The End

maryBy Attorney Mary B. McKee

I tried not to write about this.  I kept starting and stopping and skirting the issue.  But Events have conspired against me and now I want to just get it over with.

My dear father died last November.  Quickly (thankfully), but not suddenly (thankfully).  My mother-in-law, almost twice as old as I am, just died on the Fourth of July.  Slowly—too slowly, if you ask me (or her, for that matter)—but not in pain.  My cousin has declined dialysis and is winding down.  I was about 11 when she took me to Little Sister weekend at Kent State University in 1971, and now, treating me like a big girl again, she wants me to say a few words at her funeral.  Age 60 seems young to me, especially compared to 79 and 97, but she’s lived a good, full life.

Time magazine’s recent cover story “How to Die” stared me down, flanked by The Last Word column at the back of my favorite magazine, The Week, titled “The Ending No One Wants,” which quotes Philip Roth’s Everyman:  “Old age isn’t a battle.  It’s a massacre.”

I give up, I’m surrounded.  So here goes.

Who knows, by the time the Baby Boom boomerangs, as we all must one day, the sheer number of aging, dying people pelting the next generation may overwhelm them.  Maybe the Hep-lock Society will merge with the Hemlock Society, and You-Tube will become Eu-Tube, where well-wishers can upload eulogies for their subjects to enjoy in advance.  The Facebook generation will gather up a lifetime of virtual Post-Its for each other’s online obituaries, celebrity roasts will take on a whole new meaning, and MySpace will be resurrected as cyberspace cemetery plots or the geographical coordinates of the point from which you’d like your cremains to be scattered.   Maybe by then there will be a special ride for us at Cedar Point, but you only get to go around once.

We can’t demystify death itself, I know.  It will likely always be considered sacred, or profane.  But I’m beginning to think we ought to bring the earth-bound, mundane part of dying into the realm of the necessary, if not comfortable, range of conversation.  To actually talk about what it means to promise someone you’ll deprive them of food and water on purpose, out of love, one day if that’s all you can do to speed up the inevitable.  Yeah, that’s what “nutrition and hydration” means.

Sometimes I think of hospice workers as midwives, ushering souls out of our world instead of into it.  So if vaginal birth is the “natural” way (yes, it hurts, and no, there is no “birth with dignity,” either).  And dying in your sleep of old age is to die of “natural causes” (think James Garner and Gena Rowlands curled together in their nursing home bed at the end of The Notebook).   Then what about those of us who aren’t so lucky to arrive or leave that way? Without getting into a whole bioethics debate and whether old Hippocrates could have imagined the extent to which “do no harm” could now prolong suffering—I mean, medical professionals help hasten blessed events all the time on the front end….

I can’t tell you how many times I’ve thought to myself, and occasionally uttered out loud:  “We don’t even put our pets through this.”  There are no guarantees, I know, but that vet scene from Marley & Me, be honest, it wouldn’t be so bad to be put down like that, would it?

Please, I am not trying to offend anyone’s sensibilities or startle anyone with what I’m sure some will find to be unduly gruesome musings.  I am not talking about urging anyone to go against their religion, or to start down that slippery slope between real-life death panels and an elder’s real or imagined duty to die to preserve wealth or ration healthcare, I’m not talking about playing God or involuntary anything.

I’m talking about Don Marquis’s Lesson of the Moth.  You know, the poem in which archy the cockroach converses with the moth who keeps ramming into the lightbulb.  “Have you no sense.”  “Plenty of it.”  I’m talking about the possibility that some of us, maybe in droves, could one day make a rational, not unnatural, deliberate decision not just to decline extraordinary measures and refuse ordinary treatment, but to actively check out.  Before “our time.”  As if we could not be still alive after “our time.”  (What is it now, 30% of Medicare dollars are spent in the last year of life.)  And whether we are bound to have our last act be one of nonviolent, civil disobedience.  (Unless, at the crucial moment, we happen to live in one of the more progressive, enlightened states or countries where you don’t have to wing it alone or bank on a bunch of well-intentioned amateurs.  So far, the majority, like Dylan Thomas, do not intend to go gentle into that good night, and in most states, the Golden Rule is a crime.)

There was a stretch there when I would climb up on the top bunk and hold my daughter’s hand, talk about the events of the day, maybe sing a little song.  She would grow still and quiet, and then say, “Don’t tell me when you’re gone,” and fall asleep.  I like the idea of me on my death-bed, us holding hands again.  I wonder who would say it first:  “Don’t tell me when you’re gone.”

Thinking back, I was with them all within hours of their death.  My father-in-law some years ago at a hospital, this past year with my own father at home, my mother-in-law just a few weeks ago at the nursing home.  (Was that the Assisted Living or Assisted Dying facility where she resided —was she transferred to the Life Care or the Health Care wing – When I get there, will the sign say Welcome to the Death Care Unit instead?  I am not being a smart-aleck—the hospice folks were wonderful.  It was their third stint with her.)  Saying Hail Marys out loud for them all when they couldn’t talk.  Now and at the hour of our death, Amen.  Row row row your boat, gently down the stream.  Merrily, merrily, merrily, merrily.  Life is but a dream.  Look, there’s Charon, rocking there on the river Lethe, or was it Styx.  Anything, just keep talking and don’t tell me when you’re gone.  And “Into the arms of Morpheus” for the last time.  Death Be Not Proud, John Donne rallied believers.  Whether St. Peter was there at the Pearly Gates to meet them will have to remain another family secret.

We respect and admire and support people who say to themselves, “I don’t want to live this way anymore,” and then undergo some radical change:  stop eating or drinking or snorting or shopping so much.  Re-habili-tation. Why would we not likewise respect and admire and support someone who can convince us that they are over it, over life itself, such as it is or has become for them, and are ready to undergo the most radical change of all?  Because we are in the habit of living.  We keep moving long after there’s nowhere to get to, we keep eating long after everything tastes like sawdust and there’s no point.  Ensure?  Ensure what?  More of the same.  “What is long life but a nightmare of endless repetition.”  That’s Gore Vidal.  Sound like anyone you know?  (It’s worth talking about with the people you care about, even if they are one of the whopping 27% who have an advance directive.  Someone you think you know might surprise you:  “Not me.  As long as there’s another book to read or music to listen to, I want to stick around.  There’s always more to learn.”)

Yes, determining whether one 82-year-old person is more depressed than the next could be elusive, but families sense and professionals treat depressed, anxious teenagers every day.  The first 20 years are rough for most of us, as, I imagine, are the last 20.  Only difference is that we all know precisely which are the first couple of decades.  I’m not saying it won’t be hard to protect outliers, just that it may well be worthwhile to admit the existence of a healthy, typically developing, mainstream norm in the meantime.  And that they, at say 82, could be “suicidal” in a non-pathological way.

For instance, I had no idea that there are helium-hoods and peaceful pills and self-deliverance methods.  Thelma & Louise meet Dr. Kevorkian.  It’s true:  (Unless it’s all made up to trap the unwary, like the endangered tree octopus, but I don’t think so.)

Unendurable pain, youth, intellectual disabilities, comas, currently incurable diseases—all these are beyond the scope of what I’m trying to get at here.  If that’s your situation, I thought Never Change by Elizabeth Berg got at the nub of things.  And the last episode of House, where “Everybody Dies.”

No, I am more focused on just plain old getting just plain old.  As my law partner pointed out with grace and aplomb: “Something’s going to get you eventually.”  For some of us, it’s that bus called old age, headed for the terminal by one route or another.  You either get on (and fall asleep, never really missing your stop), or you get hit and it’s all over, or you get caught in the folding doors and dragged along.

So far, I have been spared.  No one I love has been hurting or dwindling for weeks on end.  No one I feel responsible for has begged me to help them let go of life as we know it.  I used to joke about cornering someone who would care enough about me to smother me with the nearest pillow when the time came.  I can’t talk that way anymore. I look back at one of my blogs last year about old age and death, before all this, and I seem too flip.  The topic is really quite grave.  But seriously, just for a moment.  Everything changes when somebody close dies, doesn’t it. I am grateful I have not yet been tested in that particular way, because I don’t know if I would be strong enough, or smart enough, to pull it off.  What I need to grapple with in the coming years is how to plan ahead so if I myself ever have to resort to calling it quits and need physical help or emotional shoring up from another human being, they’ll be able to pull out all my writings and say, see, it’s not the drugs or the morbid depression talking.  She’s always thought this way.  C’mon, let’s help her wrap it up.  Or maybe our advance directives will have more check-boxes by then and pieces like this will be considered quaint artifacts.

From Shakespeare’s As You Like It, you know, the bit about how “All the world’s a stage,” laying out the seven ages of man:

Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans everything.

So straighten up and take a deep breath now with your good strong body.  Read with your good strong eyes the words I’ve written.  On purpose.  Right now.  Just because you still can.

I did, and then took a walk to clear my head and saw this license plate on a black Audi in the parking lot:  LYTNUP.  Uh-oh.  The Universe is speaking to me again.  I better listen.  With my good strong ears.

Posted in Articles, Articles: Elders and Their Caregivers.