“ Old age isn’t a battle , it’s a massacre” from Philip Roth
Q. Rabbi, when do I take my casserole to the widower — before Shiva [the period of mourning] or after Shiva?
A. Before Shiva is too soon. After Shiva is too late; he’ll already be taken.
This is an answer to the geriatric male wallflower dream -he can be a “condo cowboy” jump from one to the other , if he can still jump or the Viagra kicks in appropriately -the odds are with him -the competing males have died off -supply and demand are in his favor -or so it goes, as we hear from Jon Stewart and others who find humor in the situation. But what is the reality?
What looms above the aging scene is the Grim Reaper -there is no escape, as Philip Roth tells us from “the massacre” -the best that can be achieved is some delay -and often the delay is costly in terms of money and quality of life -that is the depressing fact that gives organized religion its main reason for existing -to provide hope in heavenly reward -most old folks don’t really believe that although many say they do -if they really believed it, they would go happily into the grave -and none that I know ever do. The facts seem to support widespread depression:
§ depression is estimated to cost the United States about $100 billion
§ included in this figure is direct medical cost (31%) and latelife suicide
So with age comes depression and the quest for diversions that will at least relieve the pain of thinking about the inevitable future that gets closer every day. Sex and love are great diversions but church, golf, football and bridge are less trouble. Travel works for a while too while the money and energy lasts -but there comes a time when drugs are the only pacifers -pain killers -either the psychic kind of anti-depressives or the physical kind like morphine or the Russ Limbaugh pain killers -whatever works and gets you thru the sometimes too short “Journey into the Night.’
I recently toured two of the major old folks communities; the villages in FL and Hot Springs Village here in AR -each featured an abundance of diversions with an emphasis on golf -the villages did more with nightly entertainment in the Square with dancing encouraged and an abundance of 4:30 specials with 2forI cocktails to get the folks in the proper mood. Health practitioners were also in abundance to handle the various ills that go with advanced age and profligate living. The politics in both places were right wing -low-keyed , but definitely Republican since it seems most old Democrats can’t afford retirement villages.
There is a wealth of literature on aging, The AARP’s Maturity magazine being among the most famous, and the themes are classic: financial security, healthy living, the best diversions, famous old folks, the best reaorts, trips, vacation lands, health plans -even some but not many on the “good” death. Here in Little Rock, we have our own aging guru -Dr. David Liptzschitz -who pours out health and welfare advice thru books, TV, newspaper columns and meetings on most of these topics. He is the Jewish head of the Catholic hospitals geriatric division and is noted for his upbeat approach to aging even while personally plagued with many of the aging ills himself -heart problems, obesity, diminished eyesight, etc. His most recent column bemoaned the hardships facing the injured and disabled he himself experienced after fracturing his ankle. He frequently lashes out at his fellow doctors for prescribing too many drugs and tests, especially when keeping the patient alive conflicts with his idea of the “good” death. Hence he has become an advocate of sorts for the sensible course of avoiding unnecessary suffering and for non hospital home and hospice care -topics that were prety much avoided until he came on the scene. He also has a sound view of the reality -focusing, for example, on the ever increasing number of the aging disabled in the US and how the boomer generation is overwhelming the system with both numbers and bad habits leading to obesity, diabetes and heart problems resulting in large numbers needing expensive assisted living.
There is also a large body of fiction that features death and aging -among the more recent examples are John Updike who took his “Rabbit” series right up to the abyss, heart attack and all, and Philip Roth who devotes his book , Everyman, to a an exquisite examination of graves and how to get into them (again cardiac arrest). James Agee pioneered this kind of end-of-life-facing novel with his Death in the Family.
Poets. too, have weighed in, like this more optimistic note from Tennyson:
Old age has yet his honour and his toil Death closes all: but something ere the end… Tis not to late to seek a newer world,
Or in his more famous on war:
Their’s is not to reason why. Their’s but to do or die: Into the Valley the Valley of Death Rode the Six Hundred Into the jaws of Death… Into the mouth of Hell
And , further he exhorts us to, “Come not, when I am dead” and it is too late to save us. Do Something now to end war and death! He speaks to us over the ages to the current debate over Afghanistan and Health Care Reform as the discussion focuses on how to die and at what expense, as in the recent “death” panel flap started by Sarah Palin and picked up by the GOP tea baggers. It hit a sensitive note among Americans who are for the most part content to ignore or divert attention from the aged among them. Palin picked up on a health care reform amendment that called for covering end of life counseling on living wills by medical doctors -generally considered a sensible thing to do -but, as interpreted by the right wing as “pulling the plug on Grandma,” politically sensitive reformers were forced to delete the amendment -even in the face of evidence that the last months of one’s life are usually the most expensive and can be the most painful as well. The inability to be sensible about death may be one of the reasons for the growth in suicide in the country with males leading the trend.
But it is hard to be sensible about any health problem in America -the most frequent advice that is given by Dr.David and others is “talk to your doctor” -a difficult thing to do even for those with insurance -you have to get an appointment -get yourself there wait sometimes for hours -pay a co-payment -all for five to fifteen minutes for a meeting with a guy that may not have time or an answer for you -or, he may prescribe an expensive pill or demand even more expensive tests which may or may not be covered if you have insurance. So most of us stay away -if at all possible -which can be a disaster. Old folks without money or transportation are particularly prone to put off the inevitable knowing the doc is not going to want to see their old and ugly bodies.
If you try calling a geriatric clinic -even if you want to give them money or donate your organs, it is hard to get an answer -forget about e-mails -I tried several calls and e-mails trying to get the forms for donating my body to science before finally finding someone to respond -not sure every place is as bad as Arkansas -we usually rank in the last two or three slots for most services -the Cleveland and Mayo Clinics are supposed to be better but we all can’t go there.
Despite all the diversions, old folks are consumed by health problems and discussions about them are endless at the Senior Center in my town -recent operations, upcoming ones, the costs involved, yours, mine everyones…., so it goes…What is not discussed is the underlying depression -that like death must be avoided, One of the few books that challenge this demand for false optimism, Barbara Ehrenreich’s recent book, Brightsided, is a resounding criticism of the phoney cheerfulness demanded of breast cancer patients positive thinking, smiling faces, upbeat remarks -all demanded from women who feel awful, are in pain and are facing death -one hopes this is only in America. The result is a kind of loneliness -a separation of outward response and inner feeling -the classic incongruence that is the harbinger of depression. You can’t even shuck this phoney cheerfulness by dying -there are more lies on the obit pages than anywhere in even the most irresponsible newspaper -ever read any obit where the deceased didn’t fight heroically against cancer? Or where the death is blamed on some stupid medical error? Or no matter how evil the deceased does he ever go to hell rather than to be with the Lord?
Or birthdays, people tell you to have a happy birthday even if you are on death’s doorstep. Again there is no regard for your life and where you are in it or what you have done with it -like you are supposed to be happy even though your circumstances indicate depression is appropriate -how many people can say they feel your sadness, understand it, validate it? Are they with you where you are rather than where Hallmark thinks you ought to be.
Not long ago I went to a funeral for a friend I had spent years with in a group where the practice was designed to promote those I-Thou feelings, how to be with someone you cared about. Since the group leader was there I expected her funeral to reflect this healthier approach to life and death -but no -it was by and large the usual homilies and the leader didn’t say a word. Makes one wonder what we spent all that time and money for. And, I had to admit, I was frozen in silence myself -afraid to make a scene -a case of social pressure triumphing over therapy.
Unlike your average funeral, the hospice experience seems to help both those dieing and those there to ease the pain. Prisons because of aging populations have had to face death and called for volunteer hospice workers from among their prison populations -here below is one volunteer’s assessment of its effect:
“It’s helping me mature,” he said. “My views of life and death are changing. I was unsympathetic when it comes to death. I’ve had friends die, and I was callous about it. Now I can’t do that. I’ve come to identify with these guys, not because we’re inmates, but because we’re human beings. What they’re going through, I’ll go through.” (from the NYTimes)
The curious thing is that here a convict with no training is by instinct doing the right thing while those of us with education and training are held hostage by society’s rituals. The key it seems to me is life experience -if you have had a similar experience, then you can be empathetic, if you haven’t, faking it doesn’t work -the convict shares the confining near death of his fellow inmate and relates naturally -and there is no restrictive society watching him -he is free to be with his fellow prisoner -the irony being that the lonely convict is getting better care than many a dying patient surrounded by family that has no clue how to be with anyone, perhaps stricken by the demand to be cheerful, to deny the reality of the death that is occurring in front of them and afraid that they will say or do something that society will not approve of.
They let the death workers take over, the priests, ministers and social workers who develop a glibness that may simply cover an emptiness -like a doctors bed side manner, it may bring calm, but leaves the patient just as lonely -for them it is just a job. I felt that with the deaths of both my parents -I had no reference point to understand what was happening, no way to relate to their departure and way of reaching out to them before they were gone -I left it to the death workers even though I sensed a disconnect between what they were saying and what I knew about my parents. As with my speechless behavior at my friends funeral, so it was with my parent’s -a resounding silence!
What ties all this together is that in each case, it is some external organization that comes between the elder and those he would relate to, and congruent relating is difficult at all stages of life -it is near impossible when dementia is present in the elderly person -he can’t relate or make his wishes known. This lack of understanding about the physical toll of dementia means that many elders near the end of life are subjected to:
aggressive treatments that would never be considered with another terminal
illness. People with advanced dementia are often given dialysis and put on
ventilators; they may even get preventive care that cannot possibly help them, like
colonoscopies and drugs for osteoporosis or high cholesterol. “You can go to an
intensive-care unit in most places,” said Dr. Greg A. Sachs, chief of general
internal medicine and geriatrics at Indiana University School of Medicine, “and
you’ll find people with dementia getting very aggressive treatment.”
Stories like that above from the NYTimes make the need for Living Wills all the more crucial in giving an elder a chance to make his wishes known before reason is lost. Often the needs of the caretaker will trump a reasonable course of treatment unless the Living Will is there to specify what the elder wanted -and lurking in the background is the profit motive affecting medical personnel and the hospital administration. As one expert put it, “In medicine we have turned the laws of supply and demand upside down," Elliot Fisher said. "Supply drives its own demand. If you're running a hospital, you have to keep that hospital full of paying patients. In order to, you know, to meet your payroll. In order to pay off your bonds. And:
"We have a system where everybody wants as much as they can get, and they
don't understand the true cost of what they're getting. The one thing that could
bankrupt America is out of control health care costs. And if we don't get them
under control, that's where we're headed,"
One would think that given all the bullshit, there would be a resounding cry of “Stop” from the elderly -but there isn’t -with few exceptions like Ehrenreich, most are conditioned to “suffer in silence” or as Queen Victoria used to say about the women’s role in sex “lay back and think of England.” and let the profit motive take over. Look at all the money made from cosmetics and plastic surgery designed to disguise the physical effects of aging for both male and female. There is perhaps nothing more cruel than the physical ravages of age -the body usually weakens and the skin deteriorates before the mind -you know how ugly you are -even though you lust mentally just as you did as a teenager -watch those oldtimers at a dance -it is no different from high school except everyone is a little more aggressive. Then there is Viagra designed to help out the fading condo cowboys and assorted lubricants for their dried up conquests. Maybe it beats golf, line-dancing and bridge as a diversion but it is more expensive and requires more self deception.
There is a movie out called the invention of lying -it recreates a world where only the truth is told -then it all begins to change when the hero has to place his mother in a nursing home called “A Sad Place Where Hopeless Old People go to Die”, but he can’t do it so he invents a tale about “golden years” and this dancing,,singing, and games playing place she is going to find joy and meaning in preparation for an even greater reward in heaven. All the rest of the lies follow -fast food cheap fat meals become super burghers, soft , sugary, obesity causing drinks are sold as “refreshing” -you get the picture -it’s capitalism.
Well, was it ever better for old folks? There is a kind of myth of the golden age -back when there were fewer elderly and it was cheaper to keep them -supposedly they were better off. That seems largely to be a myth -first, there weren’t fewer elderly -it is just that birthing and childhood diseases took out a lot of folks -but if you made it -chances are that unless the plague struck, you would probably live to 60 -and your kids would be just as unlikely to want to support you as the “spoiled” brats of today (all this comes from Pat Thane, A history of Old Age -she supplies art from the past that proves the plight of the aged -lonely and miserable facing death -just like us).
There was long ago a lot of diversions that we have given up -the Fountain of Youth that Spanish explorers searched for -Dantes heaven and hell -the monastic life -and a host of salvation myths from all manner of religions. Since Darwin, the world has become more secular even though some fanatics and evangelical congregations exist along side the Muslim Wahabi and the Buddhist Dalai Lama -but fanaticism is for the young -the elderly try not to think about it -and the money is to be made in diverting their attention from the inevitable end.
As a kid, I used to hope that by the time I got old, technology would have a cure that would let me become immortal -but the best they have been able to do is give me the promise of a few more years if I starve myself the way they have done with monkeys -no thanks -red wine sounds better-reservatol might add a few years and the challenge of drinking enough without killing your liver is a fair game. But you have to know, the scientists aren’t really all that into finding ways for longevity to be increased -look at the burden of paying the way for the old and the infirm -and there are more of them every year threatening the fiscal survival of SS and medicare and generally making the economic survival of nations ever more difficult.
It is ever harder to disguise the fact that everybody is better off if the old just die off early. As a retiree, I have noticed the deaths of those just retired or almost retired are of benefit to me since the financial viability of my pension and SS are stretched out a little with every fatality -you die, I win is the gruesome game! I have also noticed how they place Senior centers in polluted areas and serve them high fat lunches -then they encourage a walk in the polluted air -hurry up and die is the unspoken message -it resembles the GOP health agenda -die quickly and expensively so the health care racquet gets to eat up your savings before you go. No accident that much of the GOP venom led by Sara Palin was reserved for advising seniors about a “good” death that might interfere with the profitable early death they have planned for you.
The economic statistics tell the grim story -old societies like Japan feel the burden of the elderly -lots of folks on pensions relative to the number of taxpayers -so it is harder to compete with younger societies like India with its massive, young workforce -Europe too is feeling the pain of its aging population -relieved somewhat by immigration from the third world as America’s labor pains are relieved by Latin Americans . Fiction writers have played with the problem as Huxley did in Brave new World turning the population into carefully controlled workers -genetically programmed with the right IQ’s for the their appropriate role -then there is the movie that turns elderly into a solution for food scarcity -making them a kind of Spam for the masses much as cattle are fed remnants of food processing in feed lots. Hard to maintain a reverence for life when those lives are devoid of joy or meaning and end as fodder for the masses.
But so far, the US has avoided herding its old folks into Spam processing facilities -it has found a much more lucrative fate for them -expensive end-of-life stretch-out -complete with all the horrors medical technology can provide -keeps the intensive care units humming and guilty relatives appeased -they’re doing “all they can” -and sense the Fed is paying the bills, it’s a win for all but the poor stiff who is kept alive and in pain and the taxpayers who foot the bill -really expensive and potentially bankrupting bills according to a 60 Minutes special report on the subject,
So does the American way of saying goodbye to the old who finally have the decency to
get out the way tell us anything? A NYTimes report on current funeral fashions
llustrate the sad truth that, as a society, Americans are no longer sure what to do
with our dead. Rituals of death rest on the basic need, recognized by all societies,
to remove the bodies of the dead from among the living. A corpse must be taken
fairly quickly from here, the place of death, to somewhere else. But no healthy
society has ever treated this as a perfunctory task, a matter of mere disposal.
Indeed, from the beginning, humans have used poetry, song and prayer to describe
the journey of the dead from “here” to “there” in symbolic, even sacred, terms.
….People who have learned how to care tenderly for the bodies of the dead are
almost surely people who also know how to show mercy to the bodies of the
living.
The TV show, Six Feet Under, explored our “least favorite activity” from a funeral home perspective with each show exploring a different death and the many ways of dealing with it. It too seemed inconclusive although the hero donates his organs to science and his lover opts for a “Green” burial, just a shroud and a grave under a tree. After reading the NYTimes long-time medical reporter, Dr. Jane Brody’s book on the subject, I opted for the donating my body to science route recommended by her sons.
That meant I had to give up on immortality, which according to another NYTimes Op-Ed may be a good thing. After a close call on an airplane he reflects
in our sober moments we recognize that we will indeed die, and that we have precious little control over when it will happen….The second, less obvious lesson of this moment of facing death is that in order for our lives to have a shape, in order that they not become formless, we need to die….Immortality lasts a long time. ….Once you’ve followed your passion — playing the saxophone, loving men or women, traveling, writing poetry — for, say, 10,000 years, it will likely begin to lose its grip. It would become boring, but more deeply it would become shapeless. Just one damn thing after another…. We cannot live forever, to be sure, but neither would we want to.
He goes on to say that happiness is based on recognizing that situation. Well, maybe for some folks, but I would bet that depression is more commonly the reaction to the certainty of death. As one mathematically inclined respondent put it:
Let n be the number of days you’d like to live. Then on the nth day, I ask you if you’d like to live one more day. If you are not disabled by illness, not in pain, and not suicidal, you would take it. So, you in fact prefer n+1 days over n days. And by induction, you prefer an infinite life to a finite life.
If you hang around old folks long enough, you begin to see that even if age has made them physically unattractive, unless dementia has set in, their minds and voices are still young. I first discovered this doing oral history under a grant from the Rockefeller Foundation interviewing victims of the tech revolution in agriculture -most had a clear understanding of what had happened and the consequences and they retained the old skills that had let them survive -to see the oldtimers work with mules and horses was a joy -but they all had understandings of plants and seasons and how to work the soil such that you couldn’t help but lament the loss of such wisdom as they died off. I tried to capture the essence of it all, but mine was just a meager effort compared with the enormous number of talented old folks that were lost. There should be a better way of capturing this wisdom before it is lost!
Corporations do this, they are by law immortal persons and the mortals who work for them dump their wisdom into memos and retirement debriefings, etc. before they are dismissed and allowed to go die someplace. Each employee builds upon what the last has left so the sum is a massive collective wisdom. The only similar effort was made during the depression when the Feds hired people to capture the oral testimony of slaves so that their history might be preserved, but no one is doing it for the thousands wise and skilled people who do not get debriefed by corporations or some special oral history project. Then, too, collecting data is one thing -using it quite another -I am collecting my wisdom here, but will it be used? Probably not -folks are just not atuned to learning from history -just look at our record of war, crime. environmental abuse, etc.
I once heard a famous astronomer who was interviewed on TV about the possibility of other planets contacting us and the possibility of moving thru space travel once the earth gets to be uninhabitable. He held out little hope because, he said, by the time humans develop the science for space travel, they will have developed the power to destroy themselves and that is the most likely outcome, not only for earth, but for those other far away earth-like planets where life may be possible -they too probably are destroying themselves before they have they required scientific prowess for space travel -hence they never get to us and we will never get to them -for them as us, it is just a question of whether we go out with a bang or a whimper -whether it is global warming or the collision of galaxies -we are out one way or another even if some among us attain immortality!
Among the few blessings of age are the decline in appetites sometimes forced by the decline in the capacity for all things pleasurable -we can’t eat, drink or fuck like we used to. So unless you ruined your liver earlier, chances are you won’t be able to drink enough or live long enough to do much damage as a geezer -you get full too fast, the stuff causes acid reflux before you get high, nobody wants sex with an ugly old guy and even if you get lucky, the strenuous exertion of good sex (or anything else) may be beyond you -I know all those Viagra/Cialis commercials lead you to believe otherwise -but the truth is we can’t even watch excessive TV without the old eyes giving up. Hence it is enforced moderation limiting the expenditure of finite energy -learning the pace of the old -a little bit at a time -so much lawn-mowing, so much wine, no hard stuff, early to bed, shut the TV off, read in the AM and early afternoon when the light is good!
And, unless you are Warren Buffet, even the thrill of taking a flyer on the stock market goes -all the investment gurus tell you to keep more in cash, bonds, and money market funds where you can pay off the doctors and not lose it all in a crash like we had last year. As they tell you, cheerfully, you probably won’t live long enough to see your stocks rise again. So, essentially, aging takes the excitement out of life and the pitch the commercials make is to sell you diversions -golf, bridge, travel, etc. for the rich -bingo and TV for the poor. What else can you do while you wait for oblivion other than divert your attention and hope it comes without too much pain?