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When people warned me about getting older, they usually talked about deadly diseases like cancer and congestive heart failure. They warned me I’d die young if I refused to go for screenings. They warned against sugar soda and smoking. They praised spinach. I stayed away from soda and ate bushels of spinach.
But in retrospect, I’m not sure I made the right choices…or that my choices matter all that much.
Looking around me, I’ve identified three different experiences of aging. We talk a lot about the first one. We have screenings to detect the second. But I suspect the third way involves more people more profoundly.
First, some people age easily with few changes to their physical health. These are the people everybody points to when they say, “Age is just a number” or “It’s never too late.” And sometimes they’re right.
I like to point to Olga Kotelko, who ran senior track and field until she was in her early 90s. She died a few weeks after being diagnosed with some kind of brain clot. No change in activity. She was here and then she was gone.
And of course countless people lift weights and go hiking well into their eighties and nineties. We see hundreds of articles praising them, often admonishing readers, “If they can do it, anybody can.” They’re wrong, of course, but they make us feel good.
Second, you could get a disease with an end-of-life predicted for the next six months, with treatment expected to be useless.
This event sounds horrible and, for some people, it is. If you want to live to see something happen – a reunion with an old friend or a grandchild growing up – the news can be devastating. You might have been planning a “once in a lifetime” trip. You might be in the midst of a creative project.
This is the kind of outcome that the medical establishment focuses on, in my experience.. Don’t smoke, they tell us. Get screened. Eat lots of spinach and exercise. And if you succumb, hospice and medical aid in dying programs are designed for this category.
One and done, with lots of institutional support.
But in my opinion, the third kind of outcome is the worst, and the one you can least prepare for. It happens to people who eat lots of spinach, exercise and quit smoking. Often they seem to be the people everybody encourages: “You’re gonna live forever.”
You get at least one medical condition associated with aging – arthritis, angina, vision loss, hearing loss, balance, joint pain, back pain, frailty, cognitive decline – usually more than one. There’s no fix. Some medical people try to convince you it’s your own fault because you didn’t eat enough spinach.
People differ widely in the degree to which they’re affected by these losses and in their own responses. Some people barely notice; some notice but shrug or even laugh it off; and some feel that they’ve lost a meaningful part of being alive.
Most importantly, there’s no end date. It won’t kill you in six months – maybe not even six years. You can’t legally hasten the end. Treatments, if they exist, often cause pain or debilitating side effects without creating long-term change.
Too often the medical system measures success by survival rates. “At least you’re still here,” they say. But not everybody shares these values.
Several years ago the NY Times ran an article about Sandy Bem, a well-known research psychologist who was diagnosed with Alzheimer’s at age 69. Bem found a way to end her life before she had to accept a life she wouldn’t find meaningful. She chose to take a pill at home.
The article has a bitter quote from Sandy: she was appalled to find herself envying her relative with stage 4 cancer, because they could at least seek aid in dying in many states. With Alzheimer’s she couldn’t have a meaningful life but she wouldn’t die within the next six months. Her options were limited when it came to ending her life. It was a grim reality, a Catch-22.
From what the article said, Sandy Bem did nothing to attract Alzheimer’s. She was a productive academic who used her mind.
You can do everything right and some elusive gene, from a distant part of the family you never knew about, will kick in.
When I met orthopedic surgeons over the years, they’d always talk about the value of exercise, especially strong hips, to prevent all kinds of conditions. So a few years ago I found myself saying to an orthopedic surgeon, “OK, I’ve got buns of steel. Why do I have hip arthritis?”
He shrugged. “These things happen.
Staying alive isn’t the ultimate objective. I tell doctors I don’t want to live to be 100. I want to be gone before I deal with a host of conditions that won’t kill my body but will kill the quality of life that’s meaningful to me.
Spies in WWII got cyanide pills to avoid POW camps; why don’t we offer something like cyanide pills to people targeted for nursing homes that have documented staff shortages and an estimated 40% abuse rate?
Of course not everybody fits neatly into one category. Some start as supremely healthy and get a serious diagnosis or pick up a condition that moves them to the third category. And people handle the physical losses of aging differently. Some people want to fight to stay alive as long as possible, maybe even if they’re forced to go to a nursing home.
I certainly don’t think anyone should be forced to make an “end it all” decision. We have to respect choices. But I do think we should widen the window of choice for those who have lost a meaningful life but won’t die in six months.
I don’t buy the argument that some evil relative will finish you off. As I say in my book on aging, If your family wants to get rid of you, they’ll find a way. And institutions will see your body as an ATM machine that gets more generous as your quality of life diminishes.
Sometimes survival isn’t the best option, but for now, in most places, it’s the only option.
