.
Stubborn.
Others might select kinder words -- independent, strong-willed, resolute, unyielding -- but "stubborn" has always seemed the most accurate description, and I employ it with enormous affection and respect.
Those of you who follow my writing know that, professionally, I spend my days running a health care marketing research agency and, to the extent that I can, interviewing physicians, patients, caregivers, and healthcare leaders. For more than three decades, I've been fascinated by one deceptively simple question: why do people make the decisions they make?
How do we persuade someone to adopt a new treatment? What motivates a patient to remain adherent to therapy over months or years? Why do some people embrace change while others cling to familiar behaviors, even when the evidence points overwhelmingly in another direction?
These are questions I've explored through tens of thousands of interviews and countless research studies. Yet sitting beside my mother's hospital bed has reminded me that human behavior is rarely governed by information alone. Facts matter. Evidence matters. But behavior is almost always rooted in something deeper.
Identity.
And nowhere has that lesson become more proximal and vivid than with my own mother.
As I've shared pieces of this journey with friends and colleagues over the past several months, I've been impressed by how universal these experiences have become.
Those of us in our fifties and sixties occupy a unique place in the arc of life. Many of us are still raising children, building and maintaining careers, and beginning to imagine what the next chapter of our own lives might look like. At the same time, we're becoming caregivers to the people who once cared for us. Advances in medicine have given many of our parents something previous generations rarely enjoyed: longer lives. That is an extraordinary gift. But, as I've discovered first-hand, longevity and healthy aging are not the same thing.
The stories I hear are remarkably consistent. Parents who insist on driving long after their children believe they should stop. Parents who refuse walkers or a cane because "I'm not that old." Parents who reject home health aides or assisted living, convinced they can continue managing just fine in the homes they've lived in for forty or fifty years.
My own family has lived this story. For the better part of six years, my brother and I have encouraged our mother to consider assisted living. We've toured beautiful, manicured communities together. We've talked through the practical realities. Every conversation has ended the same way: she wants to stay in her own home.
The same is true of other lifelong habits. Smoking. Wine. Poor diet. Little exercise. Adult children often assume these behaviors persist because their parents don't understand the consequences. I no longer believe that's the explanation. These routines become part of the architecture of a person's life. They're familiar. They're comforting. They represent continuity in a world that increasingly asks older adults to surrender pieces of themselves.
My mother once told me that smoking a cigarette was one of life's simple joys.
At the time, I heard only the smoker. Today, I hear something else.
One blessing my family has had is my younger brother, Jesse.
Dr. Jesse Pines is an emergency physician in the Washington area. During my mother's recent hospitalization, he has become much more than her son. He has become her advocate, helping ensure that every clinical decision is viewed in the context of her increasingly complicated medical history.
My mother is anything but a straightforward patient. COPD. Heart failure. Frailty. Deconditioning, and now treatment-resistant pneumonia. A recent battle with lung cancer, successfully treated with Keytruda. Multiple specialists. Multiple medications. Multiple competing priorities.
Watching Jesse work alongside her physicians has reinforced something I wish every family understood. Modern healthcare is exceptionally sophisticated, but it is also extraordinarily complex. Patients benefit when someone knows their story, asks thoughtful questions, clarifies details, and helps connect dots that can easily become separated across shifts, specialties, and settings of care.
Most families don't have the extraordinary privilege of having a physician in the family. Yet every patient deserves an advocate.
One of the things that impressed me most during this hospitalization was the nursing staff at Virginia Hospital Center. They were exceptional -- not only technically skilled, but deeply compassionate. They've cared diligently for my mother with patience, dignity, and kindness during what were clearly demanding shifts. They reminded me that while we often speak about healthcare systems, that system is comprised of each professional's everyday acts.
When I look back over my mother's life, I realize that her stubbornness has never been an isolated personality trait. It has been her main operating system.
She has been smoking since she was fourteen years old. She enjoys her evening wine: Ernest and Julio Gallo to be more specific. Exercise has never held much appeal. Throughout her life, she has made countless decisions that most physicians, and certainly most public health experts, would discourage.
Yet she is eighty-two years old.
Ironically, the same determination that frustrates my brother and me today is the determination that carried her through every chapter of her life. Personality traits are rarely all good or all bad. The qualities we admire most in someone often become the qualities that challenge us most later in life.
Even now, despite her frailty and the seriousness of her illness, she wants to keep fighting. She wants every reasonable treatment available. She wants another chance to recover and, above all, to return home.
There are moments when I wish she had made different choices. I wish she had stopped smoking years ago. I wish she had exercised more. I wish she had agreed to move into assisted living before her falls became inevitable.
But those wishes belong to me. She has lived according to her own values, not mine.
For someone who has spent more than three decades studying healthcare and decision-making, I find it humbling that some of my most important lessons have come not from marketing research studies or brainstorming sessions, but from sitting quietly beside my mother's hospital bed.
Looking back, I realize that my brother and I thought we were arguing with our mother about cigarettes, wine, walkers, stairs, falls, and/or assisted living.
We weren't. We were negotiating something much more fundamental.
We were trying to make her safer.
She was trying to remain herself.
Over the years, I've come to realize that autonomy is one of our most fundamental psychological needs. We all want to believe that our lives remain our own, that we still have the agency to make choices, even imperfect ones. As our parents lose pieces of themselves (their health, their mobility, their confidence) they often hold even more tightly to the routines, places, and rituals that remind them who they are. What appears irrational to us may feel indispensable to them because it represents one of the last expressions of autonomy and independence they still possess.
That realization doesn't mean we stop encouraging healthier choices or advocating for greater levels of care. It does mean we approach those conversations with greater humility. We think we're solving practical problems. Our parents are trying to preserve something much more fundamental: the ability to remain the authors of their own lives.
As I write this, I don't know how my mother's story ends. I hope and pray there is more time. More conversations. Another Christmas. Perhaps even one more spirited argument about moving into assisted living.
She once told me that having a cigarette was one of life's simple joys. For years, I dismissed that as the familiar rationalization of a lifelong smoker. Today, I hear it differently. It was never really about the cigarette. It was about preserving one small part of a life that was still entirely her own.
As I watched my mother in the ICU last week, surrounded by monitors, oxygen tubing, and an extraordinary team of HCPs doing everything they could for her, one thought kept returning to me. Her body may have surrendered far more than either of us ever wanted.
But her personality hasn't yielded an inch.
