On becoming old enough to die


I had an interesting discussion recently with some friends from my days in college about the extent that one should go to monitor one’s health and take steps to prolong one’s life. The discussion was prompted by an article that discusses one aspect of Barbara Ehrenreich’s new book where she looks at this question.

Four years ago, Barbara Ehrenreich, 76, reached the realisation that she was old enough to die. Not that the author, journalist and political activist was sick; she just didn’t want to spoil the time she had left undergoing myriad preventive medical tests or restricting her diet in pursuit of a longer life.

While she would seek help for an urgent health issue, she wouldn’t look for problems.

Now Ehrenreich felt free to enjoy herself. “I tend to worry that a lot of my friends who are my age don’t get to that point,” she tells the Guardian. “They’re frantically scrambling for new things that might prolong their lives.”

When Ehrenreich talks of being old enough to die, she does not mean that each of us has an expiration date. It’s more that there’s an age at which death no longer requires much explanation.

Ehrenreich, who is divorced, has talked to her children – Rosa, a law professor, and Ben, a journalist and novelist – about her realisation she is old enough to die, but “not in a grim way”. That wouldn’t be her style. While a sombre subject, she chats about it with a matter-of-fact humour.

“I just said: ‘This is bullshit. I’m not going to go through this and that and the other. I’m not going to spend my time, which is very precious, being screened and probed and subjected to various kinds of machine surveillance.’ I think they’re with me. I raised them right,” she laughs.

“The last time I had to get a new primary care doctor I told her straight out: ‘I will come to you if I have a problem, but do not go looking for problems.’”

What Ehrenreich is arguing is that she feels that she has reached an age when what she values more is the quality of life for the little time that is left to her because there is a limit to how long one can extend one’s life. Of course your mileage will vary for what is meant by ‘little time’. Although I am younger than Ehrenrich, now that I am retired, I feel that I too have reached that plateau of being old enough to die.

The seeds of these views are probably formed early in life. I have long felt that my productive life would be quite short. This may have been partly due to having polio at an early age and partly due to my father and uncles and cousins dying early. I feel that currently, to use a sports analogy, regular time on my life is over and I am on overtime, with ‘sudden death’ no longer a purely sports metaphor.

This is, of course, a purely subjective feeling. It does not mean that I am going to do anything foolish because there is much to look forward to and I do enjoy life immensely. There are plenty of things in life that I want to experience. But it does mean that I am not going to aggressively seek out potential health problems. Without making a conscious decision to do so, my temperament is such that I have practiced moderation in all things throughout my life and cannot see what I can do differently now, without going to extremes, that might make a significant difference in longevity or health. A lot of exercise is out because that is not recommended for people who have had muscle damage due to polio.in childhood.

It is not that I am ignoring or dismissing scientific expertise on what constitutes healthy living, which I would never do. It is that I think that the degree to which one follows the recommendations is not something that can be given for all ages or for all people. When you are young, taking preventive care, like vaccines and routine check ups and exercise, is much more important. In my case, I do go for annual checkups and get blood tests and I do follow the recommendations for colonoscopies because of family history. If I experience concerning symptoms, I will go and see a doctor. If the tests turn turns out that I have diabetes or something, I will treat it. But that is about it. I will not aggressively take measures or change my life drastically just in the hope of prolonging my life. ‘Life’s too short for that’ is no longer just a turn of phrase.

This is clearly a decision that is subjected to many factors, including idiosyncratic ones. My attitude is undoubtedly influenced by the fact I am fortunate that my children are grown and have their own independent lives and are not dependent on me for anything tangible, and neither are my wife or my siblings. There is no one who actually needs me for anything. While they and others may feel a sense of loss when I die, the emotion will primarily be sadness that will pass with time rather than long-term worry and stress.

That is an enormously liberating feeling for me. It means that I can make these kinds of decisions about my own life without worrying if they will have a major negative impact on those close to me.

Comments

  1. Eugene Hill says

    Dr. Singham, I also had polio as a child in 1954 just before the vaccine came out and I definitely understand what you mean. I am 69 and just had a (somewhat) mild heart attack and have come through it quite well actually. I am now in the process of working with cardiologists to decide whether to have open heart bypass surgery, and what I am most concerned about is the extensive recovery period required. Of course this is balanced against the fact that the last several years have been the happiest of my life, and I would like to be around another decade or so, or as long as I am still functional. I often think about what I consider adequate quality of life criteria and have spoken many time with friends and family about it. I agree the quality over quantity is exactly where i come down. I think I will look into that book. Thanks, I have always enjoyed reading your blog. You are one of my regulars.

  2. says

    Even at my age, some ways of dying are worse than others.
    Dying of a stroke or heart attack doesn’t really frighten me. Being crippled by one?
    That is something else.
    I watched my mom die by inches because of diabetes.

  3. Mano Singham says

    Eugene,

    As I understand it, bypass surgery is now fairly routine. I am not really familiar with the length of the recovery period but it seems to me that it is not the length but the nature of the recovery that is critical. The people I know who have had the surgery seem to live pretty normal lives. But I am sure that you and your cardiologists will think this through carefully.

    I wish you well.

  4. lorn says

    Good attitude.
    I see so many, sometimes even myself, polishing the apple instead of enjoying eating it. Life is a journey but it is also a series of destinations. it is easy to get caught up in traveling the path with such diligence that the point is to live, to feel, to experience where and when and with whom you are with. Sitting in a garden watching the birds is something I will remember and appreciate at the end of life. Traveling to and waiting in a doctor’s office on the hope I might get one more day to sit in a garden, if I can remember to squeeze that experience in between visits to doctors and other concerns, has far, far less significance.

  5. Shanti Rasiah says

    My feelings on life is just like Barbara and Mano. If there is a health problem deal with it accordingly but I do not
    believe in looking for health problems. So many of our friends are obsessed by health issues and feel they need to take preventive measures in their 60’s and 70’s to prolong life and sometimes lose their quality of life by going through surgery or treatments which are not absolutely necessary.