In the last few years I have given up on the many medical measures—cancer screenings, annual exams, Pap smears, for example—expected of a responsible person with health insurance. This was not based on any suicidal impulse. It was barely even a decision, more like an accumulation of micro-decisions: to stay at my desk and meet a deadline or show up at the primary care office and submit to the latest test to gauge my biological sustainability; to spend the afternoon in faux-cozy corporate environment of a medical facility or to go for a walk. At first I criticized myself as a slacker and procrastinator, falling behind on the simple, obvious stuff that could prolong my life. After all, this is the great promise of modern scientific medicine: You do not have to get sick and die (at least not for a while), because problems can be detected “early” when they are readily treatable. Better to catch a tumor when it’s the size of an olive than that of a cantaloupe.
But then she realized that she’s 76 years old, and therefore “old enough to die”. More:
Once I realized I was old enough to die, I decided that I was also old enough not to incur any more suffering, annoyance, or boredom in the pursuit of a longer life. I eat well, meaning I choose foods that taste good and that will stave off hunger for as long as possible, like protein, fiber, and fats. I exercise—not because it will make me live longer but because it feels good when I do. As for medical care: I will seek help for an urgent problem, but I am no longer interested in looking for problems that remain undetectable to me. Ideally, the determination of when one is old enough to die should be a personal decision, based on a judgment of the likely benefits, if any, of medical care and—just as important at a certain age—how we choose to spend the time that remains to us.
She goes on to talk at length about how much money is involved in diagnosing illnesses, and their care. It really is worth reading. You’ll learn from it. Well, I did, anyway. She concludes:
In giving up on preventive care, I’m just taking this line of thinking a step further: Not only do I reject the torment of a medicalized death, but I refuse to accept a medicalized life, and my determination only deepens with age. As the time that remains to me shrinks, each month and day becomes too precious to spend in windowless waiting rooms and under the cold scrutiny of machines. Being old enough to die is an achievement, not a defeat, and the freedom it brings is worth celebrating.
I find Ehrenreich’s view admirable, to be honest, and I expect to reach the same conclusion when I am her age. I’m 25 years away from that now, so I’ll end up having to submit to the colonoscopy and all the rest. I have a family to care for, and whose company I enjoy. I’m not afraid of death, only pain in dying. I want to be around for my wife and kids, but otherwise, I’ve had a great life, and — again, family aside — I would pass with peace and gratitude for all the blessings given me.
Still, I am at the age where my body is starting to break down, both in the usual ways and in not-so-usual ways. Lately I’ve developed a particular physical difficulty that I remembered my dad manifesting at some point later in his life. I called my mom yesterday and asked her when he started suffering from it.
“I think it was in his fifties,” she said. “They never could figure out how to treat it. He just had to live with it. He had it until he died.”
Well, I’m in my fifties too, so if this is heritable, that’s no surprise. I did some research on it, and found out that in my case, it could be tied to the autoimmune problems I’ve had for at least a decade. So, it’s off to a rheumatologist for testing. If my hunch is right, there’s not a lot they can do for me (though it’s not a life-threatening condition). But I’m too young not to seek out further treatment, so… .
My doctors have told me that the pain in my neck from the whiplash I got in a fender-bender in 2016 will likely be permanent. I feel it every day, some times worse than others. Traveling, especially, stresses it. The pain is almost always there — not too bad, most of the time, but present, like a memento mori. I have lived long enough now to regret rolling my eyes internally every time some older person of my youth complained about their aches and pains. (OK, except for the woman at the Little League park who chain-smoked and talked incessantly about her surgeries and therapies for what our moms back then called “female trouble.” She really was too much.)
That said, isn’t this, you know, life? I was born in 1967. A man who was 51 years old on the day I was born had already exceeded the average life expectancy for an American male born in 1916 by almost a year and a half. In 1867, average life expectancy for an American baby born that year was 35 years old. Can you believe? Those numbers are no doubt skewed by a relatively high infant mortality rate, but still, our ancestors could not have imagined that so many of us would live to such an advanced age, or even expect to.
I lived for so long without having to worry overmuch about taking care of my body because youth is careless. Now I have a belly and a lousy back and a pain in my neck and an autoimmune condition and wish I had done better by my body when I was younger, just like I wish I had started saving earlier for retirement. But you know, I sure have eaten well, and seen some beautiful places, and had made some great memories with people I love. That’s no excuse not to eat better now, and exercise more (or, um, at all), if only to stick around for the people I love, and the books I have yet to read. But when I get old enough to die, like Barbara Ehrenreich, I hope I have the bravery to cherish the days left to me, and to let nature takes its course. Going gentle into that good night strikes me as wise. My late father fought very hard to stave off the inevitable, and bore the many pains in his body with stoic courage. He never, ever complained.
But when there really was nothing more to be done for him, his courage led him to lay his body down in his bedroom, and wait, with the help of a home hospice nurse and his friends and family, for the end.
It was a good death. Not a beautiful death — there are no beautiful deaths — but a good one. At home, surrounded by the people who loved him, at the end of a long and eventful life.