Geriatric Case

Though leaves are many, the root is one;
Through all the lying days of my youth
I swayed my leaves and flowers in the sun;
Now I may wither into the truth.

-- William Butler Yeats, “The Coming of
Wisdom with Time”

Bioethicist Ezekiel Emanuel struck a nerve with his article in The Atlantic entitled “Why I Hope to Die at 75.” Many critics assumed that Emanuel hoped everyone would die at 75, even though he made clear he was speaking only for himself. Right-wingers saw his article as confirmation that architects of the Affordable Care Act like Emanuel did indeed favor rationing of health care and “death panels” for the elderly. But Emanuel merely pointed out the obvious, which is that a substantial portion of the population suffers significant mental and physical decline starting around age 75, if not before. Any fair reading of his article would show that he did not advocate euthanasia or physician-assisted suicide for those who lived past their sell-by date. “I won’t actively end my life,” Emanuel wrote. “But I won’t try to prolong it, either.”

At age 57, Emanuel clearly views himself as still being at the top of his game both mentally and physically, mentioning that he had recently climbed Mount Kilimanjaro with two nephews. I am a decade older and admit that I no longer take stairs two at a time, much less climb mountains. I am in reasonably good health overall and still work out regularly, but my knees are already well past their sell-by date. My mind continues to operate smoothly, although not always with the same quickness it once did, and I am occasionally subject to those vexing lapses of memory called “senior moments.”

As for how well I will be functioning in another decade -- assuming I am still around at all -- my parents’ example is not encouraging. My father’s health deteriorated rapidly after age 75. He suffered a serious heart attack, underwent quadruple by-pass surgery and also had diabetes. By the time he died of a stroke at age 80, he could barely get out of a chair. My mother fared better physically, but her mind was already misfiring by the time my father passed away. Eventually she was diagnosed with vascular dementia, which is caused by small strokes. It wasn’t just memory loss. She also suffered from spatial disorientation, and she could be flummoxed by small physical tasks, such as removing the cap from a pen or turning on a faucet. By the time she died at age 88, she was wholly incapable of taking care of herself.

Would my father have been better off if he had refused all medical care to prolong his life after age 75? Perhaps. But how about my father-in-law, a modern languages scholar and poet who needed a heart-valve operation at age 92 to prolong his life? The procedure was a high-risk proposition for a man his age. But he survived and lived for another 13 years, enjoying reasonably good mental and physical health for most of that time; indeed, he was still reading Dante’s Inferno and Montaigne’s Pensées in their original languages when he was over 100.

As a writer and photographer, I am as concerned as Emanuel about the waning of creative powers as we grow older, particularly given my family history. Having spent years in the insurance industry, I know actuarial tables count for something. But I also know that statistical averages apply to groups, not to individuals. My father-in-law was told he stood a 20% chance of dying on the operating table when he had his heart valve operation. No sane person would get on an airplane if there were a 20% chance it would crash – unless the alternative were certain death. Looked at another way, my father-in-law had an 80% chance of surviving the operation and living who-knows-how-many years beyond that. In the end, we must each make our own calculations on matters of life and death.

If you are used to being the smartest person in the room, it may take a while to discover that life goes on even when you can no longer count on sheer mental horsepower to carry the day. There are compensations for waning intellectual and creative powers. Wisdom, which comes with age, enables us to navigate the deeper channels of life without undue fuss or strain. We learn, among other things, when we have to row and when to allow the current to carry us where we need to go.

My father-in-law was forced to retire at age 70 from his position as a high-school language teacher and promptly launched a new career as a poet. He pursued it successfully for the next 30 years without giving a thought as to whether he was too old for the job. He published over 100 poems during that time, the last one appearing when he was 99.

Examples abound of individuals who ignored the actuarial tables and continued to work creatively into old age. In some cases the results equaled or exceeded anything they produced when they were younger. One shudders to think what might have been lost had Monet lain down his paintbrushes at age 75. His magnificent paintings of water lilies were produced after he had retired to his home in Giverny, when he was half-blind with cataracts. Goya, Matisse, Picasso, Liszt, Verdi and Casals were all artists who continued working at a high level in old age. The octogenarian Supreme Court justice Ruth Bader Ginsburg merely shrugs off questions about retirement, even though she has battled cancer. She is perhaps inspired by the example of Oliver Wendell Holmes, Jr., who served on the High Court until he was 90. Even the irrepressible Holmes made some concessions to age, however, when he spied an attractive woman on is 90th birthday and sighed, “Oh, to be 70 again!”

Ezekiel Emanuel acknowledges that one of his close collaborators continues to make major contributions to his field at age 90. However, he describes his collaborator is at “outlier” – a statistical term for the exception that proves the rule. Closer to the norm is his own father, who like mine suffered a heart attack in his late seventies and has been dragging around ever since. Emanuel points out that increases in life expectancy in the last half-century or so have mainly been achieved by stretching out old age – often by extending the period the elderly must live with chronic and debilitatling diseases.

So which will it be for me? Will I be happily out and about with my camera and tripod at age 80 or too sick to get out of my chair, as my father was? We can always take heart from the outliers, but is this merely whistling past the graveyard? Emanuel has statistics on his side, but I’m not sure it makes sense to take sides on this one. Age 75 is not as far over the horizon for me as it is for Emanuel. But I would prefer to wait. Wisdom would suggest this is not a time to row but to allow the current to carry me to my destination, whatever it may be.

“Why I Hope to Die at 75,” by Ezekiel J. Emanuel, The Atlantic, September 17, 2014
Nicholas Delbruno, Lastingness: The Art of Old Age

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