Living Too Long: Deciding to Die before We Quit Living by Mark DeGroot Lyrics
Lila is ninety-three years old. She lays crumpled partially on her side in a hospital bed. Her tongue and lips are crusted dry, parched by the wheezing breath which rasps through her gaping mouth. Although she seems to be sleeping, she clenches her eyebrows against invisible pain. Beneath paper-thin skin, her arms are bruised deep purple, a side effect of blood thinners which are dissolving a clot somewhere unseen in her bony body. We have come to turn her over to prevent bedsores. It’s the only time she moves. She moans from the pain we cause her. With a hoarse whisper she cries, “Help me!” “Help you what, Lila?” I ask. She doesn’t answer.
I look in her face, trying to imagine what she looked like as an eye-catching young lady, or as a little girl, running across a yard with the wind in her hair. That little girl grew up and built a life. She married, had children, and later grandchildren. She lived a full life, then she gradually outlived. She outlived her husband and her friends. She outlived her ability to walk, and then even to sit up on her own. She outlived her ability to do anything but lie in a hospital bed and breathe. Her death is inevitably near, but thanks to what modern medical procedures can do to extend life, it could still be months or even years away.
It seems we live most days without thinking about the inevitable. In my job as a Patient Care Technician at a large hospital, however, I assist people through the various stages of life’s end during almost every shift I work. For some I feel a sense of relief, especially if they suffered painfully toward the end. For others, like Lila, their chapter seems to drag on much too long. She lingers between life and death, kept alive by a tangled umbilical cord of wires and tubes connecting her to monitors and bags of IV fluids. Without their intervention, the many medical conditions could have ended her life years ago. This “bonus” time includes many lonely years she has spent shuffled between nursing homes and hospital beds, being turned and fed and cleaned by strangers who call her “dear” because they don’t know her name.
I watch Lila and wonder, what is the point of living this long?
Living too long wasn’t always a problem. Until two hundred years ago, the average human lifespan was only thirty years (Brown). People got sick or acquired an infection, and they died. Today antibiotic and medical advances have made it possible for more humans to reach old age and to remain old for a much longer time. In fact, the fastest growing segment of our population includes those over the age of one hundred (Brown). But by increasing lifespan, we may have opened Pandora’s box. By pushing back the inevitable we have also increased the time we will spend suffering the unpleasant side-effects of aging such as physical incapacity, incontinence, and degenerative diseases like dementia and Alzheimer’s.
In a recent article published by the journal New Scientist, the success of technology in extending life was compared to our ability to extend health. Over the past one hundred years, the average human lifespan has increased at the rate of 2.2 years per decade, while the rate of healthy life expectancy has increased only at the rate of 0.6 years per decade (Brown). Since the odds of developing a degenerative disease increase exponentially with age, persons born today stand an almost fifty percent chance of dying with severe disabilities and requiring round-the-clock care for years on end (Brown).
I return to Lila’s room every two hours to wash her private areas. The constant urine and watery stool she has no control over will cause skin breakdown if she is left to lay in it too long. Patches of pinkish scar tissue on her bottom testify to a history of such sores. Her nurse crushes oral medications and mixes them in applesauce for her because she can only swallow mushy foods and thickened liquids like the water I prepared for her. It has the look and consistency of hair gel. Her head turns away as the nurse touches a spoon to her mouth. She doesn’t want to eat anything. That’s why her doctors have ordered a feeding tube. Again I wonder what is the point?
I have to ask myself, is it so necessary to hang on until the bitter end of life? Standing next to Lila’s bed I know I never want to live this way. I think it might be better to leave a little early than stay too long. Isn’t a meal enjoyed more when one leaves the table a little hungry instead of stuffing oneself too much? It is a hard thing to consider, but as doctors hone their craft, I am afraid someday I may face the dilemma of excusing myself early from the table of life or lingering for years like Lila.
The timing of this kind of decision might be difficult. How does one know when it is time to go? Many people live active and happy lives well past their average life expectancy. For example, in the room next to Lila is Evelyn. She is ninety-four, and she is here to have her pacemaker replaced. Sweet and sassy, Evelyn tells me about water aerobics, her friends at the assisted-living home where she lives, and how she can’t wait to get her hair done. She is still enjoying life.
Albert, another patient down the hall, is experiencing the onset of Alzheimer’s at the age of seventy-seven. Whenever I enter his room, he insists that I sit down with him and play a hand of cards. His rules make no sense, and he is convinced we are in a bar in downtown Louisville, but most of the time he laughs and hoots and has a good time. He may seem a little loopy, but he is still enjoying life. For now, that is. Sooner or later this will change. His deterioration is inevitable. What may also be inevitable is making the choice to spend years at the end of life in a long and lingering decline, or to say it was a good life but it’s time to go.
In whispered hallway conversations outside Lila’s room, the techs and nurses I work with talk about how they never want to end their lives in her condition. But how does one go about avoiding this fate? If we can speak, and we are in our right mind, we could refuse a feeding tube and simply stop eating. Starving may seem unpleasant, but a survey by the New England Journal of Medicine found that eighty-five percent of patients who made this decision died within fifteen days, and their average quality of death was rated by the nurses caring for them at eight (zero being a very bad death and nine a very good death) (“When a Patient”).
Some reject the decision to end life early as suicide. The National Right to Life organization warns that weighing the sanctity of life against the quality of life is a slippery slope (“Why the Need”). Tom Crumplar, president of Delaware Right to Life explains that this attitude could lead to a trend where the young ask the old to “hurry up with death” (qtd. in Tahminciogly)
It may sound inhumane to ask someone in Lila’s condition to hurry up and die, but I think those who are bold enough to suggest this may have a valid point. Perhaps we need to examine more thoughtfully that point when our lives are truly over. What frightens many of us so much about spending our final years as invalids in a nursing home, unable to enjoy living, but kept from dying? We hope that our lives will end before that time because we recognize how outliving our bowel control, our mobility, and our usefulness means outliving our dignity as human beings. Having a life means more than being alive. An eighty-four year old resident of a nursing home pondered this personal limit for herself in poetry as she considered how to define when she would know she had lived long enough:
When, if I should reach the place where sunsets cannot ease me
Where rainbows have no power to lift me
Where facing trials of life no longer make me strong
Where love of friends becomes of little value
Where each day’s gifts go by without thanksgiving
Where smiles of babes no longer give me joy
It’s then I’ll know, without some other telling
It’s then I’ll know that I have lived too long
(Armstrong).
Are we morally obligated to take advantage of all measure available to prolong our own lives? Some may say that God alone decides our final moment, but David Schiedermayer, a Christian medical doctor and a poet writes, “Honoring life does not mean we must insist on all forms of treatment for all people at all times” (Schiedermayer). Maybe what Dr. Schiedermayer is saying is that the time to leave this world occurs when we as individuals recognize that we have lived enough.
Whether or not it is right to decide to leave before we live too long is perhaps a question best answered by poets and philosophers. I only know I have no wish to live out the last years of my life like my patient Lila, and I wonder what she would have decided for herself years ago if she could have foreseen her present condition. I have seen so many sad instances of people suffering day after day simply because technology can keep their heart beating. My brother has proposed that before we reach that point we should buy a sailboat, name it ”Inevitable,” and sail her round Cape Horn, South Africa, the most famous stretch of treacherous waters in the world. If we make it, we’ll turn around and do it again. Instead of living our final years connected to machines by wires and tubes, gasping for air like a dying fish, our grandchildren will be able to say, “My grandpa died rounding the Horn: Alive and with dignity”.
Works Cited
Armstrong, Lola M. “How Long is Too Long?” Nursing Homes Long Term Care 37.4 (1988): n.pag. General One File. Web. 21 Mar. 2008.
Brown, Guy. “The Bitter End: Death is Not the Real Enemy. It is Aging and the Disabilities it Brings That We Should be Fighting.” New Scientist 195.2625 (2007): n. pag. General OneFile. Web. 21 Mar. 2008.
Schiedermayer, David. “Commuting to the Valley of the Shadow of Death.” Christianity Today 37.11 (1993): n. pag. Academic OneFile. Web. 7 Apr. 2008.
Tahminciogly, Eve. “The Cost of Dying.” News Journal 10 July, 1999: n. pag. ProQuest Central. Web. 21 March. 2008.
“When a Patient Refuses Food and Fluid.” Journal of Neuroscience Nursing 35.6 (2003): n.pag. General One File. Web. 21 Mar. 2008.
“Why the Need for a ‘Will to Live’” National Right to Life News 36.6 (2003): n. pag. General One File. Web. 21. Mar. 2008.
I look in her face, trying to imagine what she looked like as an eye-catching young lady, or as a little girl, running across a yard with the wind in her hair. That little girl grew up and built a life. She married, had children, and later grandchildren. She lived a full life, then she gradually outlived. She outlived her husband and her friends. She outlived her ability to walk, and then even to sit up on her own. She outlived her ability to do anything but lie in a hospital bed and breathe. Her death is inevitably near, but thanks to what modern medical procedures can do to extend life, it could still be months or even years away.
It seems we live most days without thinking about the inevitable. In my job as a Patient Care Technician at a large hospital, however, I assist people through the various stages of life’s end during almost every shift I work. For some I feel a sense of relief, especially if they suffered painfully toward the end. For others, like Lila, their chapter seems to drag on much too long. She lingers between life and death, kept alive by a tangled umbilical cord of wires and tubes connecting her to monitors and bags of IV fluids. Without their intervention, the many medical conditions could have ended her life years ago. This “bonus” time includes many lonely years she has spent shuffled between nursing homes and hospital beds, being turned and fed and cleaned by strangers who call her “dear” because they don’t know her name.
I watch Lila and wonder, what is the point of living this long?
Living too long wasn’t always a problem. Until two hundred years ago, the average human lifespan was only thirty years (Brown). People got sick or acquired an infection, and they died. Today antibiotic and medical advances have made it possible for more humans to reach old age and to remain old for a much longer time. In fact, the fastest growing segment of our population includes those over the age of one hundred (Brown). But by increasing lifespan, we may have opened Pandora’s box. By pushing back the inevitable we have also increased the time we will spend suffering the unpleasant side-effects of aging such as physical incapacity, incontinence, and degenerative diseases like dementia and Alzheimer’s.
In a recent article published by the journal New Scientist, the success of technology in extending life was compared to our ability to extend health. Over the past one hundred years, the average human lifespan has increased at the rate of 2.2 years per decade, while the rate of healthy life expectancy has increased only at the rate of 0.6 years per decade (Brown). Since the odds of developing a degenerative disease increase exponentially with age, persons born today stand an almost fifty percent chance of dying with severe disabilities and requiring round-the-clock care for years on end (Brown).
I return to Lila’s room every two hours to wash her private areas. The constant urine and watery stool she has no control over will cause skin breakdown if she is left to lay in it too long. Patches of pinkish scar tissue on her bottom testify to a history of such sores. Her nurse crushes oral medications and mixes them in applesauce for her because she can only swallow mushy foods and thickened liquids like the water I prepared for her. It has the look and consistency of hair gel. Her head turns away as the nurse touches a spoon to her mouth. She doesn’t want to eat anything. That’s why her doctors have ordered a feeding tube. Again I wonder what is the point?
I have to ask myself, is it so necessary to hang on until the bitter end of life? Standing next to Lila’s bed I know I never want to live this way. I think it might be better to leave a little early than stay too long. Isn’t a meal enjoyed more when one leaves the table a little hungry instead of stuffing oneself too much? It is a hard thing to consider, but as doctors hone their craft, I am afraid someday I may face the dilemma of excusing myself early from the table of life or lingering for years like Lila.
The timing of this kind of decision might be difficult. How does one know when it is time to go? Many people live active and happy lives well past their average life expectancy. For example, in the room next to Lila is Evelyn. She is ninety-four, and she is here to have her pacemaker replaced. Sweet and sassy, Evelyn tells me about water aerobics, her friends at the assisted-living home where she lives, and how she can’t wait to get her hair done. She is still enjoying life.
Albert, another patient down the hall, is experiencing the onset of Alzheimer’s at the age of seventy-seven. Whenever I enter his room, he insists that I sit down with him and play a hand of cards. His rules make no sense, and he is convinced we are in a bar in downtown Louisville, but most of the time he laughs and hoots and has a good time. He may seem a little loopy, but he is still enjoying life. For now, that is. Sooner or later this will change. His deterioration is inevitable. What may also be inevitable is making the choice to spend years at the end of life in a long and lingering decline, or to say it was a good life but it’s time to go.
In whispered hallway conversations outside Lila’s room, the techs and nurses I work with talk about how they never want to end their lives in her condition. But how does one go about avoiding this fate? If we can speak, and we are in our right mind, we could refuse a feeding tube and simply stop eating. Starving may seem unpleasant, but a survey by the New England Journal of Medicine found that eighty-five percent of patients who made this decision died within fifteen days, and their average quality of death was rated by the nurses caring for them at eight (zero being a very bad death and nine a very good death) (“When a Patient”).
Some reject the decision to end life early as suicide. The National Right to Life organization warns that weighing the sanctity of life against the quality of life is a slippery slope (“Why the Need”). Tom Crumplar, president of Delaware Right to Life explains that this attitude could lead to a trend where the young ask the old to “hurry up with death” (qtd. in Tahminciogly)
It may sound inhumane to ask someone in Lila’s condition to hurry up and die, but I think those who are bold enough to suggest this may have a valid point. Perhaps we need to examine more thoughtfully that point when our lives are truly over. What frightens many of us so much about spending our final years as invalids in a nursing home, unable to enjoy living, but kept from dying? We hope that our lives will end before that time because we recognize how outliving our bowel control, our mobility, and our usefulness means outliving our dignity as human beings. Having a life means more than being alive. An eighty-four year old resident of a nursing home pondered this personal limit for herself in poetry as she considered how to define when she would know she had lived long enough:
When, if I should reach the place where sunsets cannot ease me
Where rainbows have no power to lift me
Where facing trials of life no longer make me strong
Where love of friends becomes of little value
Where each day’s gifts go by without thanksgiving
Where smiles of babes no longer give me joy
It’s then I’ll know, without some other telling
It’s then I’ll know that I have lived too long
(Armstrong).
Are we morally obligated to take advantage of all measure available to prolong our own lives? Some may say that God alone decides our final moment, but David Schiedermayer, a Christian medical doctor and a poet writes, “Honoring life does not mean we must insist on all forms of treatment for all people at all times” (Schiedermayer). Maybe what Dr. Schiedermayer is saying is that the time to leave this world occurs when we as individuals recognize that we have lived enough.
Whether or not it is right to decide to leave before we live too long is perhaps a question best answered by poets and philosophers. I only know I have no wish to live out the last years of my life like my patient Lila, and I wonder what she would have decided for herself years ago if she could have foreseen her present condition. I have seen so many sad instances of people suffering day after day simply because technology can keep their heart beating. My brother has proposed that before we reach that point we should buy a sailboat, name it ”Inevitable,” and sail her round Cape Horn, South Africa, the most famous stretch of treacherous waters in the world. If we make it, we’ll turn around and do it again. Instead of living our final years connected to machines by wires and tubes, gasping for air like a dying fish, our grandchildren will be able to say, “My grandpa died rounding the Horn: Alive and with dignity”.
Works Cited
Armstrong, Lola M. “How Long is Too Long?” Nursing Homes Long Term Care 37.4 (1988): n.pag. General One File. Web. 21 Mar. 2008.
Brown, Guy. “The Bitter End: Death is Not the Real Enemy. It is Aging and the Disabilities it Brings That We Should be Fighting.” New Scientist 195.2625 (2007): n. pag. General OneFile. Web. 21 Mar. 2008.
Schiedermayer, David. “Commuting to the Valley of the Shadow of Death.” Christianity Today 37.11 (1993): n. pag. Academic OneFile. Web. 7 Apr. 2008.
Tahminciogly, Eve. “The Cost of Dying.” News Journal 10 July, 1999: n. pag. ProQuest Central. Web. 21 March. 2008.
“When a Patient Refuses Food and Fluid.” Journal of Neuroscience Nursing 35.6 (2003): n.pag. General One File. Web. 21 Mar. 2008.
“Why the Need for a ‘Will to Live’” National Right to Life News 36.6 (2003): n. pag. General One File. Web. 21. Mar. 2008.