To be clear, many “disconnected” adult children don’t step back in. For them, there is no going back. The outside world may judge them harshly, but it matters not. I have a friend who walked away from his family at an early age, and refused the urgent call in his fifties to reconcile with his dying mother.

Cold hearted? Depends on whose reality you choose to inhabit. In an unusual moment of transparency, he shared with me his childhood trauma. It was raw and left me distressed. He broke away in his mid-teens and never went back. Understandably, he spent many non-linear years trying to outrun his demons and scars, but finally, with help, righted his thinking and his life into a stable success story. Then he got the call.

His mother was dying. She wanted to see him. He refused. “I barely survive her once,” he told me. “I can’t take a second round.” And he didn’t. Her deathbed request went unanswered. His family condemned him. He has no apparent regrets.

But others change their minds. Unlike my friend, they see an opening that allows them to return and lend a hand. Some find their ability to forgive is big enough for both parties. Some find an all too familiar disappointment they recognize from their childhood. I think all of them hope for some form of a better ending for their story about their earthly parents. And that, I think, is the key to those who return and those who won’t.

At some point in the parent-child disconnect, you decide its time to let it be. It’s over and probably for the better. That point may be death, but for many, it comes much earlier in the saga. These early adopters resign their affiliation and call it a day. It’s not a case of good or bad, but what is necessary given the players and the circumstances of the family drama. Those who leave but don’t disinherit their family keep the door open for some form of reconsideration. What is important for adult children is to recognize that both choices get the job done. Bad connections are one of life’s nasty dilemmas, leaving all parties unsure of what to say, do, or expect. In the end, we all wind up doing our best, as we understand it. Nothing more. Nothing less. Accepting that, proves to be another matter…

But this is no ordinary article about a bad outcome involving aging parents. This is a seminal article about a new and quite sobering level of vigilance that attends our role with our aging parents. The rapidity of events and the ever present pressure of “medical necessity” in the last phase of life can push families into decisions they not only regret but, as Ms. Butler so eloquently and heroically portrays, resist our best efforts to unwind them. If there was ever an article on this subject to read in a quiet, non-distracted moment, this is surly the one…

The main focus of my work has been on the developmental agenda of the last phase of life of older adults, the need for control and legacy. But what about the developmental agenda of a life cut short from its normal longevity? Does a terminal illness in younger adults usurp their normal developmental stage by superimposing the final agenda of older adults? I didn’t know, and that’s what I told the friend of the family.

I also told the friend of the family that under the circumstances, I thought it was worth considering. If I was right, the need for control and legacy had taken center stage in the older sister’s life. As with older adults, I suggested that the younger sister initially reframe her conversations and energies around control issues. Specifically, how could she help her older sister preserve control in a world where all control was being lost to such a devastating illness? This could give the sisters a common cause that might be the basis of a more effective partnership. The friend of the family shared this idea with the younger sister. “At this point, ” the younger sister said, “I am willing to try anything.”

“Anything” began to open a door. The older sister’s burden of fighting for control in the face of a terminal illness was in desperate need of reinforcements. Instead of being rejected, the younger sister’s overture to assist her older sister with “control management” was accepted. Their differences became less important and a new, more effective dialogue began to emerge. “Now what?” the friend of the family asked me Add legacy I told her. The door swung open.

The same legacy questions that opened up heart felt conversations between adult children and their aging parents offered the sisters a new, deeply personal way to communicate. Not surprising, the older sister’s life review took center stage, and with it came powerful remembrances, joy, regret, sadness, healing, and legacy. They were able to cover critical emotional terrain before the older sister passed away, being there for each other until the end.

I now believe that the last mission of life can come either on time when we are old or it can come “too soon” when are not old. Either way, it brings with it the overpowering need for control and legacy. Either way, it offers a way for all of us to partner with those who need understanding, care, and comfort at the end of their journey.

Uncle Ed was a bigger than life Norwegian fisherman with a red beard and an infectious flare for life. But out of nowhere, his robust life was brought to an end when he was diagnosed with terminal cancer and given only a few months to live. Wisely he retreated to the sanctuary of my grandmother’s house for his final days. The news of his leaving spread quickly in their immigrant community and a procession of family and friends began. They showed up at all hours to tell stories, drink beer, laugh, cry, pray and be part of his leaving. This daily ritual continued until he died.

Then they held his wake and for three days family and friends came to my grandmother’s house at all hours and told stories, drank beer, laughed, cried, prayed and comforted each other as well as his sister, my grandmother. Even as a child, I knew that this was the way to go, how I hoped my life might end, surrounded by the comfort of family and friends.

But leaving is not what it use to be given the reality of medical technology. A new metaphor has captured our focus and muddied our decisions about our aging parent’s final exit not to mention our own. Leaving has been usurped by lasting.

This shift in the balance of power at the end of life carries enormous consequences for adult children and their aging parents. Already feeling guilty about not doing enough, adult children are now confronted with a medical technology that haunts them with the question “is this where you stop?” Lasting has become the new benchmark for our collective efforts to fight the good fight. No one wants to let anyone down. While medicine is in the business of preserving life, no one really knows, amid machines, drugs, and heroic procedures that suspend leaving, when we have had enough.

This not a dilemma any of us can unwind; our generation owns it. But we can reframe how we think about the technology option to keep from being unfairly biased towards lasting at all costs. While the question of lasting, to what degree and at what cost, is vital to the discussion, an equally compelling question is “what is quality of the leaving?” This query reminds us that the final act is not just a battle against biology to extract more time, but a profound reconsideration of the entire journey. In leaving lies potentially the most important insights and conversations of a life time. As such, the question provides us a much needed counterbalance in the struggle to determine what is enough. It reduces the need for technological heroics to prove anything and champions low-tech conversations from the heart.

This is what uncle Ed’s passing taught me. It was the same lesson I was to learn years later in my medical career: cure when possible…comfort always. At middle age it becomes all to clear that there is no cure for leaving, and that the comfort of family and friends is what means the most to all of us.