On Old Age and Death 1

“The meaning of life is that it ends.” -Franz Kafka [1883-1924

I am in my eighty-third year, and statistically closest to death of all select age groups. I still buy green bananas but am beginning to question the economic wisdom of that practice. My generation is beginning to dwindle; and among my friends and former classmates, there are many who face or fear the impending end. I would like to suggest a more wholesome attitude.

“Death can be our friend. Embracing the inevitable would reduce both unnecessary suffering and costs… As birth and death actually occur; and our brief career is surrounded by vacancy, it is far better to live in the light of the tragic fact, rather than to forget or deny it, and build everything on a fundamental lie.”

-George Santayana

“Oh build your ship of death. Oh build it! for you will need it. For the voyage of oblivion awaits you.”

-D. H. Lawrence

That is, instead of living in fear of death--or of the pain of death, or of the losses death portends—embrace the inevitability of it; prepare for it physically, emotionally, and spiritually; assist your loved ones, friends, business associates, and your community, to ready themselves for what is coming. For those of us of old age, we can be more sanguine and more specific about our own and others’ approach to the long, slow, perfectly individual, path we must follow. Fighting the natural cycle of birth, struggle, and death, is a waste of time and energy; it is better to pursue an effort to understand and to embrace it as the stages pass.

My own education on the subject began rather early. My father had a massive myocardial infarction when I was twelve years old which rendered him an invalid, bitter, and angry and wont to make some foolish choices, such as continuing to smoke despite the strong advice of his cardiologist. He was a physician, a true old country doctor who made house calls and knew the name of every person in his county and could recognize every one of them face-on or by the back of their heads. He had already lost his religion—his spiritualism and belief in life after death—as a result of the awful rigors of going through medical school in Chicago during the depression. The specter of being unable to live out his life practicing medicine--the life he most loved--haunted him. Despite the very strong efforts at intervention by his doctors, and the heart-felt pleading of his faithful wife, he returned to his medical practice and his smoking with a vengeance. He died at the age of fifty-one sitting at his medical office desk. I was fourteen; my brother was ten.

I was too young to face the grim reality of the finality posed by death. I was called to his hospital office by the county sheriff to be the head of my family and to pronounce him dead. It was no great scientific feat; he was cold and in rigor. By virtue of my chosen profession, death in all its forms and causes was a common, almost daily presentation. I learned something over time about causation and responses to the disparate approaches to the end.

During my pediatrics rotation in medical school, my professors perceived me to be cold and unfeeling because I contained my emotions even in the face of pain, suffering, and death. I was assigned to the fourth floor pediatrics ward where—by triage—children whose death was well in sight, were sent for hospice care. Many--even most—parents and many physicians and nurses could not bear having to deal with the unfortunate children for whom there was no cure; and in many cases, not even treatments in those early days. Leukemia and most other blood dyscrasias, polio, smallpox, most pneumonias and cancers, cystic fibrosis, and many cardiac disorders, especially developmental defects, would have to wait as much as fifty years to find a cure. During my stay on that hospice ward, no child with leukemia survived after being placed on my ward.

Children are interesting little souls. Most of them are a great deal stronger than their parents and siblings would think. What they could not endure was people lying to them about their condition. They knew that other children with the same disease as theirs were dying on the ward—almost every day. The fear of death was not nearly so terrible for them as was the knowledge that their disease was so terrible that their parents were afraid to tell them about it, and the doctors and nurses avoided what had to be—a discussion about their approaching deaths. A lie about the facts coming from parents meant that there was no one they could talk to and express their deeply-seated confusion, ignorance, and fear.

Many parents pled with me to give the awful news—the truth—that they could not bear to speak. So, I did. I found that the children already understood the truth; they could feel it in their bones and brains. They were almost always relieved when I answered their burning question: “Am I going to die?” I learned the first day, how harmful it could be to answer with “Everybody dies sometime, you’re not going to die today.” Most children turned their backs and faced the wall when given the useless euphemistic rubbish.

I watched the children’s faces when I answered, “Yes, my dear boy/girl. It is so. There is no cure in all of medicine for your illness. We are all here to make you as happy as possible, comfortable as long as possible, and the help you to show your poor parents that you can handle the truth, and they need to do so as well.”

Almost every child heaved a sigh of relief to learn what was real and true after receiving pablum answers since coming to the hospital. Immediately, the aspect of fear dissipated, and they took me at my word that I would see to it that their pain would be relieved; so, they could finally rest. When I told their parents the final and absolute truth, many broke down and fell into my arms, not to plead for more or better medication and treatments, but for solace; so, they could give their children the final nurturing they so needed. The truth is a good thing, even about death.

It is my personal opinion that euphemisms about death are a poor substitute for real and honest talk: a spade is a spade, and the truth, the whole truth, and nothing but the truth, is the best policy for conveying serious information. Avoidance of “passed away”, “passed on”, “departed”, (dearly or not), “gone on a long trip”, or “lost” as in “We lost Dad a year ago March.” That sounds like someone being careless and misplacing the gentleman.

During my naval service in the Viet Nam era, and later during neurosurgery training and practice, I found it much less confusing and disturbing to be frank and candid to both patients and others who needed to know about medical conditions. Many of the patients I cared for during training in a violent and impoverished big city/county charity hospital were either ignorant of multisyllabic Latin/Greek medical terms or were illiterate. They needed to know that their loved one was “low sick” or was about to “slough his mortal coil” or just plain dying or already dead. Everyone understands that even if they do not want to. We spoke to them in kindness and with compassion but spoke the truth and helped them begin the mourning process.

I was the brig medical officer for my naval base; and as such, I was required to attend to some medical needs of prison inmates. I saw several men who had been on California death rows awaiting execution for years, even decades. I found that many of those individuals facing imminent death had had more time to process the idea of death and dying, and therefore, were more accepting of its inevitability. They also had a very good idea about how they were going to die—if not precisely when--which brought some sense of peace or acceptance. Many of those men were grateful to have some nonjudgmental person to talk to about death and an assortment of unrelated topics.

The less something is openly discussed, the scarier it becomes. While avoiding talking about death can seem to reduce a little discomfort in the short term, it makes most of us much more anxious about dying in the long term. An outright lie raises a false hope which will lead to crashing realization later when the individual is less capable of enduring and to a profound distrust for the purveyor of the lie.

In a recent medical/psychological study of death row inmates, it was found that, overall, those facing death focused more on what makes life meaningful, including family, and religion.

“We talk all the time about how physically adaptable we are, but we’re also mentally adaptable. We can be happy in prison, in hospital, and we can be happy at the edge of death as well.”

-Kurt Gray, researcher