Archive for the ‘aging’ Category

Some Compensations

July 13, 2015

This is a nice piece from the Sunday New York Times about Alzheimers, written by a man whose mother is actually much more playful and fun than she ever was in her regular life.

“Nice piece about Alzheimers” may seem an improbable collection of words, but I was reminded of my own father, who died nine years ago. Please understand that it was an agonizing process to witness a brilliant man gradually lose all his faculties. There were some compensations, though. He said thank you, and showed genuine gratefulness, in a way that he had rarely done in his more competent years. A more tender and relational side came out. As his speech ran out, we had physical contact we had never known before: holding hands, touching, hugging. When I remember those years, I don’t recoil in horror. It’s bittersweet.

I think people generally are scared to death of Alzheimers, as though it’s the worst thing that could ever happen. It’s bad. I wouldn’t wish it on any family. But I’m sure it’s not the worst thing.

Self-Driving Cars

July 7, 2015

I feel a lot of interest in Google’s development of a self-driving car. The technology is certainly here, now. We could roll out a whole new regime of driving in five years, from what I can see. What hold us back are political and legal concerns. People are made very uneasy by something so new occupying such a central place in society. They are wary of large, heavy objects hurtling about without human guidance.

So my question is: what will push us past these concerns? What positive attractions will convince us to adopt this exhilarating, life-changing innovation?

There is the possibility of greatly alleviating traffic woes, as computer-driven cars need much less safety space between them. There is the prospect of much greater highway safety, as drunk drivers, distracted drivers, and poor drivers no longer put themselves and the rest of us at risk. There is the attraction of reading a book, playing a game, or watching a movie while you drive.

There is the ambition (of car companies) to sell millions of new, wonderful, expensive gadgets.

For my money, though, the force most likely to propel self-driving cars into orbit is my generation: aging baby boomers. Old people don’t drive as well. Old people ultimately don’t drive at all. They thus lose control of their lives: can’t shop, can’t go to the doctor, can’t go to a concert, can’t go to church. Somebody else has to drive them.

But with self driving cars, elders can remain independent much, much longer. When they (and their children) realize this, they will be hard to stop.

Being Mortal

April 1, 2015

I wish every doctor in the world would read Atul Gawande’s Being Mortal, because it speaks so eloquently—and practically, as well—to a fundamental change in the way we live. It’s a change we owe partly to modern medicine: we not only live longer but we die slowly. It used to be, Gawande says, that the majority of deaths came without much warning—heart attacks, sudden infections, strokes, or even the sudden onslaught of cancer for which medicine had no healing response. (TB was the one great exception.) Now our mortality tends to a long, slow decline.

Medicine tries to beat back this trend, fighting for life, but not paying much attention to what will make our lives worthwhile day by day. Because medicine is so dedicated to resisting death, it does a terrible job acknowledging its inevitability; and because it focuses more on disease than on the human beings who are diseased, it is quite capable of making our lives worse. Caught up in the dramatic imperatives of the medical system, people get lost and end up with miserable existences.

Gawande, a Harvard surgeon who writes for The New Yorker, tells the stories of many patients, including his own father, who had to negotiate this journey without much help from their doctors and sometimes with the doctors’ actual interference. He also introduces us to medical professionals who have thought long and hard about these matters, and gives us hope that a long, slow, miserable death is far from inevitable. Something can be done to make it better.

Gawande is attracted to the holes in medicine—not to modern miracle stories of bizarre diseases and heroic science, but to medicine’s blind spots and failings. He has written extraordinarily well about why medicine costs so much, and about why there are so many medical errors (and what can be done about it). But in writing about mortality, he has landed on a subject with deeper, more fundamental implications.

“The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had almost no view at all. Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet—and this is the painful paradox—we have decided that they should be the ones who largely define how we live in our waning days. For more than half a century now, we have treated the trials of sickness, aging and mortality as medical concerns. It’s been an experiment in social engineering, putting our fates in the hands of people valued more for their technical prowess than for their understanding of human needs.”

This social experiment has many sides, but perhaps the most pernicious is the loss of autonomy by the aging. Gawande quotes a colleague: “’We want autonomy for ourselves and safety for those we love.’ That remains the main problem and paradox for the frail. ‘Many of the things that we want for those we care about are things that we would adamantly oppose for ourselves because they would infringe upon our sense of self.’”

Gawande explores the institutions we have designed for the elderly and the chronically ill—nursing homes and assisted living facilities—and helps us see how, by eliminating autonomy in the name of safety and care, they often create an inhuman environment. He describes in detail how 911 and ICUs and heroic cancer-fighting tools may actually shorten life as well as make its end horrible and inhuman. But he does much more than identify the disease, he probes for a cure.

It is hard to imagine that Gawande is really a surgeon, given that he is so willing to admit his own failings as a doctor, his own ignorance of how to treat his desperately ill patients.

The result is a very moving book, one that often brought tears to my eyes. It also made me think long and hard about my own life and the lives of others, about the kinds of questions and responses I myself make to friends who are seriously ill or dying.

Looking backward, looking forward

March 13, 2015

Yesterday I celebrated my 65th birthday—the usual surprise, how could this have happened to me?—and this morning Popie and I listened to Pray As You Go for morning devotions. The Scripture was Jeremiah 7: 23-24, which (in the NRSV translation) says of Israel, “They did not obey or incline their ear, but, in the stubbornness of their evil will, they walked in their own counsels, and looked backward rather than forward.”

It was the “looking backward” that caught my ear. These days I am aware of the temptation to believe (as the Israelites tended to do) that the best is behind me; that the future is full of stresses and strains that may build my character but won’t amount to anything substantial. At 65 there is a tendency to look backward with nostalgia and forward with your guard up.

But that is not a view that God endorses. The stance of the Christian is always forward, learning from the past only in order to lean toward the future. And according to Jeremiah, there is a moral component to this.

To put a point on it, the 4-mile run from my front door, which I’ve been doing for at least 20 years, gets a little slower every year, no matter how hard I train.

But there is more to life than my body–and even that, I’m told, will be renewed.

The Case Against Assisted Suicide

February 4, 2015

We are once again experiencing a wave of heartfelt appeals for assisted suicide. Two reasons for it are usually cited. One is that a prolonged death is painful and horrifying; the other that a person’s individual autonomy includes the right to choose when to die.

Against the first reason stands hospice, which enlists both medical science and personal compassion to ensure that death is not painful or horrifying. Many people have awful ideas about the process of dying, but hospice is extraordinarily effective in alleviating suffering and indeed encouraging a sense of meaningful care. Nobody has to have a dreadful death. On the contrary, as many, many families who have relied on hospice can testify, my own included.

Take that fear away, and the argument is really about suicide. Is it an acceptable option? Should each individual choose whether to go on living at any moment?

One strong argument against assisted suicide is the “assisted” part. It is impossible to be sure that relatives, doctors or friends are not giving a sad and frightened person a little push; not just assisting but enabling. There exist many reasons why those closest to the concerned person may want to get on with it—financial reasons, emotional reasons. None of those should be reasons to end a life, but under what regime of safeguards can we be sure they are not in fact the true underlying motives? Older people are often obsessed with “not being a burden.” It might not take more than a slight suggestion, a mere tone of voice, to convince them that they would be less of a burden if they put an end to themselves.

But suppose you hedged in the act of assisted suicide with laws that made it unlikely for such suggestions to overwhelm a person’s choice. Then you have the question of suicide, period. Is there a right to suicide?

If you have had any involvement with someone who ended their life, you know the horrible ripping it does to the fabric of family and society. It is a terrible act of violence that does not affect just the one who ends their life; it changes everybody, forever. Of course it is most violent when done by the young, but who is to say it is benign when done by someone old or sick? This is not to blame the suicide—but it is to suggest that we ought never to encourage self-inflicted death, and always to put as many barriers in the way as we can, at any age and in any condition. In this we are voting not just for the life of the potential suicide, but for the life of the community he or she will leave behind in the wake of choice.

Ultimately, we face a fundamental clash of values in assisted suicide. Do we love life, all of life? Or do we love autonomy more? Life is what comes to us: we open our eyes on it each day, not knowing what great or awful things it will hold. We do not choose life, only how to respond to it. Autonomy, when held as the highest value, asserts that life is material for us to mold, or not to mold. We can turn off the game any time we like. In the final analysis, the choice of values is about God. Who rules? Someone or Something who gives life, and to whom we owe a response? Or Me, the Maker and Destroyer of Worlds?

People will commit suicide, with or without the assistance of others. We cannot help that, and they are our fellow human beings, to be treated with compassion.  I would never, however, pave the path for their self-inflicted death.

New Birth

January 14, 2015

The week after Christmas I got to hold my newborn grandson, Micah. He was less than a week old when I met him, and at that age babies don’t make eye contact. Yet Micah seemed to be looking around in every direction, trying to make sense of what he saw and heard and felt. After all, it was all new. Until a few days before he had never taken a breath, swallowed a mouthful of milk, seen a color or felt cold air on his skin. He had emerged from utter darkness to discover the pain and the joy of our world—and to begin to try to sort out what was going on. Good luck, Micah.

I was still swimming in the backwash of that reality when I had dinner with an old friend, Ginger. Something like a year ago she fell from a horse and smashed her head, fell into a coma, and very nearly died. This was the first time I had seen her since. She has recovered quite astonishingly, but—as she described it to me—she is still fearfully exploring her world, learning so many things that she once knew. Carrying on a dinner conversation, for example, has an element of novelty tinged with dangerous uncertainty. She cannot remember anything about her accident or the days that followed. She has, like Micah, the sensation of emerging from darkness, except she is discovering a world that she once knew.

How poorly I notice this amazing thing called life, at least compared to Ginger, who is finding out the fine points of daily living like a skater testing the ice. And though none of us remembers what Micah, and every baby, is experiencing, we all did once, and I suppose nothing we have experienced since has been so dramatic.

All of us will, I understand, one day enter a new world, where elements we remember (dimly?) have been transformed. I attended a funeral yesterday in which one of the relatives said that her mother, just that week, had looked forward to running again. She said it was difficult to imagine her 90-year-old mother running, but she had a photograph of her running down a Dutch sand dune as a child. That was what her mother imagined for herself.

Like Micah, like Ginger, we may be surprised and challenged as we emerge from darkness.

The Beginning of the End of the Beginning

December 2, 2014

The latest Atlantic Monthly has a cover story by Jonathan Rauch regarding midlife crises. He describes his own mid-40s time of frustration, and sums up the experience this way:

“Long ago, when I was 30 and he was 66, the late Donald Richie, the greatest writer I have known, told me: ‘Midlife crisis begins sometime in your 40s, when you look at your life and think, Is this all? And it ends about 10 years later, when you look at your life again and think, Actually, this is pretty good.’ In my 50s, thinking back, his words strike me as exactly right. To no one’s surprise as much as my own, I have begun to feel again the sense of adventure that I recall from my 20s and 30s. I wake up thinking about the day ahead rather than the five decades past. Gratitude has returned.”

That’s about right, at least for me. But life in my sixties has brought other realities.

In my fifties, a big recognition began that life has a definite horizon. That means that when you make a career choice, it might well be your last one. Is this my last book? Moving to a new place, or even redecorating the kitchen, bears something of that finality. The horizon is not endless. I cannot see exactly where it lies, but I know it is there, that I will reach it, that it is not an eternity distant as it seemed to be when I was young. This makes me more serious and reflective. I want to live my life well; it is my last chance.

What I’m discovering in my sixties is a very distinctive sense of—well, call it serenity. I have less drive, and a lot less ambition. I don’t care as much. I’m less easily distressed. I’m better able to wait on things: whether family issues, or lines in the grocery store. I’m more content to watch other people lead the way, even when I think they are mucking it up.

The flip side of this coin is a pervasive sense of loss. None of my closest friends is yet gone, but my parents (and Popie’s) are, along with most of their generation, some of whom I knew well. Some of my peers have died, and it’s quite clear that this is a trend.

I’m in good health, but I can’t help noticing physical loss. I don’t like to hike as far, I run more slowly, I wake up stiff or sore just from cooking dinner. In every way, I’m less physically vital—and this, too, is a trend.

This adds up to an internal sense of loss. In some ways, it’s just that I miss the drive I once had. I miss caring about my future. I miss ambition.

I live with an awareness that life is slowly leaking out of me.

So, I live with my internal thermostat set at 62. It’s a little cold, but it’s not so uncomfortable I want to get up and change it. I can pull a blanket up. I’m happy enough with my book. This can look and feel like serenity. Or, it can look and feel like mild depression.

And this, too, is surely a trend.

What am I to do with this reality? It’s not something I expect to rise above. It’s rather something I hope to inhabit in the best way possible. I’m still exploring what that means. I think some of these are involved:

–learning to number my days, so that I don’t let them flood past without noticing or appreciating.

–learning to pray.

–learning to love.

I value your thoughts.

Comfort

October 23, 2014

Our small group has been studying the Heidelberg Catechism, using a book called Body and Soul by Craig Barnes. The first question alone makes the catechism worthwhile.

Q: What is your only comfort in life and in death?

A: That I am not my own, but belong—body and soul, in life and in death—to my faithful Savior, Jesus Christ.

Barnes says that our culture is dedicated to the myth of the right choices. This is the underlying narrative in nearly every graduation speech, and in much child-rearing, and in most how-to books. Make the right choices—of school, spouse, career, friends, clothes, make-up—and you will be happy. This emphasis on choice makes us very anxious people—since, of course, we cannot know what the right choices are in most cases, and even when we make the best choices we often remain quite unhappy.

By contrast, the comfort of the gospel is “the discovery that our lives do not belong to us.” (p. 29) This startling and counter-intuitive assertion is the basis for everything that follows.

I find it interesting that the catechism, written nearly 500 years ago (by a 28-year-old pastor), begins with comfort—and comfort in the first-person singular. While much of faith (and the catechism) deals with communities of people, comfort is always singular. This is what we want to know: what comforts me, in life and in death?

The answer, that I belong to someone else, someone great and faithful, speaks to me very deeply.

This comfort applies to both body and soul. It is not a purely spiritual comfort. It encompasses sickness and mental illness and Alzheimers and much else. Nor is it a purely material comfort—it reaches far beyond the promises of prosperity.

The promise of belonging extends to both life and death—that great unmentionable fact. Among other things, this explains why Christians are so dubious about assisted suicide. Assisted suicide is wrapped up in the ideology of better living (and dying) through choice. It breeds the belief that comfort comes through making the right choice as to when one should die. But the catechism claims that the only comfort comes through belonging—and that your death, as your life, belongs to Jesus Christ. This does not imply in any way that we should preserve life at all costs. It merely means that our ideology of choice is undermined, that a deeper reflection will seek to affirm whom we belong to, rather than what our plans should be. If we have paid attention to life at all, we know that our plans prove to be highly fallible. And that is particularly true for our plans about death. There above all we are out of our area of competence. That we belong to Jesus is our only comfort.

Death and Disappearance

August 16, 2014

A friend of mine, Steve Morris, disappeared last week. He was in the Trinity Alps on my church’s annual men’s backpacking trip . On Saturday he and a few other men took a day hike to a nearby peak. On the way down, Steve got separated from the others. He never came into camp. Search parties have been looking ever since, using dogs, helicopters, GPS mapping. They scoured the area, which is not that large and not that rugged. (I’ve hiked there.) They found not a trace. Nothing. Not a footprint, not a water bottle, not a trail for dogs to follow. The sheriff called off the search this week, there being nowhere left to search.

It’s extremely unnerving. Steve is an experienced backpacker. He wasn’t despondent or depressed. Where has he gone? Why can’t they find some sign? Where is his body? Death itself is devastating to family and friends. Disappearance is worse. Earlier this year I read Rick Atkinson’s three-volume history of the western theater in WWII. He mentions how difficult it was for family and loved ones to deal with soldiers who went down in a ship or were shot down out of the air–who went missing. Family longed for some tangible proof of death, or at least a grave where they could mourn. Steve’s disappearance is worse by a factor of ten. No one saw him go. No one can say how he left.

I’m not sure I understand why disappearance is so upsetting, but I think it’s probably related to the insult that death poses in all its forms. It’s not just adolescents who expect to live forever. We all do. It’s really impossible to imagine that we will cease to be. Me! A known fact! My death seems as impossible as the moon blinking out one night.

At least when we see the body there’s some story of continuity we can tell ourselves. But it’s not a very convincing story. One moment, personality in full flower. The next, nothing but meat and bone. You are gone. That’s the aching surprise that greets anyone who watches a loved one die. They really are gone. That body left behind is not them, not much. It reminds you of them. But in reminding you, it reinforces the reality: they are no longer here, and you do not know where they have gone.

Is it easier to lose Robin Williams because we can still watch his funniest moments again and again on video? I don’t think so. I think it makes it harder. They remind us of him. They remind us that he will never again walk into a room.

Steve’s disappearance makes us feel this in a different, more bewildering way. We have nothing to mourn over, no focal point for our desolation. Truthfully, though, we never really do. Death obliterates all that in an instant. There is life, then there is no life. If you cannot believe in resurrection life, you are left with no reason to get up in the morning.

The Forgotten Child

July 16, 2014

Last week, when we were visiting the Eastern Sierra, we spent the night at Sawmill Campground not far from Tioga Pass. It’s a walk-in campground in a lovely little valley where I camped with my family as a child.

When I visit Fresno, the town where I grew up, a lot has changed. In fact, some years ago I tried to show my children the high school I attended, and I couldn’t find it. Some of that has to do with my memory, of course, but it’s also that the familiar markers have disappeared.

But at Sawmill, hardly anything has changed. The campground is better developed (picnic tables no less) and the road access is gone. (I remember the car bottoming out as we scraped and jolted our way to a spot flat enough to thrown down our massive canvas tent.) But the valley is identical. The view of Mt. Dana that I cherished as a child has not changed an iota. I’m not sure they have even changed the mosquitoes.

I found, wandering and rediscovering the trails I followed as a child, an almost magical reawakening of memory. I was again that child, enchanted by the snow-patched ridges. Such is the joy of landscapes that do not change, but welcome like an old friend. The mountains bypass time–or seem to, for us changeful creatures. And so, for a brief sojourn, I catch a glimpse of my soul, which does not age like the rest of me but remains, at some depth, at least half a child.