I am not suicidal. But at 67, I think about dying a lot more than I did ten years ago. What I think about the most is how I'm going to cross that last threshhold. I've even checked out my "healthy life expectancy" using Mortality Tables relied on by insurance companies and the federal government. "Healthy life expectancy " is the number of years a person might expect to live free of serious illness or disability. For me, when your healthy life expectancy runs out, it's good to know what you're going to do next. You need to have a plan.
I'm not crazy. Just determined I'm not going to float around in a nether world somewhere below the surface of being the conscious, mobile and thinking person I am. I do not want to morph into a drooling, unmanageable caricature of myself in a diaper. Nor do I want to rot away, festooned with tubes and monitor lines running in and out of my body, as I lie in bed praying to die. The following story led me to seriously consider my "check out time."
Last July, Sir Edward Downes, 85, and his 74-year old wife Joan traveled from Britain to Zurich, Switzerland. Their fifty-four year marriage has been described as "an enduring love story". He was the principal conductor of the BBC Philharmonic for over fifty years. She was a former ballet dancer and choreographer who, in her later years, chose to become her husband's personal assistant.
Lady Downes was suffering from terminal cancer of the liver and pancreas. Sir Edward, although not ill, was nearly blind and deaf. In Zurich they entered a clinic where, after drinking a cocktail laced with barbituates, they laid down side by side and while holding hands, fell alseep. Minutes later they died peacefully.
What led to their mutual deaths wasn't so much the fact that Sir Edward wouldn't have been able to care for himself without Lady Downes, but that he didn't care to live without her. Friends said,"They were inseparable." And, "It was a real love match."
The assisted suicide of the Downeses intensified the heated debate about the morality of suicide and whether we have the right to end our lives as we choose, particularly at that time when age, infirmity or illness carries us beyond meaningful life and leaves us in Death's waiting room.
Do we have the Right to Die, to decide while still mentally competent, that we are through with being held captive to sickness and pain? Shouldn't we be able, when virtually blind and deaf, to declare that for us, life is no longer worth living? Doesn't a time come when we are so diminished by age or illness that society loses dominion over us and we are free to do with ourselves as we please? Who, other than each of us, should have the right to decide when, where and how we shall die?
It is foolish and irresponsible to avoid thinking about life's last big event. Leaving end of life decisions to family or friends, those who always pray for our miraculous recovery, not only places a heavy burden on them, but it can ignite conflict and resentment among them. And, as you lie there helplessly, you may find yourself being driven down roads you'd rather not go.
For instance, in their desperation to prolong or save your life, your family could decide to place you in a promising but tortuous experimental drug program. Alternately, they could choose to have you undergo painful and highly expensive cutting-edge surgery which, while extremely risky, is worth the gamble to them if it holds out a chance of extending your life.
While such scenarios are extreme and unlikely, they're certainly not out of the realm of possibility. The most common situation has children faced with putting dear old Mom or Dad in a nice nursing home. There, families feel a parent will have the benefit of 24/7 medical attention.
Unfortunately, I've visited plentyof nursing homes. In my mind, none came even close to being nice. To be fair, it's more honest to say that I've never come across one I would choose to live in rather than die. To me they all smell alike--a malordous ether of urine, disinfectant, unattended bedside commodes and cooking fumes, tinged with the sweet scent of gladiolas which, unfairly or not, I associate with funeral homes.
Scattered through the hallways are people slumped over in wheelchairs, most with their heads hanging. It's impossible to tell if they're asleep or too weak to hold them up. The alert residents capable of standing, if unable to walk, shuffle-walk, wandering aimlessly hoping to find a friend or the affection of a warm, "Hi, how are you today?" Smile and a few smile back. Often you see eyes brimming with sadness and loneliness. Some have no reaction, but stare vacantly through you.
Nursing assistants (CNA's) are grossly underpaid and typically assigned more patients than they can possibly attend to, let alone stop to converse or hold a hand and listen. Some aids are surprisingly energetic, vibrant and openly caring towards their charges. They are a few, the only "regulars" who carry sunshine into the lives of the residents on a daily basis.
Many CNA's are sullen, obviously resentful of being stuck in low-paying, tough, dead end jobs that demand heavy lifting, mopping up urine and washing feces off the floor and patients. They know the job they have is likely the best paying one they'll ever get. Like the residents, they are trapped in a hell hole and hate it.
As you walk the hallways you hear television noises coming from the rooms, people calling out for someone or something, frequently making no sense at all or worse, wrestling with pain. Almost always the air carries the sounds of people crying, moaning or laughing out loud to themselves.
There are nursing homes you might call "more livable". At least they try with bright colored curtains, plush carpeting, pleasant pictures on the walls, big windows to let daylight stream in, comfortable nooks for visiting and attractive dining rooms. The food looks better than it does in the typical nursing home, but that doesn't mean it's good tasting.
Study these "nice" homes and you'll see that the homey touches are mere window dressing. The ambience is intended to camouflage the smells, the sights of demented residents and the odd noises of patients and blaring televisions back in their rooms. The nicer homes mute the horror of life in any institutional setting, but they're not much of a step up from the less expensive facilities.
None of them, no matter the price tag, is a place where anyone full of life would choose to exist. These so-called homes are the last stop before the funeral parlor. I will never, ever allow myself to be placed in any of them.
Adult children may think your best interest lies in placing you in an upscale nursing home. Good intentions will convince them that there you'll have the protection of watchful eyes, enjoy meeting new friends and be involved in the home's social life and activities. Most important to them will be the availability of immediate medical care for you.
When they start shopping around, the prices will make them cringe. A run-of-the-mill home starts at $4,000 a month. More acceptable settings are $5,000 and up. To the surprise of almost everyone, Medicare pays for a mere 20 days, period, and then you're on your own. If a patient doesn't have long term care insurance, the money is going to have to come from family.
If you can't afford the going rate, you may be able to "spend down" in order to qualify for Medicaid. You will need the advice of an Elder Law Attorney before taking action. Then you can start hunting for a home with a open bed. Medicaid has never been funded well enough to make its recipients welcome at most facilities. Regardless of price level, all nursing homes are under federal and state mandate to set aside a fixed percentage of beds for Medicaid patients. But there is no guarantee Medicaid will get you a bed. In fact, it likely won't.
The reason is not price discrimination, but the result of a gross failure of government. Despite being warned decades ago that a massive shortage of beds was ahead as Baby Boomers aged, the state and federal governments have never seen fit to allocate the money necessary to encourage the construction of nursing homes. Today hundreds of thousands of people are slowly dying on waiting lists for nursing home beds. A health care tsunami is underway as the Baby Boomer wave is just beginning to unfurl. In five to seven years there will be nowhere to turn. Due to the inexcusable irresponsibility of government and unwilling taxpayers, there will not be enough beds for our elderly for many years to come.
For a lot of elderly, it will come down to a decision of whether or not to move in with family. If you were facing this choice today, would you see it as likely to increase your quality of life? Would you really be happy living in someone else's home? Remember, it's not just a change of address, but a change of environment. No matter how many times you've visited, someone else's home it's a place you've never lived. Moving in will seem a good idea, but you'll have to surrender your privacy and independence and be prepared to learn things about family or friends you never knew before.
Depending on your health, the arrangement may not be workable for long. As your illness or disability progresses, the question of what to do with you will likely come up again. If you fall victim to stroke or heart attack, the decision may ultimately be out of your hands. Even people with money and fame such as writer Hunter S. Thompson, can face unthinkable choices.
Thompson, the originator of "gonzo journalism" and author of several best sellers such as Fear and Loathing in Las Vegas, Fear and Loathing on the Campaign Trail '72 and Better Than Sex, had a storied and wild life. His new style journalism injected his quirky, outlaw persona into his reporting and, combined with his irreverant humor and offbeat but accurate takes on American society, made him a counterculture icon.
Thompson's life was a rollicking circus full of unimaginable characters, crazy and dangerous high jinx with drugs, guns and motorcycles, drunken nights that ran into drunken days, hobnobbing with professional athletes, movie stars, and celebreties and an endless supply of good weed and pretty women. Then it all blew up in February 2005. Suffering with a variety of ailments, in agony from recent hip replacement surgery, trapped in a failing body and aware that
his writing talent had flamed out, Thompson lifted one of his favorite pistols to his head and fired.
His suicide wasn't the product of a hasty or ill-considered decision. Thompson had been thinking about it for a long time. Then, four days before his death, he laid his feelings out in the following message to his wife:
Football Season Is Over
"No More Games. No More Bombs. No More Walking. No More Fun. No More Swimming. 67. That is 17 years past 50. 17 more than I needed or wanted. Boring. I am always bitchy. No fun for anybody. 67. You are getting greedy. Act your own age. Relax--This won't hurt."
There are, I imagine, not many among us who love life more than Hunter S. Thompson did. But there in his beloved hideaway, Owl Farm, ten miles outside of Aspen, Colorado, he made an accounting and decided that for him, life was no longer worth living. For him, it was the right time to leave.
There is no arguing with death. All we can do is decide how we are going to meet it. Some of us aren't going to think about it at all, but plan to keep on moving and never look back. Let the last grains of sand fall when they will. Some are going to wrap themselves in religion and lean hard on their faith and prayers. Many, out of concern for family and friends, will buy a cemetary plot, pay for a service and wait it out. Others are going to stick to their moral code and hang tough through their last illness. Similarly, there are those who emphatically believe that life, no matter how pitiful, painful, empty and joyless it is, remains precious. They scorn suicide as the easy way out, the coward's solution.
End of life issues require serious thought, discussion and, if necessary, awkward conversation. Nothing should be left unplanned or unsaid.
The sanctity of life must be observed and honored at all its levels. It is unlikely that our society will any time soon approve of laws that will give us the right to freely choose how or when to end our lives. Yet a growing number of us hold fast to the concept that personal autonomy--freedom-- is as precious as life itself and manifestly more important than society's claim to be able to regulate our lives right down to our very last breaths. That being the case, we must each make important choices for ourselves while we still can.
