Being Mortal

I am not by nature a big picture/policy king of guy. I get quite enough satisfaction reading the law and trying my best to get the details right. When clients complain to me about the unfairness of this or that law, I seldom have anything to say about it. "Write your congressman," I suggest. "As your lawyer I deal with the way the law works today in the county where you live."

On the other hand, I do try to stay current on new popular literature that deals with aging and end of life issues. Most of the new books dealing with aging and death are not that great. One of the exceptions is, Atul Gawande's, Being Mortal. The book contains the author's reflections as both a doctor and a son on the ways in which we die and the ways we have been doing it wrong.

In certain respects, Being Mortal, reiterates the themes addressed in Sherwin Nuland's, How We Die. Nuland's book is a masterpiece and deserves the Pulitizer it received. I enjoyed How We Die immensely, but I like Being Mortal even better.

Gawande's reflections on death and dying are less technical than  Nuland's. Missing are the detailed biological mechanisms by which the major causes of death take us out. In its place are many wise and nuanced observations about the decisions the dying and their families face. Two of the things he discussed were of particular interest to me.

First, he talks about the change in values that appears as we get old. We become less competitive, less acquisitive, and more attached to family. In my gerontology classes this was explained as a developmental stage of adult development, but that is not really an explanation. Gawande reports studies showing that everyone's values--expressed as life goals--change when the time is short. Young people, for whom the future seems like an eternity stretching before them, would rather meet new people than spend time with family and old friends. Old people, who know that their time on this earth will not be long, opt for time with family. However, when young people are told that the end is near--their lives will soon be completely disrupted--they do opt for the family and friends. The change in values is a matter of perspective. Making a career and saving for old age is no longer a value when old age is already upon you.

Second, Gawande finally made clear to me how hospice works. It is not a substitute for treatment. When I go to the hospital I give up my quality of life temporarily so that I will have a great quality of life when I get out. The short term stint of bad quality life is made worth it by the amount of good quality life I will have thereafter. As we age, however, and our bodies begin to fail, the stints of bad quality life in the hospital become longer and the times of good quality life thereafter become shorter and more unsure. The tragedy it the person gives up everything in hope  of a full and active life once he or she is out of the hospital only to die in the hospital bed after months of being kept alive by experts and machines.

Hospice is the choice to have quality of life today. He points out that with some fatal disease people on the average live longer in hospice than they do in the hospital. It is not so much that they are killed by the cure, but rather that quality of life gives them a reason to live. And that, maybe is Gwande's point. Doctors, nurses and social workers need to play a role in giving their patients a reason to live, for without that all the high tech medical procedures will be of no avail.

The book is thoughtful, intelligent and and often poignant. I recommend it to anybody who is mortal.

I was meant to be old

(What follows are my personal observations on being old, first published on my Salon Blog)

I am fifty-nine years of age, and I consider that old. I think that I am better at being old than I was at being any other age.

A friend of mine is sixty-eight. She is eagerly anticipating her fifty-year high school reunion. I can't understand it. I don't have anything against high school reunions. I didn't have unpleasant experiences in high school, but to me high school was just one of the many schools I went to on the path to getting old. I don't think much about high school or any of the schools I went to, and I have no great desire to revisit them.

Different people, I think, are better at different developmental stages. I was not good at being a child. I can't remember much of it, but I know there wasn't a lot about it I liked. Children are small, undisciplined, and uneducated. That is not a formula for happiness. I remember the sense of insecurity that came from knowing any adult with the inclination to do so could beat me up. I couldn't drive or vote or smoke. I found other children as helpless and hapless as I was, and adults were only condescendingly interested in what I had to say. On television children are either carefree and happy or victims. I was neither. To the best of my recollection, I was bored and ignored. If there are great pleasures in childhood, I didn't find them.

When I see children today I feel sorry for them. I think it is one of the worst times of a life--so stressful that many children can be driven to sobs several times in a day. When I have a chance to talk to children I assure them that things will get better. They seem to appreciate that.

I was not good at being a teenager either. I was physically larger by then, and eventually I could drive and smoke (not vote), but adults still didn't pay me much mind. As a teen I found my peers interesting, and that was a comfort. I got through my teen years mostly by not attracting undue attention. It was a time of hormone-driven confusion about what one was supposed to do in this thing called life. Some people I know were good a being teenagers. The prom queens, football stars, and class presidents among my friends can remember those years with a clarity and detail that I find somewhat frightening. I gladly exited my teen years and don't give them a lot of thought.

In my twenties I could finally vote and grow a beard, but I wasn't much better at young adulthood than I had been at being a teenager. Those were college days. Some of my friends blossomed; others fell by the wayside. I think athletes and scholars are happiest in this stage of life. I am not an athlete or a scholar. I managed to get through college and then law school. These schools did not seem to me much different from high school. I learned what I had to learn, but I don't remember my teachers' names, and I didn't develop long term friendships. I don't go to those class reunions either.

Middle age is a time for careers, mortgages, raising children, and productivity. I shaved the beard and quit smoking. I competed in the market place, but the house and the kids and the competitiveness that surrounds earning money hung on me like a another man's suit. Some of my friends thrived in middle age. I had bouts of contentment, but they were few and far between. For me middle age was better than what had proceeded it, but not a lot better.

And then I got old. I became old when I turned fifty. The beginning of physical and cognitive decay was a great relief to me. I could finally relax. I pared down the material goods that I had accumulated in middle age. I continued to earn, but ceased to believe that what I did was particularly important or that I had to excel at it. I never felt a close connection with other children, other teens, other young adults, or people in middle age, but I liked other old people. I wonder if I was born old, and had to get through all that other stuff to become who I was meant to be.

I like the accoutrement of being old. I like tweed jackets with leather patches on the elbows, slip-on shoes, all-cotton dress shirts (with medium starch) and silk ties. These things feel more natural than did the denim jeans, the Nikes, and the leather jackets of my younger years. I like my compact home with no yard to mow and no noisy children to quiet. I don't go to school any more or think that I ought to. I don't know how the country should be run and don't argue with people who do. The annoyances of life are less annoying now that I am old. I am seldom busy or in a hurry. I can finally read Proust.  

I don't claim that being old is better than the other stages of human life. That would be a middle-age thing to do. I think that people find their places in the world at different times. It wasn't my turn until I got old.

There are drawbacks to being good at being old. The big one is that you have to wait five decades for your time to shine. Another is that your ability to enjoy it is constantly infringed by a decaying body. My reunion-attending friend protests that we old people are boring, and she never wanted to grow up. Old age may not be the best time to become good at life, but it is better to be good at being old than to be old and be good at something else.

I was sitting on the deck of my mountain cabin a while back talking to my father. He is now in his eighties. He is old-old, as the gerontologists say. I can't say how I will do at that stage of life, if I make it, but I am not afraid of it. My father looked at me and at the cabin and, remembering all the drama in my younger years, he said, "I think this is the best part of your life right now." He was right.  Being old becomes me.