In 1994, after falling and fracturing her hand, Ann Richards went for a bone density test. She was diagnosed with an early stage of osteoporosis. After witnessing both of her grandmothers and her mother fall victim to the disease, Richards was determined to overcome its incapacitating effects. She began a physician-approved regimen of medication and dramatically changed her lifestyle. In “I’m Not Slowing Down,” the former Texas governor, known for her saucy straight talk, tells women what they need to know to combat this devastating disease. Here's an excerpt:
Right after I was elected governor of Texas, we were in turmoil trying to put things together, hire staff, move into the capitol office, and move from my house to the Governor’s Mansion. In the midst of all this, we got a notice that the Queen of England was coming to Austin. It is a real undertaking to entertain the queen. We had to go to “entertain the queen school” to learn how to act around her. Secret Service flew in from Washington to tell us where we could and could not go and what we could and could not do. On the day she was to arrive, I was in my office at the capitol when I got the call saying the queen was at the airport. I went tearing down the stairs and running across the rotunda to meet her on the capitol steps and my mother’s voice went through my head as clear as a bell saying, “Where do you think you are going, to see the Queen of England?” And I thought, Yes, Mama, I am!
CHAPTER 1: MAMA
People do not think of osteoporosis as a fatal disease, but it is. My mother died of it. Well, that is not literally true. She died from cancer, but I swear her spirit died from osteoporosis.
Mama’s name was Iona Warren, but everyone called her Ona. She was an industrious, thrifty child of the Great Depression, born and raised in a tiny town outside of Hico called Hogjaw. Her father was a farmer and they were dirt poor, but she was ambitious and hardworking-the only one of three sisters to leave home and make a life on her own. In fact, her sisters still lived in Hico when I was a child. Mama finished high school, an enormous accomplishment in her time, and left the family home to move to the big city of Waco. Today, young women do this all the time, but back then it was highly unusual and courageous. My uncle I. V. lived in Waco and he encouraged Mama to come to the city. In Waco, she took a job in a dry goods store and later she met my father on a blind date.
I have told the story of the day I was born to people in the past because it perfectly illustrates her character. Before she went into labor, Mama had arranged for a neighbor lady to fix Daddy’s supper on the day she delivered me, but the woman did not know how to wring a chicken’s neck. To kill a chicken, you break its neck, and it takes skill to pop your arm in a way that breaks the chicken’s neck clean. When my mother would do it, the head of the chicken would literally come off. That day, Mama delivered me in the morning and she was lying in bed when the neighbor came in to say she did not know how to kill the chicken. Mama said, “Bring it here,” and she lay in that bed and wrung the chicken’s neck.
Both my parents came from poor farming families, and all of my young life I remember Mama trying to figure out how she could make a little money, but whatever she made went for necessities or into the savings. When she was not working to make money, there were chores to be done. She spent every second housekeeping, tending the vegetable garden, sewing clothes, or taking care of our chickens.
There was no time reserved for having fun because she always had so much work to do, but she said, “You do whatever you have to do and you do it without whining.” It was from Mama that I learned the value of hard work and to never linger over those things in life that could hold you back, and it had a great influence on me.
Mama taught me that you should never expect anyone else, a man included, to do what you can do for yourself. About five years before Mama died, I went to visit her and when I walked onto her patio, I looked up and saw her on the roof of the Austin condo she and my father had bought after they had sold the house in Waco. She was in her early eighties. She looked down at me and said, “I know you are going to fuss at me, but the TV said it was going to rain and the man who was supposed to clean out the gutters did not come. The periwinkles I planted the other day will be washed out if I do not clean these gutters.” I just said, “Well, Mama, you have got a perfectly good reason for being on that roof and I just hope when I am your age that I can get up on a roof if I need to.”
Despite her independence, my mama began to break off in pieces. She broke her wrist, and then her arm. Mama had lost about two inches of height over the years, but no one ever mentioned the word “osteoporosis.” The shrinking and broken bones were considered a natural part of aging. She was so independent that even with the cast on her arm, she refused to let me hire household help. Mama was impatient with illness. If you scratched your knee or had a stomachache, she would say, “Just get over it. I do not want to hear about that. It will be gone in the morning.” Or she would say, “Go wash it off with some soap and water.” It was not acceptable to feel bad because it slowed you down, and being sick was a waste of time. With each of her injuries it became harder and harder for her to keep up with the housework, but she was not going to let anybody else do it. So far as she was concerned they were not going to do it right and she would have to do it anyhow. After Daddy died and I was working in Washington, D.C., she was on her own much of the time.
I was spending half of my time in Washington, D.C., but the law firm I worked for had an office in Austin, so I would commute from D.C. to Austin every week or so to make sure she was doing okay.
As the years went by, there were a few warning signs that Mama was not well. She would lose her train of thought in the middle of a sentence. She got lost driving from her house to my house. Her driving scared the family to no end! When she fell and broke her arm, she had to stop driving and we took her car one day and disabled it so that she could not drive. We kept telling her we would get it fixed, but of course we were not going to do it. Then one day, my son Clark and his wife, Sharon, were sitting at the kitchen table with Mama when she fainted. They took her to the hospital, and it was then that we learned my mother had a malignant lesion on her brain.
Mama was sent for radiation treatment. She was sick and lost her hair, but she would not wear a wig, so I bought scarves and hats for her. When I gave them to her, though, she would say, “Why did you spend your money on that?” Or I would take her to the hospital and when we arrived she would say, “I know how busy you are so do not bother coming in with me.” That was her way. She did not want to be an inconvenience and I understand it because I worry that I will end up an inconvenience to my children.
Not long after she was diagnosed with cancer, she left something burning on the stove in her condominium. And though I did not want to relocate her on top of everything else, I knew there was no way she could continue to live alone. I really admire the Chinese and the Mexican cultures for how they take care of their elders by bringing them into the family, but there was no way I could make a living and give Mama the care she needed. Besides, my mother cherished her own space and she would have hated living under my roof. It is funny how much like my mother I become as I get older, and how, like her, I often crave solitude. I suppose we get set in our ways, used to our own spaces, our own ways of doing things, but I still needed to figure out something that would make Mama comfortable. I asked Mama if she would allow me to take a look at an assisted-living apartment for her and she said yes, she thought she would, and she said that she was just as concerned about her ability to care for herself as I was.
After considering a few options, we found an assisted-living facility in Austin that combined three sections: go-go, slow-go, and no-go. I wanted a place that would allow her to remain in the same facility; moving is so disorienting. The rules of the facility required Mama to be able to take care of herself when we first bought the apartment. This is called the “go-go” stage because she could still care for herself. If we waited until she could no longer care for herself, it would be too late to get her into that particular facility. Once we bought the apartment, it would be Mama’s for the rest of her life, and if she needed assistance it was available in the slow-go or no-go sections. When she died, the go-go apartment would be sold to someone else.
Not long after our discussion, we moved Mama into her new assisted-living apartment. What a job! Years and years of accumulated stuff-my mother saved everything. By the end of her life, she had clothes hanging in her closet she had not worn in years. She was certain that one day she would need that old sequin dress! It had reached the point where there was no more room in the closet and she had started hanging things on a rod over the bathtub. The garage was filled with boxes full of paper bags from the grocery store and plastic sacks full of more plastic sacks. She never threw away a ragged towel or old socks since these could be used for cleaning. Before my father died I had arranged for Meals on Wheels to help out, and when I came to visit, I would find the refrigerator filled with leftover Meals on Wheels boxes. If they did not eat everything in the box, Mama would save what was left. Even after she was on her own, she saved her leftovers. The problem was, she could not remember what was in the cartons-it was just a mess. And because Mama was a gardener there were always boxes and sacks of dirt in the garage. She was big on bringing dirt home. She would see some dirt on the side of the road that looked rich, stop, get the shovel out of the trunk, and fill up a box. When we moved her things out of the condo, she loaded a box of dirt into the car trunk because she said she would need dirt for potting plants. She had antique china dolls with elaborate dresses, and there were china cabinets full of cut glass and figurines. We found multiple lists: “silver service in hot water-heater closet, Indian jewelry under stairs.” Time had dulled her memory so she had to make lists, but then she could not remember where she’d put the lists. Mama spent a lifetime worrying that I would not appreciate the things she collected, but the truth is that toward the end she lost interest in all that stuff herself. All that mattered to her were family and friends; everything else sort of fell away. All she cared about was having us visit. Life was measured from visit to visit.
Mama’s new apartment was really quite pretty. It was important that she have the option to prepare her own meals or choose to go to the central dining room because I wanted to be certain that she could remain independent for as long as possible. At first, Mama was adjusting well and I think having other people around gave her back some of her confidence, but then she fell and broke her hip. I do not know how long she lay on the floor before someone found her. Now, for anyone to experience an accident is difficult, but for older people, it is traumatic. There are so many different stages of treatment that require different facilities, different doctors, and multiple medications. They lose track of where they are and for what reason. They go to the emergency room and there is one set of doctors and nurses. Then, from the emergency room they are moved to a regular hospital room and there is another set of doctors and nurses. If they need to have a bone set or have surgery, there is another specialist and a new group of nurses. Once past that, they are moved to a rehab center, where there is a new group of therapists, nurses, and physicians. For those who leave the rehab but are not well enough to go home, there is a way-station facility and another set of personnel. And then by the time they get home, if they get home, there is a home-health care nurse and a rehab therapist. And on top of all this confusion, they have to decipher the label on the medicine bottles that instructs them on what to take, how much, and when. It is no wonder my mama became terribly confused when she broke her hip.
When Mama got out of rehab, she was unsteady on her feet and could not return to her go-go apartment, so while she recovered, she stayed in the slow-go section of the assisted-living facility. We all wanted what was best for her, but looking back, I think moving around like that caused Mama a great deal of confusion. Even in the go-go apartment that was furnished with her things, she sometimes became puzzled about where she was. When she left the central dining room, she would get lost looking for her apartment. As Mama was shuffled around from one place to another after her accident, her confusion escalated. When she was in the rehabilitation unit, the doctor would question her and Mama would answer, “Well yes and thank you”-always very courteous-but after he left the room she would say, “Who was that?” And I would say, “Well, that is the doctor here in the rehab center.” “Oh,” she would say with resignation.
Mama had to use a walker and she hated it. Now began a real, real serious loss of cognizance, and this time in her life is a very painful memory for me. We visited her a lot, but she would forget anyone had been there and the very next day after one of us had been there, she would ask why we never came to see her. She would call me or my daughters and say, “I am at a hotel downtown. I need somebody to pick me up.” I put some of the furniture from her go-go apartment into the slow-go room so she would see familiar things. When she would call me in confusion, I would try to talk her through it. I would say, “Mama, you see those chairs there? You remember we got those chairs covered in that new fabric?” And she would say, “Yes.” “So you know that those are your chairs and you are in your room.” And she would say, “Well, I guess I am.” Once I went into her room and found she had written “help me” in lipstick on the mirror in the bathroom. My heart broke when I read her message. I just know that she got up in the middle of the night and did not know where she was.
I thank God for the slow-go nursing-care unit in the assisted-living complex because I never would have wanted to move her to yet another location. The facility was really nice, but I had a sinking feeling of sadness every time I walked out the door and left her there. Except for the delusional periods, Mama was not afraid. She did not talk much in those last months, but she wanted us to talk to her. We talked about the weather, what the weather was yesterday, what the weather would be tomorrow, what the children were doing, and what the grandchildren were thinking. Mama did not complain, and she would not have wanted us to complain on her behalf, but she did not have any control over her situation or an opportunity to alter her circumstances. For a woman with Mama’s spunk, I sometimes think it might have been worse than dying.
We would take her out for Sunday brunch and that really cheered her up. We would go to Luby’s, where she could get her favorite vegetables, and she would tell me that some of the people in the nursing home were really crazy! There was a woman who shouted all the time and a man who never talked at all. The complex had a minister come once a week, and she would attend even though she said he was boring. And a church lady came and sang songs that Mama enjoyed. I remember her seated in a circle with a group of other women. They were rolling a red ball back and forth to each other, a form of exercise I suppose. Even with the walker that she hated, Mama tried to participate in life until the end, but it was obvious that she was dying. I was still commuting between Austin and Washington, D.C., and I was giving speeches all over the country, so I hired someone to stay with Mama all the time, and we got hospice care.
My mother told me at some point in those last few weeks that she had seen her mother, although in reality she had been dead for many years. My mother loved her own mother dearly. She said that my grandmother had come to her room and sat with her.
In the last days of her life, hospice caregivers told us that even though Mama was in a coma, she might still hear and understand what we said to her. The night my mother died I talked to her. I said, “Do you know how you told me you saw your Mama? Maybe you are really going to get to see her.” I said, “You know, Mama, I do not know what heaven is like, but if it is there, then Daddy will be there and Grandmother and Aunt Elta. You will get to be with them.” My children talked to her, too. Whether that was any reassurance to her or not I do not know, but I like to think it was.
I have come to the conclusion that not only do we have to learn to live well during the years we have, but we also have to learn to accept dying. We should be allowed to live out our last days with dignity. Mama had signed the power of attorney and the power of medical decisions and every necessary document because she did not want to die an ignoble death, but her death was hard. She went through all of the sad, gasping death throes. I keep thinking that as time passes, that memory will fade, but it has not. In her last days, Mama was not conscious. She had to be turned to avoid bedsores. The day before she died, I came into her room to find one of the staff members at the nursing home spooning a black substance into her mouth. Mama was semiconscious and unable to swallow because her mouth was so ulcerated. I was shocked and upset so I said, “What are you doing?” And the woman replied, “I am giving her vitamins.” I could not believe it-Mama was dying, but since the doctor had not marked “vitamins” off the chart, the woman had mashed vitamins into chocolate pudding and attempted to administer the stuff even though my mother could not swallow.
I did not realize how strong our bodies are until I watched my mother die. Dying is hard. Shepherding her through those last years was traumatic. The last lesson I learned from my mama was to put my health first. I do not want my kids to remember my last years the way I remember Mama’s.
Mama died on February 15, 1997, just after midnight of Valentine’s Day. For a long time I felt untethered from the world, like a balloon whose string is suddenly severed.
I often think about what I should have done or could have done when she was dying. I think that I did all I could. It is just that she was failing more rapidly than any of us were willing to accept. I do not think most of us want to admit that our mother is dying. I kept thinking that with every illness, she was going to spring back, because she always had. I would not have wanted her to live one minute longer the way that she was. That is no life. When I think about this sad time, I realize the real regret I have about my mother is that she had to move into assisted living. Not long ago I bought a new condo. It has a spare bedroom I call the nurse’s room, and I intend to make the place easy for me to negotiate in my old age. I want to live as long as possible in my own home.
After Mama died, I talked a lot about my mother’s aging and dying in speeches I made around the country. I talked about how we have to take responsibility for our own health. We can give no greater gift to those we love than our good health. I tapped into something with those speeches. Women came up to me afterward and talked about their own fears of aging and remaining independent. They talked about their situation with their own aging parents and I realized that there is little shared information about our feelings when our parents need care.
I do not know why I have such a fear that my children might have to be responsible for me when I am old, but I do. I hope I am still doing the same thing I am doing now when I am eighty, but I may not, so I need money in the bank that can support my needs and will let me travel, and indulge my children. I do not want to be limited by the lack of money or by my physical health. These are the two things that women think the least about when they are young. Women are always caring for somebody else. I do not know why it is that way, but it has always been that way.
Mama held on to her gumption for a long time, but her body and mind had given up. If I had known then what I know now about osteoporosis, years before my mama had broken that first bone, I would have insisted she get a bone-density test and from there, choose a regimen to strengthen her bones. It would not have kept her from dying, but her last years would have been better. Watching Mama, I knew I was seeing myself in a few years, and it motivated me to become aggressive about taking care of myself.
Osteoporosis makes living difficult and that is why it is so frightening. The good news though is that new medical information and medications offer women the opportunity to overcome this disease. What matters to me is being independent for the rest of my life, able to do whatever I want without being held back by infirmities. I do not want to end up in a trailer in my daughter’s driveway. I have tried to lead an active, productive life, but I did not always take care of my health. I want to keep doing the things I enjoy; so today I make my health my top concern.
Reprinted from “I’m Not Slowing Down” by Ann Richards with Richard U. Levine, M.D. by permission of Dutton, a member of Penguin Group (USA) Inc. Copyright © Ann Richards, 2003. All rights reserved. This excerpt, or any parts thereof, may not be reproduced without permission.