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Our Obsession with Longevity is Making our Lives Miserable

Illustration for article titled Our Obsession with Longevity is Making our Lives Miserable

You have to force yourself to get through "A Life Worth Ending" by New York's Michael Wolff, and not because it's a bad piece. It's beautifully written and evocative — it's just that it's almost too evocative for anyone who has ever watched a loved one die slowly from illness. But it's a reality check, and it's a must-read about how our obsession with living longer is actually making life harder to live for us all:

Age is one of the great modern adventures, a technological marvel-we're given several more youthful-ish decades if we take care of ourselves. Almost nobody, at least openly, sees this for its ultimate, dismaying, unintended consequence: By promoting longevity and technologically inhibiting death, we have created a new biological status held by an ever-growing part of the nation, a no-exit state that persists longer and longer, one that is nearly as remote from life as death, but which, unlike death, requires vast service, indentured servitude really, and resources.

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Throughout the piece, Wolff drops some horrifying statistics, such as: In 1990, there were more than 3 million Americans over the age of 85, but ow there are almost 6 million. By 2050 there will be 19 million, which is approaching 5 percent of the population. The elderly currently use 50 percent of all hospital days.

And on the subject of dementia, which his mother suffers from: There are now more than 5 million demented Americans. By 2050, upward of 15 million of us will, quite simply, "have lost our minds." This year, the costs of dementia care will be $200 billion, and by 2050, it will be $1 trillion.

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Yet, it's not too trite to say that the financial costs can pale in comparison to the emotional price of watching your parents take years to fade away. In many cases, if it were up to them, they wouldn't want to go like that. But what happens when they're incapable of making that decision for themselves, and medics and family members alike find it impossible to discuss the elephant in the room — death — when there are so many options that help us stay alive? Wolff's mother lives in what he describes as a "pre-coffin," attended 24/7 by two daily shifts of caregivers. "And yet, I will tell you, what I feel most intensely when I sit by my mother's bed is a crushing sense of guilt for keeping her alive," Wolff writes. "Who can accept such suffering — who can so conscientiously facilitate it?"

Wolff concludes by saying that death panels might not be so bad after all — perhaps they should be called "deliverance panels":

The alternative is nuts: to look forward to paying trillions and to bankrupting the nation as well as our souls as we endure the suffering of our parents and our inability to help them get where they're going. The single greatest pressure on health care is the disproportionate resources devoted to the elderly, to not just the old, but to the old old, and yet no one says what all old children of old parents know: This is not just wrongheaded but steals the life from everyone involved.

It doesn't have to be that way. Last weekend, my best friend's grandmother died, at home, surrounded by her family, after a few months of bedridden illness. To celebrate her life — and her fairytale-like house in an idyllic hillside area of Northern California, which served as a home base for all of her relatives over the decades — my friend and her cousins had a "last party" and played cornhole, found old bathing suits and went swimming, sang songs, and danced under the eclipse. "She was the ultimate hostess, so everything had to be just so, knowing that she would approve," my friend told me, who also cooked her favorite foods to celebrate her memory.

I have no idea how I'll deal as my parents age — it's hard to even type those words, to be honest — but stories like my friend's, and Wolff's, remind us that there's an alternative. "My bet is that, even in America, even as screwed up as our health care is, we baby-boomers watching our parents' long and agonizing deaths won't do this to ourselves," he writes. "We will surely, we must surely, find a better, cheaper, quicker, kinder way out." Let's hope so.

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A Life Worth Ending [NY Mag]

Image via Oleg Golovnev/Shutterstock.

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thegatekeeper
TheGateKeeper

Thank you, thank you Jezebel for posting this. This has made my night as jaded nurse who is exposed to unnecessary suffering like this every time I go to work. Forgive the length of this post, but it is an issue that I'm very passionate about.

Ever since I started working as a nurse 2 years ago, this is an issue that haunts me daily, gives me nightmares, makes me question wanting to continue being a nurse as well as forcing me to ponder my role in health care as it stands.

I currently work in a busy cardiothoracic intensive care unit at a large, university hospital. I take care of people who have received all different types of open heart surgeries, heart/lung transplants as well as cardiac assist devices for people who either don't qualify for or are waiting for heart transplants.

As a large, "prestigious" university medical center, our cardiothoracic surgeons will often operate on patients who have been told by other surgeons that they are too "high risk" for any number of reasons (existing lung disease, end stage kidney disease, extreme old age, etc..) Sometimes, these people end up just fine; I love these days when I get to watch people recover and send them to a step-down unit: it almost makes it all worth it. However, more often than not, these patients, especially the very elderly, die in horrible circumstances because the doctors or the family are not willing to admit defeat to death.

Sitting in the conference room at 7 p.m., all of us nurses tsk when we hear of patients older than 78 undergoing major surgeries....we all know what the likely outcome is...

I've watched men and women who should be at home with their families, enjoying their last years in dignity, enrolled in palliative care and hospice die, slow, miserable deaths...

The picture attached is from a Google search, not my hospital, but it could be.

First, they cannot be taken off of the ventilator because their lungs aren't strong enough and their hearts aren't recovering the way they should after surgey. Likely they came in with pre-existing kidney disease and it's only made worse with the medications we give them to perform the surgeries. After a few days of not getting off the ventilator, we insert tubes in their noses/mouths in order to feed them liquid food. After a week of not getting off the ventilator, they will get a tracheostomy (a hole cut in their throat with a special piece inserted) so they can continue to breathe on the ventilator and get a tube inserted into their stomach/intestine so they can continue to get nutrition. Their bodies are not healing properly and their immune systems are compromised, so it's very likely that they will get infected. They often are too weak or unstable to get out of bed. They are often on multiple, incredibly potent IV medications to keep their blood pressure at the bare minimum. They lose weight, and even with the best pressure point relief, they will get sores on their bottoms or backs. Their muscles atrophy and they start losing control of their bowels, so we stick tubes in there in order to help keep them from sitting in puddles of their own excrement. They have catheters in their bladder so we can watch as their urine amount gets smaller and smaller as their kidneys fail. The rest of the body starts to shut down, they are pumped with antibiotics to make the infection better, but this causes other body systems to fail, especially kidneys. Their hearts may start making bad rhythms as toxins that can't be filtered out slowly poison them. They may start to get delirious because they aren't sleeping much, the medications given and toxic by-product buildup. If the family says "full speed ahead," they will be put on a machine that will replace their kidneys and get a gigantic IV catheter put into their chest to do this. Eventually, their bodies will fail so badly that they start to seize, and or go into cardiac or respiratory arrest.

One of these elderly "chronics" who can't talk because of the hole in his throat, is trying to tell me something. I'm bad at reading lips and miming, so I bring him a white board to write on. At first I think he writes "poop," he shakes his head erases it and tries again with his weak, shaky writing. "Food," he writes. I look at him sadly and explain that he's getting liquid food through the tube in his stomach/intestine and that he can't swallow anything because he would choke. He looks at me with the utmost despair in his eyes, closes his eyes and nods sadly. If he wasn't so dehydrated from the diuretics he's getting to keep his lungs from drowning him, he probably would have shed tears. These are the days I go home defeated. I ask him, "this isn't what you thought it would be, is it?" His eyes go wide and shakes his head no. I then asked him if he has given up and doesn't want to do this anymore and he nodded yes. As a nurse, I cannot order a palliative care consult without the surgeon's approval..more often than not, the surgeon will say no.

I just wish people could understand from a nurse's perspective, 8 inches away as we watch these people die in pain and there's little we can do. These patients will often rack up medical bills in the MILLIONS of dollars only to die on the verge of FINALLY going to hospice.

While I went into nursing school with the idealistic goal of helping to alleviate all patients' suffering and being a crusader for patient rights, I feel as though I'm failing miserably. And now when asked why I became a nurse, I say "somebody had to, didn't they?" Nursing is not what I thought it would be...I feel so far away from my Florence Nightingale ambitions.

Just because we can do these "amazing life prolonging treatments", should we?

I feel a new zeal to get our policy about palliative care consults changed and promote hospice... it's the only thing I can do in the memory of those who died without justice, without their fragile voices being heard...