Die In The Summertime

Manic Street Preachers, “Die The Summertime”, The Holy Bible

Right, that’s enough Christmas cheer people; time for a reality check.

Further to my post a couple of months ago on assisted dying, I recently came across this article from an American doctor on our unrealistic attitudes towards death that has struck a chord with me:

If I’m lucky, the family will accept the news that, in a time when we can separate conjoined twins and reattach severed limbs, people still wear out and die of old age.  If I’m lucky, the family will recognize that their loved one’s life is nearing its end.

But I’m not always lucky.  The family may ask me to use my physician superpowers to push the patient’s tired body further down the road, with little thought as to whether the additional suffering to get there will be worth it.  For many Americans, modern medical advances have made death seem more like an option than an obligation. We want our loved ones to live as long as possible, but our culture has come to view death as a medical failure rather than life’s natural conclusion.

These unrealistic expectations often begin with an overestimation of modern medicine’s power to prolong life, a misconception fuelled by the dramatic increase in the American life span over the past century.  To hear that the average U.S. life expectancy was 47 years in 1900 and 78 years as of 2007, you might conclude that there weren’t a lot of old people in the old days — and that modern medicine invented old age.  But average life expectancy is heavily skewed by childhood deaths, and infant mortality rates were high back then. In 1900, the U.S. infant mortality rate was approximately 100 infant deaths per 1,000 live births. In 2000, the rate was 6.89 infant deaths per 1,000 live births.

The bulk of that decline came in the first half of the century, from simple public health measures such as improved sanitation and nutrition, not open heart surgery, MRIs or sophisticated medicines. Similarly, better obstetrical education and safer deliveries in that same period also led to steep declines in maternal mortality, so that by 1950, average life expectancy had catapulted to 68 years.

For all its technological sophistication and hefty price tag, modern medicine may be doing more to complicate the end of life than to prolong or improve it.  If a person living in 1900 managed to survive childhood and childbearing, she had a good chance of growing old. According to the Centers for Disease Control and Prevention, a person who made it to 65 in 1900 could expect to live an average of 12 more years; if she made it to 85, she could expect to go another four years. In 2007, a 65-year-old American could expect to live, on average, another 19 years; if he made it to 85, he could expect to go another six years.

(…)

This physical and emotional distance becomes obvious as we make decisions that accompany life’s end.  Suffering is like a fire: Those who sit closest feel the most heat; a picture of a fire gives off no warmth.  That’s why it’s typically the son or daughter who has been physically closest to an elderly parent’s pain who is the most willing to let go. Sometimes an estranged family member is “flying in next week to get all this straightened out.” This is usually the person who knows the least about her struggling parent’s health; she’ll have problems bringing her white horse as carry-on luggage.  This person may think she is being driven by compassion, but a good deal of what got her on the plane was the guilt and regret of living far away and having not done any of the heavy lifting in caring for her parent.

With unrealistic expectations of our ability to prolong life, with death as an unfamiliar and unnatural event, and without a realistic, tactile sense of how much a worn-out elderly patient is suffering, it’s easy for patients and families to keep insisting on more tests, more medications, more procedures.

Doing something often feels better than doing nothing. Inaction feeds the sense of guilt-ridden ineptness family members already feel as they ask themselves, “Why can’t I do more for this person I love so much?”

Opting to try all forms of medical treatment and procedures to assuage this guilt is also emotional life insurance: When their loved one does die, family members can tell themselves, “We did everything we could for Mom.”  In my experience, this is a stronger inclination than the equally valid (and perhaps more honest) admission that “we sure put Dad through the wringer those last few months.”

At a certain stage of life, aggressive medical treatment can become sanctioned torture.  When a case such as this comes along, nurses, physicians and therapists sometimes feel conflicted and immoral. We’ve committed ourselves to relieving suffering, not causing it. A retired nurse once wrote to me: “I am so glad I don’t have to hurt old people any more.”  [My emphasis]

When families talk about letting their loved ones die “naturally,” they often mean “in their sleep” — not from a treatable illness such as a stroke, cancer or an infection. Choosing to let a loved one pass away by not treating an illness feels too complicit; conversely, choosing treatment that will push a patient into further suffering somehow feels like taking care of him.  While it’s easy to empathize with these family members’ wishes, what they don’t appreciate is that very few elderly patients are lucky enough to die in their sleep.  Almost everyone dies of something.

Close friends of ours brought their father, who was battling dementia, home to live with them for his final, beautiful and arduous years.  There they loved him completely, even as Alzheimer’s took its dark toll.  They weren’t staring at a postcard of a fire; they had their eyebrows singed by the heat.  When pneumonia finally came to get him, they were willing to let him go.

It reminded me of Manic Street Preachers’ less-than-comforting ode to growing old from their classic, white-hot-scattershot-punk masterpiece, The Holy Bible:

“Die In The Summertime”

Scratch my leg with a rusty nail, sadly it heals
Colour my hair but the dye grows out
I can’t seem to stay a fixed ideal

Childhood pictures redeem, clean and so serene
See myself without ruining lines
Whole days throwing sticks into streams

I have crawled so far sideways
I recognise dim traces of creation
I want to die, die in the summertime, I want to die

The hole in my life even stains the soil
My heart shrinks to barely a pulse
A tiny animal curled into a quarter circle
If you really care wash the feet of a beggar

I have crawled so far sideways
I recognise dim traces of creation
I want to die, die in the summertime, I want to die

I have crawled so far sideways
I recognise dim traces of creation
I want to die, die in the summertime, I want to die

Or as The Who once phrased matters, “I hope I die before I get old”.

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