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View Full Version : NY Times essay: We are all going to die



pinkytoe
1-21-13, 7:53pm
I read this essay this morning and thought about it all day; how everything in our culture shuns aging and the inevitability of death. The comments too are thought-provoking:
http://opinionator.blogs.nytimes.com/2013/01/20/you-are-going-to-die/

MamaM
1-21-13, 8:08pm
Very interesting---really makes me think.

catherine
1-21-13, 8:11pm
Very good reading. Thanks for sharing it. So true about death. I, on the one hand, love getting older! I really do. I find freedom in my impulse just be who I want to be, and if you don't like it, well [finger gesture here]. But at the same time, I'm very bad at really facing death in the face, and always have been. I regret that when my MIL said to me on her deathbed, "Well, looks like I'm not going to get out of here this time" I covered up and made some really lame reference to her getting antibiotics. She knew better, but she went along with my charade. Same with my own mother--whom I invited to New Jersey when she lay on her deathbed.

I just love a book that my favorite client (a market researcher but former librarian) recommended to me: The Fall of Freddie the Leaf (http://www.amazon.com/The-Fall-Freddie-Leaf-Story/dp/0943432898/ref=sr_1_1?ie=UTF8&qid=1358813846&sr=8-1&keywords=freddie+the+leaf). You have to read it. It's a children's book, but it's so simple but so profound in its truth. I bought two copies for my family after my MIL died, because basically it very simply says that we die just as surely as the leaves fall off the tree in the fall. That's just how it is. And it's OK to cry.

Lainey
1-21-13, 11:28pm
thanks for posting, pinkytoe. I'd recommend this book also: "Another Country: Navigating the Emotional Terrain of Our Elders" by the wonderful author Mary Pipher. Real people in their older years, and how they are dealing (or not) with it.

ctg492
1-22-13, 6:41am
I like many shy from this topic. My folks are a daily issue for me. I stopped reading for a moment after the first line >My sister and I recently toured the retirement community where my mother has announced she’ll be moving. < I thought WHY can't my mom and dad take me to a place like this instead of me having to make the decision to take them to a place some day and it probably won't be a retirement home more of a nursing home :(
This was one of the best article I have read on the topic. Thank you for posting it pinkytoe.

ApatheticNoMore
1-22-13, 11:58am
I hear you ctg. This is what I wrote and more before deciding it was very personal and VERY unhappy and I'd wait unless anyone wanted to hear. And I'm not the primary caretaker, mom is.


Plenty of people before me have lamented the way that we in industrialized countries regard our elderly as unproductive workers or obsolete products, and lock them away in institutions instead of taking them into our own homes out of devotion and duty. Most of these critiques are directed at the indifference and cruelty thus displayed to the elderly; what I wonder about is what it’s doing to the rest of us.

But ... anyone who thinks it is that simple does not know what full time care giving is. People can put old folks in a home simply because the full-time job of caring for another person becomes too much. It's nothing you can do and have other responsibilities in the world. What if ... they yell for you every 15 minutes, they won't take their medicines (even medicines they wind up in the hospital for not taking), what if they refuse to get out of bed and thus get weaker and weaker and then need to be lifted all the time even just to use the restroom (and yet the people doing the lifting have health problems themselves, arthritis etc.). But the yelling, at the top of their lungs every 15 minutes, then half the time they dont' even need anything. What about asking for food and then when you bring it "I didnt' want that, do I have to eat it?". What if they routinely fall down and when you leave you find them on the floor when you come home. What if it starts to destroy the care-giver? Another life consumed .... down the hole, and this one a bit before it's time.

ApatheticNoMore
1-22-13, 4:28pm
By the way the discussion of people who think healthy eating and lifestyle will prevent aging and death ... lately I can't even read a healthy eating thread without sneering to myself and bitterly rolling my eyes. I took on no challenges this month it would have been all wrong (still like cooking at home though). But honestly my mood was in no place for challenges (I really underestimated how much the stuff in the previous post - getting dramatically worse was weighing on me) It's one of the worst old age and long long long deteriorations I have ever witnessed, and not the only I have ever witnessed. And there was always an interest in healthy lifestyle there, where do you think I got it ... Wheat germ oh yea wheat germ! Odd alternative health protocols, oh yea those. Eye exercises to improve eyes, oh yea those ... But conventional medicine was not shunned either. Always eat OJ with hotdogs, so the vitamin C could neutralize the nitrates growing up, oh yea that (and hot dogs were rare). Chicken rather than meat most of the time? Of course. Now the health information in those days isn't even anything I still believe is healthy for the most part. Margarine rather than butter. Yes, that's how it was done. But always a keen interest in health.

And at this point I really wonder whether any of it makes the slightest bit of difference anyway. Does it matter whatsoever whether one eats healthy, they're going to die anyway, but aren't they also just going to go through a decade of horrible deterioriation first anyway? To believe otherwise, isn't it more faith than reason? I don't know .... And a pathetic faith at that. It's like the joke about a loyal Catholic who dies and finds out Jah is a Rastafarian, only it's a lot more pathetic than that - you just believed in the wrong nutritional dogma, sorry. I will not be taking part in the sugar free challenge this month :) (my cookie ... out of my cold dead fingers you'll have to pry it). Why keep eating it? Because it's comforting, and that's a lot in this human life (see above post). Why quit? Faith that it will make any difference in long term health, and it occurs to me that might be a pretty wild and crazy thing to believe in indeed. Something I believed in it's always been ... but how much we believe (because we WANT to believe it makes any difference?) and how little we know.

SteveinMN
1-22-13, 4:40pm
anyone who thinks it is that simple does not know what full time care giving is.
Preach it, anm!

IMHO, as much as the elderly and sick are marginalized in American culture, the caregivers behind them are marginalized even more. There are all kinds of support programs and resources for the incapable -- and very few for the person providing the care. It's an idea that is just now coming to the fore.

But I think this country is going to have to start facing the issue of what to do with our less-capable and incapable residents. There will be more of them as Boomers age and as people live longer in general. There are fewer children being born and fewer still who will be able to leave work to care for an incapable family member without killing their career (or, ftm, their family relationships).

My DW is a social worker at a neighboring county. In that county (typically toward the vanguard of social service in the state), they are no longer building (public) nursing homes or adding on to existing ones. Even building of more group home beds is on hiatus at the moment. Keeping the incapable at home, even with round-the-clock care, is cheaper than moving them to nursing homes. Adapting homes for wheelchairs or a Hoyer lift, putting in ADA-height toilets and grab bars, and moving washers and dryers to the main living level to avoid stairs typically is less expensive per square foot than building structures for numerous people needing care -- and leaves adapted houses in the community when the original persons can no longer live there themselves. People who can no longer live by themselves and do not have friends or family members to care for them may end up with live-in help or multiple shifts of care assistants.

The rub, though, is that these care assistants are paid peanuts. Most of them do not have company-paid insurance or any other benefits (they're private employees). Few make more than a "living" wage. If we want to have enough people to do this job and to know how to do the things that our incapable residents need (catheterization, using lifting techniques and tools, injecting meds), we will need to pay more. And that is going to raise the price of care. I'm sure there are individuals out there (not here) who look upon that additional cost as a sponge on their healthful younger lives. But it is coming and we are going to have to deal with it somehow. And some of that consideration ought to go to the support of family members who are able to step in and perform this very demanding job.

razz
1-22-13, 7:55pm
When others were worried about their retirement goals, I rarely heard about extended nursing care in the retirement budget.

We have good nursing homes, a defined benefit pension, extended health benefits and still I watch my money because I don't know how much I will need or for how long if I require nursing home care. One can buy LTC insurance but it has significant limits as do most insurance programs or so I have been told so of questionable value.

There is the modest baseline of care covered through our ministry of health but extras add up very quickly.

LilyB
1-24-13, 6:39pm
We are trapped in a Catch-22 situation at the moment with my Mom. She is paralyzed on her right (dominant) side and cannot swallow. She has short term memory loss. She will need 24/7 care just for her basic daily functions. Medicare will help pay to adapt her house and pay for 2 hours a day of care-giving. However we need to sell her home to afford extra caregivers since it is impossible for my husband and I together even to lift her.

Her other choice is to sell the house and a find skilled nursing care facility to live at until the money from the sale runs out. Then she becomes eligible for Medicaid.

BTW, she is 85 and had not been sick at all before the stroke. The irony is that her main concern that, like her father and elder sister, she would end her days with dementia. She had told us that was her biggest fear.

Her mind is quite clear but she is trapped in a body she can no longer control, and the hospital psychologist feels she is depressed and should have extensive counseling. Er...wouldn't he be depressed in this situation. I would!

I probably wandered off topic, but I am sick to death of "experts" giving her and us unfairly rosy predictions of what her life will be in the future.

pinkytoe
1-25-13, 9:42am
There will be more of them as Boomers age and as people live longer in general
Otherwise known as the silver tsunami and not something we should be ignoring. I am reading a book called The World Until Yesterday about traditional cultures around the world. There is an entire chapter on how various cultures have dealt with their elders - everything from assisted suicide to widow-strangling. Unless a society was very large, it usually revolved around how many resources they had to keep an elder alive. I recall trying to deal with my mother's decline after a stroke (two years on a feeding tube in a nursing home). It was inhumane and shameful but I had no other options at the time. I hope we can do abetter job in the future.

catherine
1-25-13, 9:50am
Otherwise known as the silver tsunami and not something we should be ignoring. I am reading a book called The World Until Yesterday about traditional cultures around the world. There is an entire chapter on how various cultures have dealt with their elders - everything from assisted suicide to widow-strangling. Unless a society was very large, it usually revolved around how many resources they had to keep an elder alive. I recall trying to deal with my mother's decline after a stroke (two years on a feeding tube in a nursing home). It was inhumane and shameful but I had no other options at the time. I hope we can do abetter job in the future.

So true--and as you point out, pinkytoe, the times make a big impact. We now have the medical technology to keep people alive--and what for, in some cases? As a family member, your emotional reaction is to do that--to never want to "cut your loss" in a literal sense. But is that natural? And is it even right?

When my MIL died it was after a brief illness while we were on vacation in Vermont. She had abdominal pain and so we took her to Bennington Hospital. There was one surgeon on call. He told us she had a gangrenous bowel, and that she could either have surgery, from which there would be a long recovery, or we could let her go. She was 85. He gently suggested that if it were his mother, he would not subject her to that surgery.

It was a Friday night and I remember cynically thinking that he probably has a dinner reservation waiting and he's the only surgeon on call. But we did take his advice, and she died the next day, peacefully.

I've often wondered if we had been home and had instead taken her to the big academic medical center here in New Jersey. What would the outcome have been? Would we have been given different advice? Would we have tried to keep her alive no matter what?

I personally feel it was her time to go, and I have no regrets, and in fact, I think it was a blessing that we got the old, wise doctor up in farm country!

citrine
1-26-13, 11:25am
Our culture is very different in the aging aspect....both my parents have a DNR and are totally against living off tubes and being immobile. We think that when it is time to go...it is time to go. I have never had a fear of dying....just a fear of being immobile and dependent on others for daily life. If that was the case, I would definitely do my best to find someone willing to help me leave this world with dignity rather than waste away.
I plan on taking a CHHA course to get the knowledge I need to help my parents as they age and keep them out of the nursing home....another cultural thing. Our elders were kept within the family and were taken care of. DH's mom passed a year and a half ago and had spent the last seven years of her life immobile and with dementia....very awful and sad.

jp1
1-26-13, 5:48pm
On a recent episode of Radio Lab they talked about the extreme difference between what sort of medical interventions most doctors would want in the event that they had an illness from which they were not likely to recover, vs. what non-doctors would want. Basically the doctors wanted very little intervention compared to average people. The reason being that they know that many of the common interventions (cpr, artificial respiration, etc) are not terribly effective in producing long-term success of regaining health and independence, especially with older patients, and secondly, most of these interventions are fairly brutal for the patient. For instance I had no idea that people on artificial respirators typically have to be made paralyzed so that their bodies won't fight the respirator.

Personally I think I'd much rather end up in catherine's MIL's position, quickly dead with no long drawn out painful illness. Would it really have been realistic to expect her, an 85 year old woman, to recover from surgery and go on to regain any sort of active lifestyle? We'll never know for sure, but I would doubt it.

My dad has requested, and had the appropriate documents drafted, that he deosn't want any invasive medical procedures beyond stabilizing ones done to him. As a frail but still functional 84 year old man I can understand why. While it makes me sad to think about, I respect the fact that he's lived his life and is now fine with the prospect of it being over, and will honor his request, even though it will be terribly sad.

ApatheticNoMore
1-28-13, 4:09am
It's very hard to say what is excessive medical intervention and what isn't. Giving medicine interveniously while a patient is in the hospital is considered intervention that should maybe be stopped if the patient expresses suicidal wishes. It is exactly this that has been discussed with me as being stopped (a respirator? surgery? uh no, giving medicines to stabilize blood pressure and heart beat interveniously) Physical therapy may be considered excessive intervention for an elderly, ill, and uncooperative enough patient.

Maybe almost noone should really live beyond 80. Oh and that's probably what all the dietary stuff is about as well, preventing a few problems people might get that might kill them or interfere with quality of life in the 50s or 60s or something, but after 80 it's probably downhill no matter what you did in terms of diet and lifestyle. It's always what has been most horrifying to me, how much people fall apart after that age.

sweetana3
1-28-13, 7:02am
But then you have to look at my Dad who remarried at 87 to a 45 year old. Or my mother in law who sold most of her stuff to move to our city and start a new life. She did this at 80 and walks or exercises every day.

Or the 80 year olds working at our Habitat for Humanity or or or.

It is not "falling apart" but aging in a pretty normal manner. We are all going to do it and it only matters whether we do it graciously or nastily.

I have discussed what I want with my husband and need to reduce it to writing.

Gardenarian
1-29-13, 2:35pm
Very interesting article. Iespecially like what he said about people treating death as the result of a "poor lifestyle choice." I know a lot of people who think that health problems are entirely a result of behavior, and I find this not only unfair but foolish.

You can be extremely fit, do all that you can to stay healthy, but disabling diseases can attack anyone, anytime. No one gets out alive.

ApatheticNoMore
1-29-13, 2:54pm
Very interesting article. Iespecially like what he said about people treating death as the result of a "poor lifestyle choice." I know a lot of people who think that health problems are entirely a result of behavior, and I find this not only unfair but foolish.

All the diet and lifestyle gurus are selling what is probably illusion. Isn't it? As much an illusion as what the weight loss places sell (with basically zero sucess rate after 5 years), only they sell health in old age and not just skinny. Whole industries, mountains of illusion. They all think their diet is the fountain of youth. Well .... isn't it pretty to think so .... >8)


You can be extremely fit, do all that you can to stay healthy, but disabling diseases can attack anyone, anytime. No one gets out alive.

Yea, also all those diets and stuff to completely follow them you are supposed to go through life without addictions or more without security blankets. But man human life, this vale of tears afterall, and it is, there's death and grief enough for anyone, without security blankets in food or drug to alter mood? Oh my ... I have a boatload of sympathy for those who drug of choice is not just sugar or caffeine but heroine or whatever, I understand exactly what motivates them - if makes them feel good, it relieves the pain, but I try to save some of them, because that extreme is not a life you can live and be a contributing member of society and all, who isn't hurting those around them.

jp1
1-29-13, 11:16pm
But then you have to look at my Dad who remarried at 87 to a 45 year old. Or my mother in law who sold most of her stuff to move to our city and start a new life. She did this at 80 and walks or exercises every day.

Or the 80 year olds working at our Habitat for Humanity or or or.

It is not "falling apart" but aging in a pretty normal manner. We are all going to do it and it only matters whether we do it graciously or nastily.

I have discussed what I want with my husband and need to reduce it to writing.

I agree. Everyone's individual situation is different.

My 84 year old dad is very frail from having been a heavy smoker now for 65 years. Back when he was just 80 he was still a vigorous active person. Now, 4 years later, he's on oxygen fulltime and even so is not getting enough because his lungs are in such terrible shape. For a little over a year now he has pretty much not left the assisted living facility except for doc appointments and to go out to dinner at least once every time SO and I come to town to visit. He's still mobile and fully functional but a serious illness or accident would likely cause a permanent end to that. Perhaps if he weren't a lifelong smoker he'd still be as active as he was 4 years ago. But eventually decline would've happened, unless he was lucky enough to just go to bed one night and die in his sleep.

On the other hand I recently met an 87 year old man who was still spry and perky and active. I would've guessed to be easily 10 years younger. He still actively runs a winery and on the night I met him was the host of a wine tasting potluck dinner in his home for approximately 80 guests.

On the third hand I have a friend my age, 45, who has had health issues her entire adult life. In her early 20s she learned that she has a hereditary kidney disease that killed her father in his 50's. Now she's on dialysis and the docs are assessing whether they can do a transplant. In her late 20s she was diagnosed with fibromyalgia. In her early 30s she had a seizure that has left her permanently disabled. And those are only the highlights. Brutal migraines and other less 'serious' problems also plague her. She's been as gracious about all of it as is humanly possible, but really, life's a crapshoot. Some people are lucky enough to age well and some aren't. We can try to stack the deck in our favor by eating well, exercising, etc, but in the end the reality is that there's a whole lot that is out of our control.