Living in Free Fall

 

Free Fall A recurrent theme in my life is that you grow the most when you step outside your comfort zone. It is a heady feeling to realize that a painful experience that had you in free fall for a time has made you stronger and wiser … to realize that, using Bradbury’s metaphor, you have indeed grown new wings.

What’s easy to forget, once those new wings have grown and set, is just how rough it is when you are in free fall … when you don’t know where you’re trying to get to … when you don’t trust your own judgment … when you have no idea quite what to do next.

It’s all the harder when you are in free fall off a cliff you didn’t even see coming.

To put this in perspective, I will take you back to 2008. Depending on how you count, I had changed careers half a dozen times over the previous 38 years, including several times when I dropped off the corporate ladder for a period of years. Some transitions were harder than others, some more successful than others, but there seemed to be a consistent pattern, one in which my skills in one arena provided a temporary branch to hang on to while I grew new wings in another.

When I decided to give up finance to be a creative writer, I expected this transition would go smoothly. After all, I was an experienced business writer. I’d taken university-level courses on creative writing. I’d published a memoir about sailing around the world at age 40.

Friday, I was a financial consultant.  Monday, I would be a writer.  How hard could it be?

Pretty hard, as it turned out.

What I overlooked, as I launched myself into the writerly world, was the common thread that stitched my earlier transitions into a satisfying quilt … the opportunity to work with smart people who were big thinkers. My success lay, to a very large extent, in my ability to carry out complex projects that these big thinkers—whether mentor, client or husband—believed were important.

In 2008, however, there was no client or mentor or husband. I had lots of ideas, but no way to set priorities or assess whether they were worth pursuing.

And then, one morning, as I waited for the first edition of Sailing Down the Moonbeam to be delivered, I recalled one of those wing-growing experiences as we sailed across the Pacific Ocean. Most of the time, my husband and I were vulnerable to unpredictable winds and currents. Setting goals was an exercise in frustration, since we could not control our progress on any given day. The best we could do was set a course that took us in the right general direction. All too often, we revised our course several times. More than once, we had to change our destination.

The metaphor seemed obvious.  If I wanted to I be a writer, I needed to write and hope my words would cumulate to a writer’s persona. Write something. A blog. A book review.  An essay.  Anything. Now, today.

It was a eureka moment.

I’d like to be able to tell you that I grew my writer’s wings that day.  I didn’t. Those simple goals got me out of bed every morning, but it was months before I did so with any enthusiasm.  It was several long and painful months before my wings started to grow.

Now, six years later, I have a writer’s wings. A novel and a memoir. A regular blog. A steady stream of freelance work. Invitations to speak to book clubs, libraries and community groups.

But once again, I seem to be in free fall. How can I be a writer if I don’t have a meaningful story I feel compelled to tell, or an idea I feel compelled to write about? Having just turned 70, I’m intrigued by the personal and societal challenges as the boomer cohort ages.  But how much of my thinking is unique enough to be worth writing about?

Once again, I seem to be grasping frantically for a branch to retard my free fall … give me a few extra moments to develop the wings I’ll need for my next act?  But what’s that next act? A writer in her 70’s with temporary writer’s block. Or a humanist for whom aging IS the next act, whether you write about it or not? Or maybe something else I haven’t even thought about?

What do you think? Can we still sprout wings at 70??

The Ineffability of Aging

 

IMG_9068No so long ago, I viewed 70 as the beginning of “old age.”

Trouble is that today—my 70th birthday—I don’t feel old.  Yes, I have grey hair, along with wrinkles in some places I would never mention in polite society. I do get annoying muscle cramps more often than I would like.  But I can climb six flights of stairs several times a day, and the body that I see in the mirror looks a whole lot better than it did when I was 18. I have fewer aches and pains today than I did at age 50, a combination of eating better and getting more exercise. And good genes certainly don’t hurt.

Statistics tell me that I could live another 10-15 years; given my health and genes, it could be easily be another 30 (my mother lived to 90; I have countless friends with parents approaching 100).  I’ve been encouraged by several articles I read of late, including a recent editorial in the New York Times by David Brooks, that report on the “U-Curve,”–the pattern of changing levels of emotional satisfaction over the course of life.  Statistics on the U-curve suggest that happiness/ contentment declines from childhood to about age 50, and then trends upward more or less steadily. Given my own emotional pattern over the decades, I should be bordering on ecstasy by 100.

But do I really want to live another 30 years?

An interesting approach to the question of aging comes from physician, academician and bio-ethicist Ezekiel Emmanuel. In a recent article in the Atlantic Monthly, he coined the term “American immortal”—what he calls the obsession “with exercising, doing mental puzzles, consuming various juice and protein concoctions, sticking to strict diets, and popping vitamins and supplements, all in a valiant effort to cheat death and prolong life as long as possible.”  You can add to his list, of course, all of the various medical interventions—mechanical, surgical and pharmaceutical—that we use to mask the reality of our inevitable aging and mortality.

Emmanuel has concluded that he would prefer to die at age 75. In his view, that is plenty long enough to have lived a full and rich life with a satisfying career, a good marriage and a thriving family, including grandchildren.

It seems at first, to be a curious position for someone who opposes suicide, assisted or otherwise. But his argument is not that he refuses to live beyond 75.  Rather, he has decided that as he approaches 75, he will cease taking pro-active steps to retard aging or prolong his life. No flu shots, vitamins, or anti-biotics. No screening exams. No surgical or mechanical (e.g., a pacemaker) interventions. No chemotherapy.  No drugs (e.g., statins or blood pressure meds) to keep his bodily functions performing as if he was still young.

The only medical treatment he will consider is palliative care, if he needs it to keep him comfortable toward the end. In his words, “I will die when whatever comes first takes me.” This is, of course, what mankind has done for thousands of years … until medical technology took over the management of aging and death in the mid-1900’s.

I find his argument compelling, although I’m not sure 75 is the age I’d choose.  Perhaps 80 or 85.

And I also find myself pondering the boundaries of palliative care. Shouldn’t it include the repair—surgical, pharmaceutical or mechanical— of traumatic events that diminish the quality of life but will not kill you? A broken arm or leg?  A case of poison ivy. A hernia. And what about diet and exercise? Eating properly is its own reward, just in how you feel, regardless of its long-term benefits for your health.  Similarly, exercise stimulates brain chemicals that make you feel better, mentally and physically. Should I stop doing it simply because it has the age defying-ability to preserve muscle tone and bone density?

What would you do?

P.S. Emmanuel explicitly reserves the right to change his mind at any point along the way!

Thoughts on the “End of Life”

 

What is your definition of death? Is it the same as “the end of life”?

End of LifeBased on survey responses from the participants in my seminars on the Bio-Ethics of Aging, the answer depends on whom you ask. What stands out, from their responses, is that discussions of end-of-life issues are fraught with potential for misunderstanding, as the same words mean different things to different people.

For example, most participants defined death in terms that pointed to the cessation of lung and heart function.  A few defined it as the cessation of brain function. Both are accepted medical criteria, but they can result in very different conclusions in different circumstances. Moreover, under current medical practice, policies and procedures to establish the time and fact of death may vary from state to state and from hospital to hospital within each state.

What counts, when you are facing the actual or imminent death of a family member is not your definition of death, but the opinions of your doctor and/or the policies of your hospital. Do you know what they are?

By contrast, the respondents offered definitions for “end of life” that covered a much broader spectrum.  A few individuals defined it in medical terms, often based on religious beliefs.  What I had not expected was that so many participants would define it in terms of the ability to engage in everyday activities—and that there were almost as many definitions as there were respondents to the questionnaire.

For example, some defined it in terms of the end of “useful life”—the inability to contribute in some way, be it financial, emotional, or simply helping with the grandkids. Others defined it in terms of loss of dignity, e.g., the point at which you can no longer take care of yourself. Some defined it in terms of the mental or physical capacity to participate in everyday activities at some—for the most part, undefined—level.

What was clear, from these responses, was that not being dead was not the same as being alive. But these definitions left many questions unanswered, and offered little guidance for someone having to make a decision about a medical treatment that would prevent biological death, but would not return your parent or spouse to the kind of life they wanted.

The issue matters.  I know from painful, personal experience that it is so easy, when you’re struggling to cope with a traumatic situation, to let your physician make all the decisions. When my mother fell and broke her hip, her Alzheimers had already advanced to the point where she could not reliably dress, bathe or get herself to the bathroom. She was not dead, but neither was she alive by her definition; her wish to be dead in that situation was very clear.

Even so, she was sent automatically to the hospital, where I seemed to have no choice but to authorize surgery to repair her hip, an operation from which she never recovered enough to even use a walker. She was even less alive than before the surgery.

The incident prompted my brother and I to research our options in the event of additional trauma.  Our decision, with which many may disagree, was that we’d keep her comfortable but would not authorize any treatment that required hospitalization or would delay the death she so clearly wanted.

When my mother’s physician disagreed, we found a new physician who shared our point of view.  To this day, however, I cringe to think of how it difficult it would have been for my brother and me if the first we learned of our doctor’s definition of “end of life” was when my mother was a candidate for treatment of cancer or a urinary infection … and when we did not yet know what our legal and medical options were.

If you’ve never talked about this with your family or your physician, maybe it’s time.  What most of us want, when an end-of-life occasion arises, is the ability to deal with an already difficult situation with love, compassion and the certainty that you are doing the “right thing.”  Are you prepared?

The Right to Decide

 

medical_heartMuch of the focus of the seminar I teach on the Bio-Ethics of Aging relates to the distribution of health care in a world of finite resources.  An equally important issue, based on the responses of the participants during the three sessions, is the nature and scope of one’s right to decide how to die.

In this context, I would note that the initial impetus for my interest in bio-ethics was the prolonged and painful process of dying suffered by both of my parents.  My father, a devout Catholic, was bedridden and in pain at age 54 with the gruesome complications of diabetes. While his faith made it impossible for him to “hasten” his death, he repeatedly expressed the desire to be allowed to die. The last and most tragic chapter of his illness was that four of the five times his heart failed, his doctor took extraordinary measures to get it pumping again.  When resuscitation failed the fifth time, I mourned loss of his life, but celebrated his death. Legally, he had the right to decide to die a year earlier, but he did not have the stamina to overcome his doctor’s refusal to let nature take its course.

The situation was quite different with my mother who hung in there until a week before her 90th birthday. A talented, capable, vibrant woman who romped through eight decades with élan, she made her end-of-life wishes known when she was 70 and still outrageously sound of mind.  She handed my brother and me each a packet containing detailed instructions from the Hemlock Society, a guidebook for “hastening” her death if she was terminally ill and could not manage for herself.

Her wishes were excruciatingly clear. But in 1985, who knew about Alzheimers?  Her advance directive did not include brain plaques as a “terminal” disease that would trigger her living will.  And even if it had, the laws of the U.S. made it impossible for us to honor her wishes and preserve her dignity during her last decade. No longer of sound mind and increasingly unable to take care of herself—the essence of what she wanted to avoid—she did not meet the requirements of those few states that provide for physician-assisted suicide. The tragedy of her illness was that her occasional flashes of coherence—when she begged to have us end it for her—were far too fleeting to meet the legal requirements in even the most compassionate of states.

And so, a decade after my mother’s death, I’m doing my small bit to prevent others from having to endure the painful and prolonged process of dying that my parents went through. In theory, each one of us has the legal right to decide whether to accept or reject health care. Unfortunately, many do not realize that this legally enshrined principle of “patient autonomy” gets short shrift in far too many cases.

One of the prime offenders of patient autonomy, as I saw with my father, is the medical profession. As Atul Gawande observed in his recently released and not-to-be-missed book, Being Mortal, “the way our professors saw it, the purpose of medical schooling was to teach how to save lives, not how to tend to their demise.”  But death is an inevitable part of life.  Medical advances can make our lives longer, but they cannot “fix” the fact of our mortality. What is to be hoped is that more and more members of the medical profession will learn to help us live a good life and then die a good death.

State laws also conflict with the concept of patient autonomy and the ostensibly legal standing of an advance directive. The five states that allow “physician-assisted” suicide do so only for patients who have the mental capacity to articulate their desire to die in the presence of two separate physicians, as well as the physical capacity to self-administer the medicine of choice. The mental capacity without the physical ability is not sufficient. An advance directive that explicitly documents the desire for death in the case of mental incapacity is not sufficient.

As I contemplate my next novel, I know that end-of-life issues will be a key plot thread, and the source of a broad range of conflicts between my characters.  Over the next year, I anticipate doing a series of blogs on health care issues, blogs that raise critical questions for which there are, at present, not very many answers.

I hope you will find the questions helpful in finding your own answers, in exercising your own right to decide.