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The Dilemma Of Meeting Mister Death

Sometimes I wonder why this little poem by e.e. cummings has stuck in my brain for over a half-century: “Buffalo Bill’s defunct……who used to ride…….a watersmooth-silver stallion……..and break onetwothreefourfive pigeonsjustlikethat………Jesus he was a handsome man……..and what I want to know is…….how do you like your blue-eyed boy Mister Death?”  Could be a very important question!  This column is about death, so I am going to call on two experts, an Iraq War veteran and a nurse for the elderly. Derek Farwell wrote about death in his “Purple Heart” column in the Extra. He was in enough deadly experiences—close bullets, IED attacks, and seeing many fellow soldiers killed and wounded—that he no longer thought about if he died, he thought about when he died. He saw 31 of his friends killed and dozens more wounded, so he reached beyond “if” to “when.” His quote tells it all: “And I found that when I had come to terms with my own death, then whatever happened was going to be OK. I had seen my friends die, I’d seen absolute devastation of some of my friends. I’d seen them die from gunshot wounds, I’d seen them blown up in the most violent and destructive fashion, I’d seen them burn to death trapped inside a burning vehicle and more. It was some awful stuff, but it taught me in a hurry that death most surely is a part of life. Death was final and uncompromising. Even six years out of my deployment, leaving that state of mind behind is very difficult. I’m still not scared of death though I would be less accepting of it now.” He should be considered an expert.
   My other expert in the field of death is Gill Pharoah, a healthy retired British nurse at age 75 who just died of a legal and lethal injection in a Swiss clinic. Why did Gill choose death over life? In an interview she said: “I have looked after people who are old, on and off, all my life. I have always said, ‘I am not getting old. I do not think old age is fun. I know I have just gone over the hill now. It is not going to start getting better. I do not want people to remember me as a sort of old lady hobbling up the rode with a trolley’.” Her lifelong partner added: “If we had laws in this country where you could write an advance directive and say if a person has a stroke that they could have medical assistance to die, Gill would have been happy to stay around for longer. She couldn’t do that (in England) and therefore wasn’t prepared to take the risk. She had to arrange for foreign currency transfers to pay and arrange to fly there.” A 2014 study by Zurich University reported that 611 people had traveled to Switzerland to end their lives in the last four years, with 126 of them coming from the UK. In a newspaper article Gill stated her reasons for seeking assistance in ending her life: “The fact is that many old people are a burden on society. Like all nurses, I have cared for the elderly as well as I could, but there were many occasions when I wondered why we were doing it. People who cannot accept this argument should work for a few months in a care home where many patients are demented, incontinent, unable to care for themselves, and have no visitors. I would like to be able to apply for a prescription which could be used if I ever feel like a quiet and peaceful exit before things get too bad.” Her two children backed her decision. One of them a nurse, said, “Intellectually I know where she is coming from.”

Aging: Does A Gene Switch Click Off Or Do We Just Wear Out?

We still don’t know specifically why we age. Over 200 years ago humans were lucky to see 30. The philosopher Montaigne wrote this in the 16th Century: “To die of age is a rare, singular and extraordinary death, and so much less natural than others. It is the last and extremist kind of dying.” When Social Security was passed in the 1930’s age 65 was difficult to reach. It took until the early 1960’s to have an average life span of 65. Now it is very close to 80 for both sexes, probably because of medical advances in devices and drugs.. Geriatricians are still looking for scientific answers. Some say we just wear out. At 83 I know I’m wearing out in joints and organs, but I hope genes have something to do with longevity because my dad lived to be 99½. The story of Richard Overton, 108, is enlightening. He is our oldest living war vet from World War II, serving in an all-black Engineer Aviation Battalion in the Pacific Theater. After the war he worked for an Austin, Texas furniture store and retired at age 65—except they kept on calling him back (four times!)—so he worked until he was 100. He still drives his old Ford pickup around the city after starting his day with a “medicinal” shot of whiskey in his coffee. And, yes, he smokes cigars daily. He still lives in a home he bought for $4,000 in 1945, does his own yard work, and drives widows who live around him to church every Sunday. This year he served as grand marshal of Austin’s Veteran’s Day parade. In 2014 he met President Obama at Arlington National Cemetery when he spoke about Overton on Veteran’s Day.   His secret for longevity? He says, “You have to ask God about that.” By the way, the oldest female vet was Lucy Coffey who died on March 15, 2015. She was three days younger than Overton! She was a sergeant in the WACs and served in the Philippines, New Guinea, and Japan. She worked off and on for the military and retired in 1971.

Do We Really Start Wearing Out At 30?

Some medicos say we start wearing out at 30. The human body is a very complex machine. We begin to run out of hair pigment cells. My mother was mostly grey at 25. Skin cells are unable to keep up that wonderful baby skin, building up gunk that eventually turns to age spots. Suddenly most of us need reading glasses because eyes become less elastic. But we do have a lot of backups for major tasks: two lungs, two kidneys, two eyes, and lots of teeth. Often we can get by without backups. But electric wires, the sewer system, and the heart and arteries begin to malfunction. The bones become thin and brittle. Messages to the brain start to go to call-waiting or the recycle bin, or are never answered.  Bodies and brains continue to deteriorate regardless of creams, potions, broccoli, Hail Mary surgeries, $1,000 pills, and Drs. Oz and Phil. Death finally comes. Kathy Butler in a Tribune article reports that 75% of us want to die at home but only 25% actually do. Most will die in nursing homes, Alzheimer’s and dementia care units, and hospitals. Almost 20% die in hospital intensive care plugged into a plethora of machines, watched by relatives waiting for the horror and torture to end. Medicare spends $160 billion on the last year of life, paying for surgeries on one-third and long stays in intensive care units. One of Butler’s friends had an 88-year-old father with dementia who spent the last ten days of his life in intensive care because of a mysterious infection. The bill was $323,000. He should have been in palliative care which focuses on alleviating  pain and suffering, improving the quality of life, and giving the family the straight dope on the patient’s condition instead of tubes, surgeries, and machines.

Now Comes The Greatest Fear—Losing Our Minds

The greatest fear of longer-living humans is that millions of us will lose our minds to Alzheimer’s and dementia. The cure for each is somewhere over the rainbow yet. In 2015 we have 5.3 million with Alzheimer’s and dementia which will cost an estimated $226 billion, with 68% paid by Medicare and Medicaid. If we don’t come up with a reasonable cure, the Alzheimer’s Association estimated that by 2050 over 16 million Americans will have the disease—and cost us $1.1 trillion per year. The best description of the mind-destroying Alzheimer’s I have heard was that of a loving wife who tried to care for her husband: “It’s like being chained to a corpse.” We have quite a few friends at our age who have spouses and relatives with Alzheimer’s who are mindless zombies in a horror movie. Victims can’t remember old memories and can’t forge new ones. My sister Kathleen died of Alzheimer’s about four years after she had sent us three Christmas cards in one week, and four years after she had run a senior marathon in London. For some it takes much longer. About 70% of Alzheimer’s patients are women.  The National Institutes of Health spend only $100 million on research. Scientists say they need about $2 billion a year for the next ten years. So far, researchers are looking at toxic proteins and “bad” bacteria as possible causes—but we may not be even close. So far the only effective treatment for dementia discovered in the world is eating the brains of dead members of the Fore tribe of New Guinea. That treatment may not become popular in the U.S.
North Dakota has the highest rate of Alzheimer’s in the nation and it is the state’s third leading cause of death. The Alzheimer’s Association estimates that a family’s cost was $414,000 beyond insurance to care for a family member with Stage 3 Alzheimer’s.

When The Brain Is Dead, What About Physician-Assisted Euthanasia?

In order to relieve needless suffering and bankrupting medical costs, why not institute a living will that covers the diagnosis of Alzheimer’s? Euthanasia and physician-assisted dying is becoming more popular and realistic around the world among elderly victims tied to hospital beds with machinery, tubes, Hail Mary surgeries, and expensive drugs. Death is a part of life. On average, today’s Alzheimer’s victim survives for four to eight years through three stages, and may live as long as 20 years. What if a living will contained the following stipulations which would result in physician-assisted dying if approved by family and medical personnel? The will would be in force if the patient is in Alzheimer’s stage 3 and:

• Requires full-time, around-the-clock assistance with daily personal care.                                                                        

• Loses awareness of recent experiences as well as of their surroundings.

• Requires high level of assistance with daily activities and personal care.

• Experiences changes in physical abilities, including the ability to walk, sit and, eventually, swallow.

• Has increasing difficulty communicating.

• Becomes vulnerable to infections, especially pneumonia.

• Is unable to recall address or telephone number or the high school or college from which they graduated.

• Has trouble controlling bladder and bowels.

• Does not recognize spouse or immediate family and may direct violent acts toward them.

• Has an increased risk of wandering and becoming lost.  

The Netherlands legalized euthanasia and assisted suicide in 2002 and the practice is slowly spreading through Europe and the United States. Oregon, Washington, Vermont, Montana, and New Mexico have approved some forms. Catholic and Protestant theologians are opposed to such laws because such laws take dignity away from dying. The top Catholic in the United States, Cardinal Timothy Dolan, says, “The real death with dignity, the real heroes of death are those who die naturally. Assisted dying devalues human life.  It cheapens human life.”  Pain and suffering are usually not measurable, particularly if it’s someone else’s pain. There is this talk about redemption due to suffering. If you suffer through great pain, do you get a better address in Heaven or Hell? What a medieval idea. Shakespeare’s Hamlet said it best about the dilemma of life and death: “To be, or not to be—that is the question: whether ‘tis nobler in the mind to suffer the slings and arrows  of outrageous fortune or to take arms against a sea of troubles and by opposing end them….tis a consummation devoutly to be wished.”