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aging, death and dying

Image by Zoe Schaeffer from Unsplash.

Caution: this post talks frankly about death and dying. If that’s too much for you at this time, you may want to skip it.

In today’s inbox was a message from a business owner, opening with the news that her mother had died. She wrote about the difficulty of processing her feelings (a cold analytical phrase for a sensitive experience that’s unique to each individual).

But as I grow older, I find I pick up on a different part of the narrative. The author wrote, “She passed away peacefully at home.”

A few years ago, an acquaintance posted on Facebook: “I’m so exasperated with my father! He was hospitalized with a serious medical condition. So tonight he pulled out all the cords and went home.”

I probably shouldn’t have posted a response, but I did: “You dad is lucky. He was able to leave under his own power. The hospital will just make him miserable. Be happy for him.”

In her book, Do No Harm,  Daniele Ofri writes about her days as a young attending physician at Bellevue Hospital in New York. She reports honestly about her conversation with a seriously ill patient. The patient wants to give up. She’s tired of the hospital and the medical procedures.

In a truly cringeworthy conversation, Danielle negotiates. “What if I could take away the pain?”

The patient responds reasonably: The only way to take away her pain is to prescribe drugs with side effects that call for uncomfortable, demeaning treatment. She doesn’t want that.

Danielle acknowledges in her mind that the patient is right. She can’t do much.

The patient hasn’t been allowed to eat. Understandably, she wants food.

Danielle makes a deal: She’ll allow the patient to eat and she’ll keep the treatment going.

Apparently that’s not easy for Danielle. The specialists are furious. She’s younger than they are but she holds firm: as the assigned attending, she’s in charge.

We last see the patient (who must be truly desperate) eating hospital food.

As I write in my book, When I Get Old I Plan To Be A Bitch, the end of life can feel like the end of a long day of a cross-country drive. You’re tired. You don’t want to keep driving. You just want to get off the road and you hope the motel didn’t lose your reservation.

It’s hard for adult children to think of their parents this way. It’s hard for doctors, too.

It’s very difficult for older people to communicate that they’re not eager to die, but they’re definitely ready.

To use another analogy, imagine you’re in a basketball game. Your team is down by a lot of points. You’re 2 minutes from the end and you need 6 possessions to tie the score.

At this point you know the game is over.

You can use the final minutes on a full-court press; maybe you’ll squeeze an extra point or two for the scoreboard. But you’re exhausted. You’ll experience great pain – and risk further injury – for a meaningless outcome.

A good coach will back off. They’ll send in the subs for some half-hearted effort. They’ll dribble out the last few minutes. The exhausted players get to relax, cool off, and go home.

There’s some point in life when you realize it’s “Game over.” You know you’ll die…maybe next week, maybe next year, maybe in ten years. Some people are so afraid of dying, they spend their final energies fighting off the inevitable. I’m no expert, but I’ve read that these fights actually make it harder to heal and may even hasten death.

Religious affiliation doesn’t seem to make a difference; Christopher Hitchens, the famous atheist, made it clear he didn’t want prayers when he died of esophageal cancer in his sixties.

What does make a difference is the way others understand acceptance. There seems to be less surprise when a devoutly religious person feels ready to go. In Rumer Godden’s book, In This House of Brede, a senior nun says she wished she knew when she would die because “then I’d know what to read next.” Dozens – maybe hundreds – of spirituals capture the feeling of “I’ll fly away” or “When the roll is called up yonder…”

I like the feeling behind those songs: joke about going to the great comedy club in the sky.

What I’d like to say to the first author is, “You’ll miss your mom, but you should celebrate. She was incredibly lucky. She didn’t have to die in a hospital with half a dozen tubes stuck in her body. She didn’t have to deal with arbitrary institutional rules about what she could eat (“even if you’re terminally ill, you can’t have ice cream”). She didn’t have to choose between pain and horrific side effects…or just suffer because not all pain is fixable.

When Justice Scalia died in his sleep, after a day of doing what he loved, I’m willing to bet that many people – especially elders- sighed, “I want that for me.”

As you get older, you realize, “There’s worse things than dying.”