Thursday, September 25, 2014

You're still going to die

A few days ago there was a post up on The Pump Handle reporting on the Institute of Medicine's report, Dying in America, that critiques end of life care and suggests ways to improve it. The post linked to to an essay by Ezekiel Emanuel in The Atlantic on the topic of old age and death. The essay has the rather catchy title of "Why I Hope to Die at 75."

As it turns out, Emanuel doesn't really hope to die at 75. He's just decided that once he hits a certain point in his life, he's going to refuse all medical interventions other than palliative care. I get it. I've worked in nursing homes. I know that despite all the hype about "60 is the new 40" and ads showing geezers having a good time, aging in general sucks. You get older and it's inevitable that you're going to start falling apart. No one has the energy at 80 that they did at 50. You're more susceptible to injury. Your skin turns crepe-y, you bruise easier, it takes longer to heal. A fall that would have been nothing when you were in your 20s can put you in the hospital when you're in your 70s. Old people look frail for a reason -- they are frail. They break easy. Your bones start losing calcium; if you're unlucky you end up with osteoporosis and discover that all it takes is a sneeze and you've got broken ribs. Everyone says getting old beats the alternative, but some days you've got to wonder if that's really true.

And then there are the cognitive issues. One of the most depressing aspects of getting older is witnessing friends and acquaintances slip over the edge into Alzheimer's or other forms of dementia. Alzheimer's gets a lot of attention, but it's not the only way to slide into senility. When you're in your 30s or 40s and you hear people talk about "hardening of the arteries" you may think "that can't possibly be a real thing." Well, it is. It's what cholesterol build-up does; the fat narrows the arteries, makes them stiffer, reduces blood flow. Reduced blood flow means less oxygen to the brain. Less oxygen to the brain means you get more forgetful, less agile mentally. The next thing you know you're one of those dithering old people who can't remember where they left their coffee cup or wants to tell you the same lame jokes over and over and over. . .

Not all geezers go senile, of course. One of my favorite people of all time, the philosopher Marjorie Grene, was still going strong in her 90s. She could argue circles around scholars a third of her age. But Professor Grene was an exception just like my own mother (who is now 92 and still sharp as the proverbial tack) is an exception. Based on my personal family history, I don't think I'm at much of a risk of losing my ability to think before other stuff fails, but you never know. The fact no one I'm closely related to has ever shown signs of Alzheimer's doesn't mean I can't be the first in the family to go senile.

Anyway, the more I see of the prospect of getting to be my mother's age, the less attractive it becomes. It has to suck to outlive all your friends. It's like signing up for a tontine where the only pay-off is you get to attend everyone else's funerals. So I'm thinking along the same lines as Dr. Emanuel. Once I hit my sell by date (which I'd mentally set at 75 long before I read the essay), it's going to be palliative care only. No trying to delay the inevitable in a way that enriches pharmaceutical companies or helps a surgeon buy a new Mercedes. After all, in the end it doesn't really matter what you do -- you're still going to die.

Cross posted at All the Good Names Were Taken.

4 comments:

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