Friends in Sickness and Health

When Stephanie Dupin learned that her kidney cancer had spread to the liver, she drafted an old friend to help her choose a mausoleum, a picture-perfect resting place for her ashes.

Dupin, 47, and Fran De La Torre, 49, visited several cemeteries, settling on Rose Hills in Whittier with its acres of sweet blooms. To soften the stark purpose of their outing, the women decided to buy adjoining niches and split the cost.

“Once I said we’d go halves, we could pretend it was just pre-planning,” said De La Torre, recalling the bittersweet moment. “We call it our lakefront property.”

Resting side by side for eternity once was reserved for kin. But the boundaries between friendship and family are blurring for the exploding population of middle-aged Americans who live alone.

Social and demographic trends--including divorce, rootlessness and the baby boom generation entering its 50s--are dramatically changing middle age. Millions more people are growing old and infirm outside the embrace of traditional nuclear families. As a result, clusters of friends are filling roles once reserved for spouses and children.

The prototype for these networks comes from the gay community. They have spread to the mainstream as more solitary adults begin to find that they cannot navigate the rough seas of age and illness as easily as their parents did in the era of “till-death-do-us-part.”

Who paces the hospital corridors during surgery? Who sleeps by the bedside on a cot, calls the distant relatives with news, asks doctors for the prognosis? Who fills the prescriptions, buys the groceries, bird-dogs the insurance claims? Who holds the power of attorney? Who shares memories of the past, plans for the future and musings about mortality?

The answer, increasingly, is friends.

“Once, family took care of family business and everybody else was an outsider,” said Pam Hoff, a social worker in the radiation department at UCLA Medical Center. “That’s not true of this generation.”

But far too few people have friends to fill the void, according to social workers and others who must cobble together alternative systems of support for this burgeoning population of middle-aged singles.

“We need a national consciousness-raising about nurturing a family of good friends,” Hoff said. “We should talk to kids about this in school.”

She describes the demographic shift as “a floodgate,” and the numbers bear her out. Between 1970 and 1990, the percentage of never-married or divorced adults in America rose from 19.4% to 30.5%. In the same two decades, the proportion of Americans living alone jumped from 8% to 13%--23 million people.

Dupin is one of them, a divorced lawyer in Altadena who is estranged from her teenage children and unable to depend on an invalid mother. She no longer can drive, often is housebound and needs help rising from the sofa, putting on her shoes and walking.

“My friends are my backbone,” she said. “Had I not had them, where would I be?”

Crystal Griffiths, 42, posed the same question recently as she readied herself for a round of chemotherapy for ovarian cancer. An anthropology student from Pacific Palisades, she is divorced and childless; both her parents are dead.

When the last round failed, Griffiths said, one friend took it almost as hard as she did. Debbie Marshall, who considered it “our chemo,” had been there for every one of Griffiths’ treatments, leaving her husband and accounting practice in the San Gabriel Valley for days at a time.

While the chemicals dripped into Griffiths’ veins at UCLA Medical Center, the pair would yak and giggle like schoolgirls until the nurses begged them to shush. Afterward, in what would become a ritual, they would stop at the sewing store for embroidery yarn and at the nursery for flats of white salvia. Then Marshall would stay the night, or several if necessary.

“If I had not had friends like this, the dark corners of my mind would have overwhelmed me a long time ago,” Griffiths said. “Do I fear pain and suffering? Of course I do. But not as much as I fear being alone. That I truly can’t imagine.”

De La Torre has power of attorney, the code to retrieve telephone messages and all the important papers Dupin is prone to losing when morphine clouds her brain. Another friend, Beatrice Lawson, cleans and cooks for her. John Hopkins moved a futon from his Altadena home to hers to serve as night nurse. Amy Harris talks her through tough times over the phone.

Dupin and Griffiths are professional women being cared for by loving networks. But experts say that a far broader spectrum of people of all economic classes are leaning more on friends as they age or face illness.

“At some point, we’re all going to need to rely on someone else. We’re at that age now,” said Hopkins, who went to college with Dupin. The owner of the Oh Happy Days natural food store in Altadena recently moved to Dupin’s house so someone would be with her at night. There are other alternatives, such as nursing homes and meals-on-wheels, but Hopkins, who is single, cannot bear to think of them. “The whole idea of being cared for by strangers for money . . . “ His voice trailed off. “That’s not what I want for me or the people I love.”

Donna McClay drives Dupin to medical appointments, a 200-mile circuit that takes McClay from her home in Orange County, to her office in downtown Los Angeles, to Dupin’s residence in Altadena, to UCLA, and back.

“There’s no script for this,” said McClay, a prosecutor with a daughter graduating from high school. “We’re still young, so we think we can do for ourselves forever. But when you actually witness this, you understand that’s not so.”

Redefining the Family

The common enemy for both the sick and the aging is loneliness. It is this specter that Dupin and Griffiths are battling, with help from their friends.

Mental health professionals long have documented the critical role of social support in health, happiness and longevity. Studies of both sick and healthy adults have found that people do better when they have others around to meet tangible needs such as running errands and emotional needs such as providing companionship.

There is ample anecdotal evidence that friendship support networks offer advantages that kinship does not, say experts in health psychology.

The primary value of the family model is its intrinsic reliability. “It is difficult for family to just walk away,” said David K. Wellisch, a professor of psychiatry at UCLA. But all experts agree that families often come with far more baggage than friends: secrets, guilt, old roles and rivalries that can lead to conflict among caregivers.

“Then the patient feels guilty, has to mediate and wastes precious energy,” he said.

Dupin’s friend, Anna Sullivan, a court interpreter, has eight siblings and assumes they would take care of her if she were sick. But even a storybook family has its drawbacks.

“It’s much easier to hurt each other’s feelings and then hold that sentiment,” Sullivan said of her brothers and sisters. “I’m more accommodating and forgiving of friends.”

Friendship networks also widen the base of support, with a large cast of characters resembling the extended small town families of generations past.

“Each of us has a different schedule, different strengths, so it spreads the burden,” said Cyd Crickard, a prosecutor, who has dinner with Dupin every Thursday, arriving with gossip from the Los Angeles bar and inspirational literature, most recently “The Autobiography of a Yogi.”

Friendship, however, is not a relationship privileged by law or institutional custom, which means friends are not automatically accorded the same benefits and courtesies as family.

“Family is defined too narrowly in this society,” said Ronnie Kaye, a therapist who treats people with cancer.

That is changing, but slowly. Many people, even those in robust health, select friends rather than relatives for financial and medical powers of attorney. Hospitals that once permitted only relatives to visit the intensive care unit or stay overnight now allow friends to do the same--a legacy of AIDS. And a few workplaces are generous with time off for friends who act as care-givers.

But the three-year-old federal Family Medical Leave Act protects only those related by blood or marriage. Airlines reserve trip insurance for kin. And the American Cancer Society, in its brochures, offers guidance to “patients and their families.”

The friends of Dupin and Griffiths report generally being welcomed in medical settings. But few were confident that their employers would provide time off, even unpaid leave, once they had exhausted their vacations.

Mental health professionals who deal with the critically ill lament the fact that most of their unmarried patients do not have deep friendships as Dupin and Griffiths do. The few who do generally are female or gay, they say, reflecting the difficulty that many men have in forming close friendships.

Cheryl Abe, an oncology social worker at UCLA Medical Center, observed that few people outside the gay community pick their friends with the expectation that they will need them as caretakers.

“I wonder how many people have actually taken stock of who would be there for them?” Abe asked. “I’m doing my own self-reflection as we speak: Would I let a friend move into my house? Would I quit my job? How far would I go?”

Care and Comfort in Return

Dupin’s friends have gone the distance, testimony not only to their love but to the adage that you reap what you sow.

Even weak and in pain, they say, Dupin is a paragon of thoughtfulness, asking how the doctor is doing at the start of each visit, arranging a high school graduation gift for McClay’s daughter, loaning money to De La Torre when her checking account runs dry.

“If you haven’t done anything for anybody, why should you expect them to do for you?” said Lawson, an attorney, who tends to Dupin’s home and looks after Dupin’s mother, homebound after a stroke.

Hopkins, whom Dupin calls an “old hippie dude,” does the grocery shopping and takes care of her two dogs. If he had his way, Dupin would be eating macrobiotic, but he has given in to her Southern-fried taste. Although Hopkins refuses to have a telephone in his home, he now carries a beeper.

He has been told by the hospice workers what to expect in Dupin’s last days. A man of few words, Hopkins does not dwell on it, except to say he would “like to see her pass in her own room.”

Most evenings, Dupin has visitors who bring dinner or take her out. But Dupin’s oldest friend, Amy Harris, her tether-ball partner in elementary school, no longer can come. Harris has multiple sclerosis, which over 22 years has robbed her of her mobility.

By telephone, Harris does what no one else can: She helps her friend get through the diminution of energy that Dupin describes as “a balloon with a little bit of air seeping out every day.” Get used to it, Harris tells her, and don’t waste time trying to figure out whom to blame.

De La Torre, who taught school with Dupin in Pasadena 25 years ago, was with her for her surgery, alongside the gurney until it passed the operating room doors. She also was there months later when doctors said the cancer had spread. At Dupin’s behest, it was De La Torre who asked the hardest question: How long did her friend have to live?

Recently, in the midst of downsizing at the company where she works, De La Torre refused an out-of-state transfer, taking a job here that she hates.

“I couldn’t live with myself if I left,” she said. “This time is important. We can’t get it back.”

A Network of Talents

Griffiths has more time, enough for a group tour of Greece earlier this month to visit archeological ruins. She also hopes to travel to Egypt this fall. A high school friend, Deborah Vass, a strategic planner at Disney, will join her for that journey. But Griffiths was alone in Greece: Vass and Joy Abbott, another high school friend and an executive at MGM, could not spare the time from work, and Marshall’s husband balked at her leaving.

“I was devastated,” Marshall said. “What a lost opportunity. It’s like a ship passed by and I didn’t get on.”

Griffiths has fewer friends in her network than Dupin, but their talents mesh perfectly. Marshall, an earth mother with a flexible work schedule, delights in the slumber parties that accompany each of her friend’s chemotherapy sessions. “Sometimes I feel guilty that we’re having so much fun,” she said.

Vass surfs the Internet for information about ovarian cancer and shares Griffiths’ brutally honest approach to her grim prognosis.

“Some people don’t want to hear anything negative,” Griffiths said. “They can’t deal with the whole idea of losing you. But each time a treatment fails, I have to shift gears again. I need to bounce things off people. Not that I expect them to solve it. But saying it out loud helps me sort it out. Deborah will let me do that.”

By contrast, Abbott, who lost her mother to cancer last year, can’t bear discussing death. When the friends joined in a recent 5-kilometer walk to raise money for cancer, Abbott, a clotheshorse, chided Griffiths for her out-of-style sunglasses. Not worth buying a new pair, Griffiths said. Her friend turned away, unwilling to hear it.

But Abbott is the problem-solver. When something goes wrong, she demands, “How can we fix it?” Griffith had inadequate health insurance, and Abbott banged the telephones until she found a better policy. She hired a maid and a chiropractor. The day of Griffiths’ diagnosis, Abbott raced from work to be with her at the hospital and set in motion a telephone tree to spread the word that “something awful has happened to Crystal.”

Abbott also offered to donate or raise nearly $100,000 for an experimental bone marrow transplant when Griffiths was considering one. And she wants to move Crystal into her big house in Santa Monica, where a live-in housekeeper can help care for her.

Griffiths is reluctant because Abbott has a 5-year-old daughter. “Too depressing for her,” she said.

“That should not be a worry at all,” Abbott said firmly. “It would be a learning experience.”

More likely, Griffiths said, she will accept an invitation to move in with Vass, who is single and childless and has a two-bedroom apartment in South Pasadena--but only when she no longer can care for herself.

It is inevitable, she knows. “But giving up my stuff, my privacy, means losing my identity,” Griffiths said in her sunny apartment, overflowing with books and overlooking her flower garden. Marshall is with her, and they are in the midst of one of their precious slumber parties.

During their hours together--hours they never made time for until Griffiths got sick--they plant flowers, make quilts, watch videos, debate their incompatible views of an afterlife and sometimes just fall silent.

“Right now we can do pretty much what we want to do,” Griffiths said, wistfully.

Marshall answers in even tones: “And when all you can do is lie on the sofa, we’ll lie on the sofa.”

“Joy [Abbott] would go stark raving nuts,” Griffiths countered. They both laughed generously, loving their friend despite her inability to sit quietly with grief.

Griffiths entertains no hope of a heavenly hereafter. At best, she says, her remains will nourish the soil and help her flowers grow, and her spirit will live in the hearts of those who love her.

“You will never look at a fuchsia and not think of me,” she told Marshall.

True enough, Marshall said. But that won’t be the end of it.

“I want you to be around a lot longer than you will be,” she said. “But when it’s over, I won’t be sad for you. When all is said and done, I’ll cry for me and look forward to seeing you again. And when we come back together, we’ll hang on for dear life.”