June 1993
By Richard Fleming
Among my tasks as a doctor are helping the elderly come to terms with the limitations of old age, and assisting terminally-ill patients and their families to accept death. Patients and family members tell me I am good at this. I discuss “No Code Blue” designations (orders not to take extreme measures to resuscitate a patient in case of cardiac or respiratory arrest) and make sure affairs are in order with an appropriate mix of compassion and objectivity.
Lately, though, I have begun to feel like a hypocrite. My words of comfort to the aged and dying sound increasingly hollow. Even as I speak them, my reassurances are contradicted by a small voice inside my head saying, “Fool! There is nothing good about growing old. Aging gracefully? Hah! What rubbish! And death. Who would ever be ready to die?”
The days go by, and I continue to carry out my responsibilities as a physician, but a weird role reversal has taken place. Probably no one else sees it, but I am now the one seeking reassurance from my elderly patients that it is OK to grow old and there is nothing to fear from death.
Why, I ask myself, has this issue become a concern for me now? After all, I am only nine months into my 42nd year and my health is good. So why now? Maybe this is part of the notorious midlife crisis, a phrase I have always despised.
Yet that is where I find myself – halfway through. Though not consciously planned, I find myself reflecting, thinking about the goals I have met, the goals I haven’t met, and those goals I never set. It is a time for taking a personal inventory, to examine the good and the bad. A successful career. But maybe I could have done better. Some good friends, yes, but not as many truly close ones as I would like. No major medical problems, as far as I know, but aches and pains are more persistent.
Time accelerates every more rapidly; each year is shorter than the one before. I fear I will never reach the point where I have lived enough of life that I will be at ease with letting it go. It seems too difficult a challenge. Life is so rich with color and meaning and potential – how can aging and death be anything other than premature?
Anxiety would overcome me if it was not for my daily interactions with the elderly, those time travelers who have reached their 70s, 80s, and 90s. In what appears miraculous fashion, they counter the indignities of old age with dignity. I don’t mean this to be patronizing, but the vast majority of the elderly I work with seem so pleasant, so even-tempered, so calm. Whatever rough edges they may have had in the past – selfishness, insecurity, anger, despair – have often been smoothed away by time.
It is not that the elderly have such easy lives. Many face chronic medical problems, financial insecurity, loneliness, and isolation. And it is not that they look forward to further aging and to death. But they seem to have reached an accord with life and the inevitability of death that is beyond the reach of those who are younger.
“When death comes, it comes,” said a 78-year-old retired carpenter.
“I don’t know, I guess I’ve lived a pretty full life, and I’m ready for whatever comes,” said an 83-year-old with four children, seven grandchildren, and great-grandchildren too many to count.
I am baffled by these sentiments. Don’t these people understand what they are saying?
What accounts for how readily the elderly consent to their terrible predicament? This acceptance encompasses both the healthy and the sick, the religious and the nonreligious, those with strong networks of friends and family and those without. The answer is not to be found among these characteristics. Instead it seems intrinsic, something acquired by virtue of having lived for so many years. It is as though the elderly have crossed into a foreign land, a strange world where the requirements for citizenship include a birth date before 1920 and a quiet understanding of the realities of life and death.
I long to know this mysterious world and, I confess, it is not so that I can be a better doctor, but for reasons very selfish and personal. In my encounters with my elderly patients, I carry on as before, but with a new, hidden agenda, a desire to understand the world they inhabit. My questions to them sound no different than before.
“How are you making out at home with that new walker, Mrs. Peterson?”
“Well, Mr. Sandberg, have you given any more thought to that talk we had last visit about moving into the nursing home?”
But what I strain to hear are not merely the responses to my questions but something more. I seek clues to the puzzle of why the elderly are so accepting of themselves and how this came to pass. In so doing, I am really looking for something inside myself, some aspect of my personality or some experience that will allow me entry into that land of mystery.
I suppose I could be patient and dutifully await my turn. At age 70 or thereabouts, I will somehow acquire a visa providing admission into the nation of the elderly.
But I don’t want to wait! I’m insecure today and want to understand now. I want my own rough edges rounded off. Why can’t I cheat time? Why should I have to wait another 30 years to know my fate?
My next patient awaits. It’s Mrs. McCarthy, an 84-year-old diabetic with a heart condition. Maybe she will have the answer. Maybe she can provide me what I need, reassurance that I too can embrace the coming years of tempered expectations with some degree of peace.
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Isn’t it at age 40-50 when most of us first think about these issues. Perhaps this is because we have begun to lose elders close to us and regret not fully tapping into their wisdom and memories. Cool that you were able to retrieve this piece!
Thanks for your comment. Jim. It is the blog’s first comment! I think you’re right about why people in their 40s and 50s often start thinking more deeply about what is ahead. I definitely wish I had talked more, much more, with my parents before they passed.
Thanks for sharing your insights, Richard. I was taken in by the fact that it reads a little bit like a professional-confessional, i.e. the doubts of someone in whom so many have placed their absolute faith. In my case, amidst months of significant medical treatments, i am grateful for you, and any doctor, whose makeup includes the capacity to recognize the mystery of it all, the frustration that cannot be masked with sunny optimism, the mechanics of hope and despair that compete with the mechanics of organs and tissues. I am glad to report that through all the ups nd downs of my experience, i remain hopeful and heartened by medical professionals like you (and half of my grade school class!) for the enormous work that is undertaken on behalf of cats like me, who ignored for most of my life the principle rules of sustaining a healthy body. thanks again for all you havd done AND for sharing your thoughts.
Thank you, Tom. Powerful words you write. Now that I am retired from being a physician, my role is much more clearly that of patient. I’m now on the receiving end of health care, not the providing end. I hope your medical situation does not interfere with you enjoying many years ahead. And I like your concept of this blog as a professional confessional.
Hi. You ask how we older people tolerate infermity and illness. And how do we accept that death is a reality that is coming before long. I know the “secret” that you are looking for. It is simple. We don’t have a choice. Our task is to maintain a wonderful life in spite of the problems. But thanks for asking, and thanks for your new blog. it will be part of the richness of my own old age.
Thank you. Your approach sounds good. Living fully every year.
Of course James Young is the first to comment. You two are so special to me and I have always admired you so much. At Roosevelt Junior High, I always wondered why I was in the same advanced math class as you two. It didn’t make sense. But back to the subject at hand. I have to disagree with you, Richard, on part of your post. I have not seen the same acceptance of decreasing abilities and acceptance of death as you have in my 80+ acquaintances. Many, but not all. They seem to accept death more than they do the state of their minds and physical limitations. The fact that you saw this so much in your patients gives me hope. Thanks again for starting this blog.
A great introduction. Looking forward to many more thoughtful posts. Thanks for your vulnerability.
I look forward to your insight. The last 16 months have given me many reminders of my mortality. My wife, best friend from my Navy days, an old sweetheart, a brother-in law, best friend from work have died, as also three family members murdered. I take it one day at a time and focus on trying to do all I can do to live a life of being someone who cares for others and be a supporter and an encourager. I have also been thinking of the days at Topeka High. Some of the best days of my life.
Hi Mark. I cannot imagine what you have been through. Losing one person is hard enough. The impact of losing so many in such a short period of time is impossible to put into words. I will just say I am very sorry.
I was just told today about your blog by a good friend, and I am glad of that. I look forward to reading more. I am 83, which seems so strange as I say it, but gradually I grow closer to accepting it, especially with the camaraderie of friends of like age.