And Then You Die . . . #2

Old Age Sucks – And Then You Die, Part 1 (now in archives). This is Part 2: Old Age Still Sucks – And Then You Die!

If you haven’t sorted through the list of old-age maladies in Part 1, I invite you to do so. In Part 2, I continue with this liberating thought: The Truth Shall Make You Free. The truth isn’t going to make you like it. The truth isn’t going to make you delirious with happiness, energy, travel plans. But Truth will make you freer. That’s a biggie.

There are gazillions of people who say they are not afraid of death. Rubbish. Maybe 5 people are not afraid of death. The rest of us, especially those of us in our 70s and 80s either refuse to think about it, think about it constantly and/or visit the doctor once a month to fix every twitch, pain and pimple. The result is the same: We die. No one gets out of here alive. NOTHING gets out of here alive. Even the sun is going to die – in 4 billion years.

In The Illusion of Immortality, the philosopher Corliss Lamont wrote: “ . . . the elderly know for certain that death is waiting for them just around the corner and that before long they must meet the fate of all mortals. They may begin to feel something like the condemned prisoner awaiting execution on a set day. And they are bound to lose the relative unconcern of younger people for whom death is a matter of the vague and far-off future.”

Most elderly people try to stave off the execution, even when it makes no sense.

Unless you are very, very lucky and have an ancient family doctor, you will not hear this diagnosis: “You have cancer. You have one of two options. The first is to operate and remove the cancer and then have chemotherapy. The second is to do nothing. There’s a good chance you will die before the cancer kills you.”

“I should do the first option, right?” you would ask.

Your old doc would say, “Maybe not. Surgeries are difficult for old people. You might emerge with dementia from the anesthesia. You would be very frail during the slow healing process. And if you undergo chemotherapy, your life would be full of nausea, fatigue, diarrhea and flu from lack of immunity. At the end of 3 years, you would probably die anyway.”

“And with option two?” you ask with tears in your eyes.

“You will go on the way you are today until your organs fail, and then you’ll have a short period of being bedridden and needing help with pain medication. You might not last as long as 3 years, but your shorter time would be more like you’re feeling today – not sick.”

Notice that the second option requires the doctor and the patient to do nothing, a concept that is anathema in our culture. We always want to do SOMETHING, even if it makes us miserable. We know pills and surgeries could make us miserable after watching our friends and relatives fight sickness and death. We probably shook our heads in disbelief and asked, “Why doesn’t he just let himself go?”

Now we know. The survival instinct is strong. It destroys our reasoning ability. We struggle to live, no matter what the consequences. Even the very devout who believe they are going to heaven struggle to survive one more hour. So . . . we make the decision and go for Option 1. And then we pay for it in frailty, nausea, fatigue and diarrhea.

True fact: No matter what we do, we are going to die. The choice is between months or years of misery or better quality of life. Doctors often do not talk about quality of life. They’re into prolonging life, no matter how dreary. It’s important that we, the patients, face the facts. NOTHING is going to prevent death. We are in the final round.

If you are 50 or 60, Option 1 would be worth the discomfort. At that age, people are more resilient and can recover fully. I don’t even call people that age “old.” They are the new middle age.

A lung doctor once told me that patients quit him because he’s honest. His office is filled with older people wearing oxygen tubing after years of smoking, working with asbestos or in factories with lots of dust.

“If they are over 70 and have stage 3 or 4 lung cancer, I tell them the truth,” Dr. Murphy said (he’s Irish, but Murphy is not his real name). “I tell them that there is no cure, no matter what they attempt to do. It would be best to enjoy their remaining months and years with family and friends and not try to prolong the inevitable with invasive therapies that will cause pain and frailty.

“They stalk out of my office in anger,” he continued. “They get another doctor, and one or two years later, I read their obituaries in the paper. The obituaries always describe their “brave fight” against cancer. What that means is, they spent their last months trying to stay alive at the cost of living life.”

Human beings are like cars: They wear out. Unlike cars, however, human beings can’t go out and replace parts with only a little wear and tear on the mechanic. Science is getting there. Most of us know people who have been to “body shops” and had knees, hips or collar bones replaced. Hearts have been transplanted. Lung transplants are now attempted. Kidneys have been replaced for decades. Perhaps someday we can replace everything but brains – and maybe even brains if we can figure out how to fill the grey matter with the “soul” and memories of the patient.

Today (2024), however, attempting to beat the clock is just magical thinking. It’s as magical as believing that walking under ladders or crossing paths with a black cat is bad luck.

The average lifespan for males and females in the U.S. is around 84 years old. We’re not going to get “well” again, not the way we expect, especially not after we submit to draconian procedures for a “cure.” The aches and pains, the bad feet, the leg cramps, the poor eyesight, the lack of hearing, the stomach irregularities, the sleeplessness – these are not going away.  The cancer, diabetes and heart disease probably won’t go away either. The engine is simply too old.

If there’s anything positive about old bodies, it’s this: Cells grow very slowly. We can use this to our advantage.

For example, Mrs. Brashear, a woman in my neighborhood, age 85, was diagnosed with breast cancer. She had been an active woman, always cheery, always ready with a greeting, and an ambitious gardener. The breast-cancer diagnosis after a routine mammogram was a total shock. Her doctor recommended surgery with chemotherapy and radiation afterward. She had a mastectomy, but she never got the chemo and radiation. Her brain was damaged by the anesthetic. She spent her next three years in a nursing home for very compromised dementia patients. And then she died.

The doctor should have told Mrs. Brashear to go home and garden. At age 85, she would probably outlive the cancer in her breast lump. If she started to experience pain, swelling or suppuration, they could give it another look. At that age, nothing moves very fast.

Most people will do anything to avoid death, even discussion about death. Mary Austin wrote about this in 1931 in Experiences Facing Death: “Most Americans are even more reticent, and possibly more dishonest about their attitude toward death and the hereafter than they are toward any other personal concern. . . Americans in general, it seems, suffer a glandular resistance to the idea of death which makes them not only averse to talking about it, but anxious to evade its mention by every sort of diddling phraseology.”

The diddling phraseology would be “passed away,” “has gone to a better place,” “has been taken home.” Anything to avoid “has died.”

No matter how much we try to avoid it, death is there. We have to face it – and be free of fear.

George Santayana, a philosopher of critical realism, wrote this in the Introduction to The Ethics of Spinoza: “Man alone knows that he must die, but that very knowledge raises him, in a sense, above mortality, by making him a sharer in the vision of eternal truth . . . The truth is cruel, but it can be loved, and it makes free those who have loved it.”