Dying to Die
Michael Wolff says his elderly mother should just die already:
I didn’t need to be schooled in the realities of long-term care: The costs for my mother, who is 86 and who, for the past eighteen months, has not been able to walk, talk, or to address her most minimal needs and, to boot, is absent a short-term memory, come in at about $17,000 a month. And while her LTC insurance hardly covers all of that, I’m certainly grateful she had the foresight to carry such a policy. (Although John Hancock, the carrier, has never paid on time, and all payments involve hours of being on hold with its invariably unhelpful help-line operators—and please fax them, don’t e-mail.) My three children deserve as much.
And yet, on the verge of writing the check (that is, the first LTC check), I backed up.
We make certain assumptions about the necessity of care. It’s an individual and, depending on where you stand in the great health-care debate, a national responsibility. It is what’s demanded of us, this extraordinary effort. For my mother, my siblings and I do what we are supposed to do. My children, I don’t doubt, will do the same.
And yet, I will tell you, what I feel most intensely when I sit by my mother’s bed is a crushing sense of guilt for keeping her alive. Who can accept such suffering—who can so conscientiously facilitate it?
“Why do we want to cure cancer? Why do we want everybody to stop smoking? For this?” wailed a friend of mine with two long-ailing and yet tenacious in-laws.
The traditional exits, of a sudden heart attack, of dying in one’s sleep, of unreasonably dropping dead in the street, of even a terminal illness, are now exotic ways of going. The longer you live the longer it will take to die. The better you have lived the worse you may die. The healthier you are—through careful diet, diligent exercise, and attentive medical scrutiny—the harder it is to die. Part of the advance in life expectancy is that we have technologically inhibited the ultimate event. We have fought natural causes to almost a draw. If you eliminate smokers, drinkers, other substance abusers, the obese, and the fatally ill, you are left with a rapidly growing demographic segment peculiarly resistant to death’s appointment—though far, far, far from healthy.
The entire essay is worth reading. Michael Wolff having the values of Michael Wolff, the entire grueling experience his mother has had — being kept alive very expensively, even though she is in dementia and seriously ill — has made him decide to devise a suicide plan so he doesn’t live through the same misery, and put his kids through the same.
I find that appalling, but it’s absurd to wish away the very real problems — both practical and moral — that come with living as long as we do. It’s something I’m seeing now, with my dad. He is 77, and in poor health, though not suffering from dementia. He’s got a bad heart, and all kinds of aches and pains, the result of a rough-and-tumble country-boy life (e.g., he used to rodeo as a young man). He is in near-constant pain in his hip, and has to use a cane to get around. I don’t know when he has last felt good. You can’t believe the medicines the poor man has to take every day, just to maintain. He’s getting too feeble to do much more than sit in his chair.
It’s making him angry. This was a man who was vigorously active for most of his life, and who, like many men, seemed to define his sense of self by what he could do. I was thinking one day that I couldn’t really understand that, that I would relish the opportunity to have nothing more expected of me than that I sat in my chair and read all day long. Then I thought: What if in your old age, you went blind, or otherwise lost the ability to read? Well, I would be bereft.
My dad is living through the equivalent of that.
I can tell he’s sick and tired of it. Sick and tired of being nothing but sick, and tired. He’s lived long enough now to bury his only sibling, and his parents. He’s even buried his daughter. He’s seen all the grandchildren he’s going to have born, and thriving. I can tell that he’s ready to go. He wouldn’t put it quite that way — or maybe he would — but it seems to me the case that he considers himself done with life. Not in a depressive way, necessarily, but in a clear-headed manner. He sits in his chair now and lives in fear that his dying will be a costly, prolonged thing, and will drain his bank account of everything he’s managed to save his entire life.
Building a legacy for his heirs — giving them a little something to show for his life — has been his greatest mission in life. And now he worries that even that can slip through his fingers, depending on how he dies. He is right to worry, too. Of course we will do everything necessary to save his life, come what may. Would you want to be the son, or son-in-law, or wife, who pulled the plug on dear old dad? I wouldn’t. You would always question your motives, at least if you were honest. Were you tempted to do this as an act of mercy for Dad, whom you know to be exhausted and fed-up with the decrepit life his worn-out body, with its constant trips to the doctor, and the constant pain it inflicts, has given him? Or are you doing it as a (selfish) act of mercy to yourself — meaning, to keep from having to help him manage his long decline? Or, is it that you are pushing doctors to save him not for himself, but for yourself — because you can’t bear to see him go?
I interviewed an experienced oncologist for the book I’m doing on my sister and her cancer death. He told me the saddest and most frustrating cases he deals with involve advanced cancer patients who are plainly ready to die, to rest and be relieved of the pain and nausea of the disease, but who hold on because they don’t want to disappoint family members. The cruelest thing, he says, is to watch how their families, out of a misguided sense of love, refuse to let them go home to God (the doctor is a Christian). The Christian theologian Jean-Claude Larchet wrote a great little book about sickness and suffering in which he listed the reasons we in the modern West have so much trouble with dying. Among them:
1. An over-valuation of biological life — that is, the idea that preserving biological life is the utmost value, and a concomitant fear that biological death means the absolute end of human existence. This can cause us to face our illness with great fear, which only undermines our ability to resist it.
2. Psychological health conceived as an enjoyment of well-being in the body. This has to do with a fundamental refusal to conceive of suffering as having any redemptive or positive effect, and with the suppression of pain and elimination of suffering — as opposed to transforming pain and suffering — as the highest value of civilization.
In my dad’s case, I don’t think any of this philosophical stuff has occurred to him. He just carries on. What else is there to do? His mother died in her early 60s of heart disease. Same as his older brother. He inherited the same heart defect, but lucky for him, when it became a problem, coronary medicine had advanced sufficiently to spare him their fate. Given his family’s history, it is a minor miracle that he has reached the age of 77 without having had a heart attack. Except it’s no miracle at all: this is what medical science has done for him, and for all of us who love him. We’ve had him for 15 more years than we ought to have done. That’s long enough for him to have seen his son get married, and five more grandchildren born. I know he wouldn’t have missed it for anything.
But life has diminishing returns. Tomorrow he has to go have another heart catherization — this, to help him get fit for yet another surgery. It’s one damn thing after another, and he’s had enough. I don’t blame him one bit. And yet, he keeps going to the doctors. He’s not really ready to go either, it appears. Thank God!
This is hard.
UPDATE: I spoke to him tonight, and I misunderstood tomorrow’s meeting with the cardiologist. It’s not for a heart cath, but to discuss whether one is advisable now.
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