What does it really feel like to grow older? This week, host Dr. Denise Millstine dives into “When the Cranes Fly South” with author Lisa Ridzén and geriatrician Dr. Erum Jadoon, exploring aging, dignity, care-giving, and the unexpected power of companionship - especially the four legged kind. A tender, eye opening conversation you won’t want to miss.
Aging isn’t just a medical journey - it’s a human one, and this episode brings that truth vividly to life.
In a warm, deeply reflective conversation, Dr. Denise Millstine, novelist Lisa Ridzén, and geriatrician Dr. Erum Jadoon explore “When the Cranes Fly South,” a novel that captures the emotional terrain of growing older through the story of Bo, an elderly Swedish man navigating loneliness, autonomy, caregiving, and the fierce love he holds for his dog, Sixten. Drawing on Ridzén’s real-life discovery of her grandfather’s caregiver notebooks and Jadoon’s clinical expertise, the episode weaves together themes of dignity, companionship, the power of pets, the complexity of family decisions, and the universal desire to maintain agency at the end of life. The result is a tender, thought‑provoking discussion that invites listeners to rethink what it means to age and to care for those who do.
This episode was made possible by the generous support of Ken Stevens.
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Dr. Denise Millstine
Welcome to the “Read. Talk. Grow.” podcast, where we explore health topics through books. Our topic today is aging, and our book is “When the Cranes Fly South” by Lisa Ridzén and translated to English by Alice Menzies. I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine, and integrative medicine.
My guests today are Lisa Ridzén, who's a Swedish novelist and sociologist and whose acclaimed debut novel, “When the Cranes Fly South,” has become an international bestseller. Inspired by her research on masculinity in rural Sweden and by notes left by her grandfather's care team near the end of his life, her work explores aging, care, love, and human dignity with deep empathy and emotional clarity.
Lisa, welcome to the show.
Lisa Ridzén
Thank you. And thank you for that beautiful introduction.
Dr. Denise Millstine
Our medical expert guest is Dr. Erum Jadoon, who's a geriatrician, an internist, and an assistant professor of medicine at Mayo Clinic in Arizona. She's on faculty with the Academy of Communication and Healthcare and teaches communication to Mayo Clinic faculty, physicians and training and medical students. This is her third appearance on “Read Talk Grow.”
Erum, welcome back to the show.
Dr. Erum Jadoon
Oh, it's always a pleasure. Thank you.
Dr. Denise Millstine
“When the Cranes Fly South” is a modern novel about Bo, an elderly man in Sweden whose wife has moved to a care facility, and so he finds himself living alone with visiting caregivers, his dog Sixten, and his son, who strives to keep him safe and fed. Bo has become progressively more frail and increasingly isolated, which adds layers of challenges and difficult decisions.
Okay, you both know how “Read. Talk. Grow.” works. We discuss books that portray health topics in an effort to better understand health experiences through story. In this case, we'll talk about aging.
Lisa, you had a personal inspiration for writing this book. Will you tell us the story?
Lisa Ridzén
Yes. So the idea for this book came to me when I was down in my dad's work shed or his tool room, or whatever you call it. And as I was waiting for him to find some screws for me, I found a little box of leftover things from my granddad, and I was just looking through, casually looking through.
And I found these, little notebooks that the care team left. The care team that looked after my granddad the last two or three years of his life. We call them home service in Swedish. So it's basically a type of care where the nurses come home to you. They visit the older people instead of looking after them at, facilities.
So, as I was reading through these little everyday notes, I was like, oh my God, I really need to write a book about an old person's perspective on life, but also on on aging and passing, I guess.
Dr. Denise Millstine
Yeah, it's so beautiful and it's true that we don't see enough protagonists in the middle parts of life and the later parts of life that are, you know, empowered and authentic. And it just really felt like you were right in Bo's mind. We'll talk more about that.
Erum, as a geriatrician, tell us your reaction to the book.
Dr. Erum Jadoon
Oh my gosh, hard to put it in words. I love the book. It was a delightful, delightful book. Very thought provoking. I felt that I was acutely aware of the passage of time. Memories playing in the mind. I actually really couldn't put the book down. It was a very heartwarming ending as well. I would highly, highly recommend reading this book. It was just wonderful.
Dr. Denise Millstine
Yeah. So many of us have aging parents or neighbors, and if we're lucky, all of us will age. So I think it's a book that applies to really everybody. So, Lisa, the first sentence of a novel is always important and yours is no different. Bo says, or the novel says, “I fantasize about cutting him out of my will, making sure he doesn't get a penny.”
So this is Bo, our main character, talking about his son, Hans. You're setting up a main tension thread here about not driving or living independently, but about Bo's dog, Sixten. What's happening and why did you start here?
Lisa Ridzén
Yes. So, as you mentioned that Sixten is a very important character in this book. I would say that it's it might actually be the closest living being to Bo. It's his companion in life where he is because Sixten is, he's staying at home. His wife is not no longer by his side, but Sixten is.
So he's someone who gives him comfort. Someone who gives him someone to look after. Basically, someone who gives him a meaning to still, you know, go on about life despite being so old and slowly losing power over his life. But his son thinks that Sixten might need longer walks. He is a bit worried about the fact that his father might fall when it takes the dog for longer walks then out of the road and back.
And he also thinks that it's not on the home service people, the nurses, to walk the dog. So he wants to take the dog away. He wants the dog to move.
As you say, this is kind of the conflict throughout the whole book, because Bo really wants to. And he makes that clear quite early in the book. He really wants to solve things with his son, Hans. He doesn't want it to end up like it did with his own father. They had a very problematic relationship, and he doesn't want it to be like that with his son. But then his son threatens to take his lovely dog away and makes it hard for him.
Dr. Denise Millstine
And to be clear, Hans is a good son. He is attentive. He is bringing food. This is a decision he's making not to be cruel in any way. He's worried about his dad, he's worried about his safety, and he's worried whether this is the best thing for Sixten. So it just really does pull your heart because you know, Hans also doesn't want to take the dog, but he just is seeing it as perhaps the smartest choice, which makes it really quite, quite painful.
Erum, we talked about aging and loneliness in episode 54 of “Read. Talk. Grow.” with the book, “Sipsworth” by Simon Van Booy and that also featured an animal. Are pets and animals really helpful as people age?
Dr. Erum Jadoon
Yes, actually there is no shortage of evidence and data out there that is very well documented and published. Most recently in a very well acclaimed medical journal, JAMA, talking about the impact of pets on aging. There is very good studies done not only in the United States but also replicated. The data is replicated in Europe, in Japan, and it talks about how having a pet actually reduces cognitive decline. It has an impact in reducing all cause mortality. It improves physical and social function.
The most recent study actually showed that pet ownership completely offsets the negative cognitive decline and effects of living alone, which is remarkable. So it was interesting that when you actually go into the details of all of this, it seems that this data is strongest for dogs and for cats, and less replicated for ownership of birds and ownership of fish, I'm sorry to say.
And, understandably, you know, having the a dog for a pet is a little is even better because the data shows that the forced walks that people do in the morning and in the evening actually has impact on muscle mass, frailty, independence; and it really does offset a lot of that. So this book, when I read that first page, it triggered a lot of things in me. It was just wonderful.
Dr. Denise Millstine
Just to summarize what you said. So when you have a pet, as you're aging, you have decreased cognitive decline. So it protects your memory, helps you to keep your memory and also reduce mortality. You'll even live longer. In addition to being less frail and having better muscle mass if you have a dog. So that is fantastic. Are you prescribing pets to your patients?
Dr. Erum Jadoon
Yes, I'm actually right, left and center. I'm very strongly recommending having a pet, adopting a pet to offset loneliness. There is a very real data that talks about increased mortality with loneliness; 57% increased mortality with persistent loneliness. This is no joke. No joke. This is a very somber percentage.
Dr. Denise Millstine
And Bo is lonely, and we see this as an epidemic. And, Lisa, I wonder if you'll talk a little bit more about the system in Sweden. So Bo is lucky to have what in the translation they call carers. I think we would call them caregivers very often, literally coming into his home, even visiting several times per day. Can you tell our listeners what that looks like.
Lisa Ridzén
Yeah, so the home service, which is the literal translation, is it's a governmentally funded service. So basically, if you write a story about an old person or aging in Sweden, in the Swedish context, you kind of have to include the home service, because basically everyone who gets to be old do get some help or the partners get some help from the home service.
And it's also a very common first job for young people. A lot of immigrants also work in the home service, and otherwise it's a female dominated working class job. And it's very cheap since it's governmentally funded. And I used to work in the home service myself, when I was younger, and I loved it. It's probably one of my favorite jobs I've had, maybe not as good as a writer or a researcher. But yeah, it's amazing because if you compare it to working in the hospital, for instance, and institution, this in the home service, you go home to people, so you get to go into their houses and see the families or the pets, the way they live.
And the thing that I enjoyed the most is that you get to know so much about the person. And something that really stuck me was that, yes, these are old people, but within them they carry all of these ages and after a while when you talk to them, because my experience is that all the people also have more time for real, interesting talk. They're not like people my age who are just so busy and working and having kids and families, careers and stuff. And I really enjoy that, that you get to talk about their whole life stories, basically.
That is also the downside because I got very attached to them. And then when you get back on Monday after the weekend, they might have passed because this is a kind of care that you get, yeah, at the end of people's life. So it's emotionally hard work I would say. I think that or one thing that I've talked a lot about traveling around, talking about the book, is how valuable and important it is with this kind of service.
Because when I've traveled around in Europe, many people say like, oh my God, you're so lucky to have this. It's amazing. Whereas in Sweden people express more a worry this service, is it still going to be there when I'm old and and so on. And it's also slightly stigmatized the people that work within this kind of job. And my opinion, they are underpaid and should be way more. What do you say? Valued higher, definitely, they do a fantastic job.
Dr. Denise Millstine
Yeah, even heroes, at that phase of life. Which to your point, people who have the home service have had this huge life experience and sometimes we treat them like they aren't these, you know, full people with full lives and that we don't recognize how much we can learn from them. And we should, we should slow down and do that.
Erum, we see some of the caregivers notes, which we now know is inspired by some of Lisa's readings of the past journals. And there are a variety of styles for these caregivers. Some are really friendly, some are all business. Bo calls one of them a battle axe. Is this something that you see this variation in caregiver styles that you hear your patients talking about? And do you know, is there like a best style for a caregiver, or do you think that combination is really the perfect mix?
Dr. Erum Jadoon
There are a couple of different factors that play into caregiving for us here in the United States, because depending on where you are, the type of services that are available are different. So for example, there is home based care where you can have what we call caregivers come to the house for a certain number of hours in a week.
And, most of these are very much dependent on the relationship or the personality of the caregiver. And I think that this book highlights that very nicely, where the one person who seems to be having or the caregiver that seems to have the most impact on the older adults mood, the older adults ability to eat or willingness to get out of bed and do things depends on how authentic and genuine that relationship is.
And sadly, that is the one thing that is very much dependent on the personality. Because similar to Sweden, a lot of these jobs are the first job for somebody or the first step into the foray of health care for many people. They are typically not very high paying jobs, is a higher turnover. And unfortunately, I do hear a lot about the dissatisfaction or the disappointment and the heartbreak that happens when a favorite caregiver moves on to a different job.
So I've had multiple stories where, oh, you know, my mom had this absolutely lovely caregiver and I walked in and she was playing, or she was doing puzzles with my mom, and my mom had the best time. And I went back and, you know, she's not there anymore. So it's very sad because we don't have that kind of consistency, unfortunately, because I think there is a commonality about the stigma and about this being a first job and all that. Definitely very similar.
Dr. Denise Millstine
I like what you said about the the relationship between the caregiver and the client or patient, that there just are different styles and sometimes you need to be collaborative and friendly, like, what do you want to eat? Let me make you this. And then there were some of them that are just telling you what to do. You get in that shower; you don't want to be a stinky old man.
Dr. Erum Jadoon
Exactly. And they are harsh. And the way they they are going to be moving around in a rush and trying to get, tick all the boxes. It's heartbreaking to see that.
Dr. Denise Millstine
But sometimes that firmness is needed, right? Because it is easy to get into that. Some of those habits and I don't know.
Dr. Erum Jadoon
Well, you know, a lot of things, has to do with the behavioral interventions that we have to put in place to allow to have that collaboration. How do you get somebody to agree to come to a point of commonality, especially when there is also some degree of memory loss or cognitive loss or confusion happening. And a lot of the times you know, even in our older adults that have significant cognitive decline, the only way we can really get them to cooperate is to buy into whatever fantasy or whatever story they or whatever time or moment they are in and not denying it, but rather going along with it and then giving suggestions to be able to do certain things. And yes, you know, if there is somebody who's not going to want to get up from their chair, is that risk of problems, then maybe you do have to be a little forceful, but I would say that would be a thing of last resort.
Dr. Denise Millstine
Fair, fair. As our communication expert, thank goodness, Lisa, one of the aspects of Bo’s life that we read about throughout the novel is food. What he'll eat, what he won't eat. Early on, Hans comments, you're getting so thin and Bo says, as though it's my fault my muscles are wasting away as though I invented the aging, useless body. Will you talk about the importance of food in the novel.
Lisa Ridzén
Yeah, I mean, food has a really important role because that is the intake of of food. It's like such a big part of Bo’s life. That's something that gives him routine, and that is one of the main purposes of the caregivers. They are there to make sure basically that he eats everything he needs to eat. But he, as well as many other old people has lacked or he's lost his a his appetite. So and a lot of things doesn't taste the same anymore.
And this is something I remembered working in the elder care that whipped cream, for instance. It has a tendency to change flavor so it can taste a bit like old and moldy almost. So things that you might have loved, you can't really eat anymore.
But there is one thing that he still likes and that is a sweet, like a little cake kind of thing called mazarin. It's a traditional Swedish cake basically, and he eats this every time he's on the phone with his best friend, Ture, because they're too old to see each other. He can't go into town anymore to see him, but instead they call each other and have a coffee break together. But yeah, food plays a big role.
Dr. Erum Jadoon
This actually really is bringing to mind a couple of different things that are also part of getting older. One is that the sense of the taste of sweet is preserved for the lifespan. Even in adults that are very old, frail, they can still appreciate the sweet flavor. So the lack of appetite is multifactorial. But the fact that we cannot taste certain flavors goes a lot into plays a huge role.
Another thing is that there is the question of early safety. So patients or as we get older we get full very quickly. This is one of the reasons why eating like a bird, so as to speak, is encouraged. And to keep favorite foods that are available all the time in within arm's reach is encouraged. Because it's really quite difficult to keep up with your caloric intake if you are going to limit yourself to just three meals in a day. And this is a problem that I see very often in my patients, especially my more traditional older adults who are used to sitting down for breakfast or sitting down for lunch, or sitting down for dinner, especially in older females, because they have just self discipline themselves not to snack. That can be a problem.
And the third thing is that food is always better when it is accompanied by somebody who is sitting with you. There is very well documented research that talks about improvement in frailty, maintenance of your weight, or even gaining weight when somebody is just losing weight because of depression, isolation, anxiety, you name it. If there is a companion sitting right next to them.
So that lovely ritual they have on the phone, it's almost like they're visiting, they're visiting. And even though, I mean, now we do have FaceTime, which has changed things a lot for our older adults. But, you know, just being able to converse with somebody and have something to eat at the same time, it really highlights the role of food in our lives.
And lastly, I have to say that one of the biggest issues I come across in my clinical practice is children who force their kids to go on a sugar free diet because they have diabetes, or a completely salt free diet because they have a history of high blood pressure. So very restrictive diets, usually enforced by kids, they are known to cause weight loss and promote frailty.
So, I mean, this is the one time in your life where you can eat whatever your heart literally desires. Just eat whatever and whenever.
Dr. Denise Millstine
Hey listeners, we hope you're enjoying this episode of “Read. Talk. Grow.” If you find our discussions helpful and insightful, please take a moment to subscribe to and rate “Read. Talk. Grow.” on your preferred podcast platform and don't forget to tell your friends to listen. Your support will help us reach more readers and those eager to learn about health through books. As always, feel free to drop us a line at readtalkgrow@mayo.edu with suggestions for books, topics or any comments. Thanks for listening.
I want to highlight a couple things you just said, Erum. The one thing that I just learned, which is why I love talking about these books so much. So it's not just about bringing food to somebody you're caring for, it's also about pausing to sit and to eat together, to accompany them during that time. It's not just the access to food that's important, but also the sharing of food.
And then you might have, when you said children, you're talking about adult children who are maybe navigating dietary modifications for their own health, for example, they have diabetes or they have high blood pressure. And so they're cutting things out of their own diet to manage their health conditions. But as people are elderly, it's fair to ease up on many of those restrictions and encourage people to eat something.
Dr. Erum Jadoon
I think, Denise, in my experience, honestly, I have seen it more as an extreme fear of losing a loved one. Because they love their mom, they love their dad. There is this extreme fear and anxiety over what's to come and acceptance of everything that's happening, which is completely out of control. This unknown and their loved one is in the middle of this.
I truly think that when you peel apart this question of why you are restricting your mother from having dessert, or why the she should do this or she should do that, a lot of these, apparently, for lack of better term control issues that I see a lot between kids or their caregivers or I mean, not necessarily just the kids could be a spouse, but usually it's the adult children. Is this extreme fear of losing their mother or their father or their grandfather, and it comes out in this extreme control.
So when you actually peel away this and you just talk to the caregiver, in my experience in the clinic, I've seen them just simply dissolve into tears and crying and just sobbing because they are stressed out. They are trying to take care of their kids, their job, there’re so many responsibilities and at the same time trying to be there for their mom and dad who's aging and just, you know, the time is passing.
Dr. Denise Millstine
Once again, it's a decision that's difficult, but it's made from a place of love. It's not that anybody is trying to be mean or cruel.
Lisa, you brought up Ture. This is Bo's oldest friend, and they have this rhythm of staying connected. And maybe they have stronger memories because they're reaching back to some of their younger years. They're working days. Can you talk about how important it is for Bo to have this rhythm with his old friend.
Lisa Ridzén
It means the world to him, really. Like I said, Ture is his best friend and maybe his only friend. Proper friend. And they've known each other for a long time, basically their whole adult lives. So they met through work. But Ture came more from a middle class background where as Bo is more of a working class country man.
But despite these challenges, because this might be something that could be an obstacle for them, but they just from the first moment they saw each other, they really flipped this, as we say in Swedish, the chemistry was perfect. So and then I think that there was something about Ture that Bo hadn't seen before. It was like a new kind of man or a new kind of masculinity, if I may say. So that showed Bo you can be a man in this way.
So Bo came from a very like restricted perspective on how to be a good man, basically. And Ture he is like this quirky, funny, a bit crazy in some ways, and that makes Bo defrost a bit and relax. And I would say that Ture is probably the person that Bo is the most relaxed with, where he you know, pulls down the fence a bit and have fun basically.
Dr. Denise Millstine
Yes, old friends are the best. And Erum, it's also important that Bo has a lot of community around him, not just the caregivers who are visiting him as part of their job, but there are these neighbors that pop in and at one point check on him because Sixten has run away and they haven't been able to find him and use technology to help Bo find Sixten again, which is something that's kind of beyond his skill set. Will you talk about community as people age and how important that is.
Dr. Erum Jadoon
Oh yes, I think it's very common for us to hear that it takes a village to raise a child. I think it takes a village even more importantly, it takes a village to really love and care for adults. And when you really think about it, that's what we do. We are social animals. We are best when we chat with friends and we connect with each other. And the fact that we retire at some point, or if we are not able to drive or not able to walk or become more frail, we are not able to do as much as just to be. It becomes even more paramount to have these social connections.
I could talk about this topic, which is very near and dear to my heart. When you think about the blue zones, the happiest places in the world, places where you have longevity, all of these places in common have this social structure where everybody is connected to everybody else. The people pause for a minute to talk to each other and check in on each other and that becomes even more important as we age. I mean, it's just lovely to read the passages in the book about all the little connections Bo has. It was very beautifully done, very lovely.
Dr. Denise Millstine
Yeah, really, really beautiful. So, Lisa, there is a scene where Bo is sitting with Sixten and petting the dog, and he notices that his hands are really stiff from arthritis, and he's thinking about how his arthritis has been worse because he had to stop his medication for arthritis due to some new medications that he was now taking for his heart issues.
And he's thinking back to the doctor, who was a covering doctor, who is quite busy and a bit dismissive. And that doctor had said to him, it's not really a hard choice between the heart medicine and the joint medicine. And then Bo thinks to himself, actually, I wouldn't mind dying from a heart attack. That wouldn't be a bad way to go. So I thought this was a clever way to portray that we do make assumptions about people; of course, you would want to protect your heart over feeling comfortable in your joints, but that's not necessarily true, is it?
Lisa Ridzén
No. Yeah. Thank you for bringing this scene up. I was actually inspired by when I wrote that scene. I was inspired by a meeting with the doctor that I had with my father, who's suffering from heart problems, and he's got rheumatism and these traditional sausage fingers, as we call them, very swollen. And the doctor made similar jokes. And I was like, I've got this feeling that working with elderly people, there is often this super focus on the medical parts, like we need to be as efficient as possible to make them live as long as possible, and that is like the main goal. And I mean, that is not a problematic goal in itself, of course.
But I guess what I want to do, and I've tried to do in this book, is to ask questions, and what more is there? Because we need to talk about these things with the older people as well. The more existential emotional aspects. For instance, there are some scenes where the priests are brought up by the caregivers as a way to deal with these worries and anxieties that are very common for old people. Because, of course, you think about the fact that you are slowly going to pass and, yeah. And I guess I wanted to investigate them and question this solo focus on just the medical aspects.
Dr. Erum Jadoon
And Lisa, you did it beautifully. I mean, you really, really, really did it beautifully, I must say, because I think what this really highlights is that in the spectrum of life and in the phases of life, the priorities change. When you are 20 years old, you cannot even imagine being 40 years old. And when you are, functional adults doing all types of, you know, activities, you cannot even imagine prioritizing or understanding how important your health or your faculties are.
I think it's a human tendency, a human condition where we do not tend to appreciate things until and unless they are gone or we've actually walked through it. And it is one of the things that is paramount for successful patient physician relationship and ultimately translates into longevity, better outcomes, less house hospital admissions, is to have this collaborative discussion where you are comfortable enough to talk about these very, very uncomfortable subjects, including goals of your treatment, your care, because it is honestly very, very easy to just write down a couple of medications and throw them away at somebody and then move on to the next patient, than it is to actually ask what is the role of faith for example, how does that translate into everyday life? Or if your heart is to stop, would you want to have just compressions? Or would you prefer to have a medication that actually allows your fingers to move better, but may mean that you tend to have more salt in your system, and you might you or you might have worsening in your leg swelling, or perhaps a medication that I would like to give you for your leg swelling is going to implicate problems somewhere else where when you stand up, you will get lightheaded.
So just asking what are the priorities from the patient and then tailoring the medical treatment so that it's collaborative. It's something that I think is very new for medicine, Western medicine, and we are hopefully moving towards it. But it's something that your book highlights very well and it's something that I personally strive for, for myself, and I hope I teach my learners. Cause traditionally it’s not like that.
Dr. Denise Millstine
I really like how you brought up to that. It's okay that those priorities change. And to Lisa's point, you know, while we make an assumption that people want to live longer, probably most people that I see want to live healthier and that expansion of their health span as opposed to their life span at the cost of feeling healthy.
One thing we do in integrative medicine is we ask people, what do you want your health for? And that is a very interesting question that most people haven't been asked before. And if it's because you want to live to see your granddaughter get married, well, that's about longevity or lifespan. If it's because you want to go climb a mountain, then that is a very different goal.
And so it's good to pivot, to know what that person is striving for. Because all of these medicines, all of these interventions come at a cost. Even decisions about whether to keep a dog or not, these come at a cost, which we see very heartbreakingly in the book. Although listeners will have to read the book to find out.
Dr. Erum Jadoon
It's not without its own dangers. You just have to know what is the pros and cons and make a intelligent decision as to how you want to live your life.
Dr. Denise Millstine
Lisa, one of the other things you didn't back away from was Bo's real frustration with his balance. He said, this is the thing that actually bothers him the most. Will you talk a bit about how important that was and how it impacted his life?
Lisa Ridzén
Yeah. So Bo has his whole life been a kind of man who puts a lot of value into being physically strong. To go outside collect the wood, carry it inside, or walk for hours in the forest with his dog and so on. And as he gets older, he loses this ability more and more. And also he, like you say, when he gets up quickly, he gets very lightheaded and dizzy and this is super frustrating for him.
And it also makes his son, he’s on his father constantly, like stop carrying in or taking in the wood or don't go for walks with the dog in the forest, you might fall over and so on. So this basically, you know, it isolates him into the house. So he is like he loses a lot of his, I would say everyday necessity, you know, just to be be outside in the forest.
Like me, myself, I live in a house very similar to Bo's house in my granddad's old house in the forest. And every time I travel to cities and so on, I just like I feel so, Ahh, it's too much. I want to go back to my forest. And if I don't get these forest walks, or if I don't get to light the fire in winter, like it's just we take it for granted when we are young. But imagine a life without these walks. Yeah, that’s Bo’s life and it's hard to put words to how devastating that is for Bo
Dr. Denise Millstine
Yeah. Erum, I could just picture you cringing as Bo was like, putting his walker aside because he figured he could just get a few steps to the shed. I could just feel you, like, No, he's going to fall.
But I want to talk about another topic that Lisa brings up with you Erum, and that's urinary incontinence. Because I think most people would think this is not a very sexy discussable topic. It is so incredibly common. And because there's often some embarrassment around it, people won't bring it up. But I just loved how the caregivers treated Bo with such dignity around this issue in terms of leaving dry clothes for him in easy places and normalizing the use of a pad or what's called a nappy in the novel. Will you talk about incontinence a little bit.
Dr. Erum Jadoon
Well, you said it well, Denise. Urinary incontinence is not considered a part of normal aging. But having said that, it is incredibly common. It is very, very common in women, but also in men. And it is associated with very high anxiety, depression, as well as isolation. So like you said, it is something that people don't like to discuss, don't like to talk. As a matter of fact, for one of the things that I have to make sure I teach my learners is that they specifically ask about it, since people are not going to bring it up. And if they are not going to bring it up, they will not know that there are so many different things that we can offer them that can help, including cognitive behavior therapy, including having access to dry clothing, access to some sort of containment garment, and things of that nature. Because it does cause isolation. This is a huge topic, and I absolutely loved how the caregivers made it seem like it's no big deal.
Dr. Denise Millstine
I imagine in your work as a caregiver, Lisa informed this as well, that you just saw it all the time, no doubt.
Lisa Ridzén
Yes.
Dr. Denise Millstine
There's another character in the book who we don't actually see very much of, and this is Bo's wife. Bo’s wife has gone to a care facility, she has dementia. And in fact, Bo is speaking to her through the whole book, literally addressing her. But he is really not energetic about going to visit her. Hans feels like it's something they need to do. Bo feels like it's something that he doesn't need to do because she's not herself, She's he says she's just a husk of herself.
What a challenge. But also a common challenge to know what to do with a loved one who is losing their cognitive function, losing recognition. Will you both just comment on the challenges with that. And maybe Lisa start with you, about how you have Hans and Bo's approach really contrasting each other.
Lisa Ridzén
Yeah, I think that for Bo, his wife is, it's almost like she's dead to him. And seeing her is just reminds him of all the things he misses about her, and that she is not the way she used to be. So it's very painful for him to be there. At the same time, he realizes that it's good for Hans to be there. So he sticks to these visits with his son to be nice to him basically.
And like you said, the whole book is addressed to Fredrika, the wife. And I did that because at first I experimented a little bit by not writing to her, despite her not being dead but feeling like she was dead. She's still such a big part of his mental thinking, and I think that for, at least that's how I experience like people that I've lost, like my granddad, for instance. He's not physically here with me, but he's still in my mind here, you know, so I feel like I can talk to him.
And I imagine that if your partner disappear, it would be a bit like for Bo. Every time he wakes up, she's there in his thoughts, when you've lived a whole life together, you know, then it's hard just to start living on your own. So I guess I did that way. Or I wrote the book like that. Just to show how even when people pass or get sick doesn't mean they disappear.
Dr. Denise Millstine
So lovely.
Dr. Erum Jadoon
Yeah, there is a very nice book on grief and loss, and it's almost as if the grief and the loss that happens with the death of a spouse, which is very final, and everything that the fallout from that. On the other hand, we often don't talk about the grief and the loss that happens when there is not a death, but rather that is the finishing of that relationship because there is no cognition, there is no memory, and there is just the husk of a person.
And do have to visit and relive that loss over and over and over is almost as if you're not letting yourself heal or you're not letting, there is no moving on. I think that is how I would be able to best explain the recurrence, reluctance, and the pain that Bo has to go when he has to visit his wife, who just simply does not recognize him.
And I see this in my patients where I have a very loving caregiving husband to his wife, who has advanced memory loss with paranoid features saying, who are you? Why are you in my house? Why are you in my bed, running away in fear or calling the cops that there is a stranger in the house. So that rejection, recurrent rejection, I think is it's almost asking too much from a human being.
Dr. Denise Millstine
There's so much compassion in that, in that wisdom. Yeah. Thank you.
Dr. Erum Jadoon
It's just very difficult. I've had grown men cry over this with me, because it's just so difficult for them to try to process that, you know.
Dr. Denise Millstine
Yeah. Let's wrap up with some advice from each of you for somebody who is caring about aging adults, trying to keep them at home and support them. Any last pieces of advice, Lisa?
Lisa Ridzén
Well, I don't know, read my book. No, I guess to to always try to ask and imagine what it would be like if you were the aging one and put yourself in that person's perspective. Yeah, empathy is always a good way.
Dr. Erum Jadoon
I would say read Lisa’s book! I would second that.
It's the acceptance of life. It's the acceptance of the phases of life and the simple, simple fact that we live on connections. Connections with our pets, connections with other humans, connections with our landscape, our garden. And if you cannot have it big, even having a little bit is what keeps keeps one going.
Lisa Ridzén
So good. Perfect. I'll copy that for for next time.
Dr. Denise Millstine
Well this has really been my pleasure. Thank you both for being here to talk about “When the Cranes Fly South” by Lisa Ridzén. It was such a beautiful conversation. I appreciate you both. Thank you.
Dr. Erum Jadoon
Thank you.
Lisa Ridzén
Thank you so much for having us.
Dr. Denise Millstine
“Read. Talk. Grow.” is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
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