Is there something perversely magical about crossing the line between 79 and 80? All I know is that no sooner did I make that transition, than I found myself hospitalized for the second time in my life – the last time being more than 40 years ago.
In both cases, the cause was the same – complications introduced by atrial fibrillation (periodic rapid heartbeats). When that happened for the first time, I entered a medical labyrinth that I swore never to fathom again.
I’m sure many of us are familiar with the drill – endless tests, being sent from one doctor to the next, prescribed medicines with threatening side effects. (I didn’t like one doctor’s answer when I asked him how long I’d be on beta blockers. “For the rest of your life, of course,” he said.)
That experience along with the tale I’m about to share have me wondering about ensuring life beyond 80. After that, shouldn’t we just back off and let nature take its course?
Let me tell you how I came to that question – and to its surprisingly clear answer.
The Medical Nemesis
I recall that during my first serious run-in with the medical establishment (again, about 40 years ago), I was reading Ivan Illich’s The Medical Nemesis. There, the great philosopher, trenchant social critic, and (like me) an ex-priest advanced a thesis relevant to my then-emerging medical situation. He wrote that modern medicine was making westerners sicker rather than healthier.
All of that was in line with his wider analysis, viz. that after a certain point:
- The more formal education we have, the stupider we become (knowing more and more about less and less, while understanding less and less about more and more).
- The further we advance in the field of transportation, the more immobile we find ourselves (sitting in traffic jams and airports, separated from each other by increasingly greater distances, and dependent on machines that only the few can afford, and even fewer can repair).
- The more “advances” in communication we experience, the less meaningful our interactions seem (as we use phones and computers to occasionally talk rather than enjoying the daily face-to-face conversations that are part and parcel of being human).
- The more food modern agriculture produces, the less nourishing its content (due to monocultures, feedlot diseases, preservatives, and dependence on inputs such as artificial fertilizers, animal drugs, and poisonous pesticides).
It’s the same with modern medicine, Illich argued. Its takeover by hospital equipment and pharmaceutical companies has us all hooked on procedures and drugs whose side effects and interactions are only partially understood. Within the system, doctors claim authority due only to those who know everything about the human body, while in reality 90% of it remains a mystery.
Even more basically, hospitals serve patients typically terrible food, which should be the major source of health in any circumstance. But instead, already undernourished patients are further deprived in places that are actual germ farms – ranking high among the most dangerous environments human beings have ever produced. It’s all “iatrogenic,” Illich charged – a disease-inducing epidemic intensified by physicians and the medical establishment itself.
To reiterate, then: beyond a certain point, the more modern medicine we have, the sicker we become.
My Medical History
Well, my experience with the medical establishment 40 years ago confirmed Illich’s insight.
For instance, after I expressed my concerns about rapid and irregular heartbeats, doctors at the Universities of Kentucky and Louisville, had me doing things that seemed well, “iatrogenic.” At one point I recall, they gave me a “tilt table test.” That meant strapping me to an upright mobile board that was turned to various angles in attempts to induce (for purposes of analysis) the very symptoms I was complaining about. The resulting sight appeared quite self-consciously ridiculous and somehow comic to me. Something seemed wrong.
At another point, I found myself enduring a stress test on a treadmill while connected by electrodes to an electrocardiogram monitor. That was o.k.; I had already done several of those.
However, this particular time, the technicians were amazed by my endurance. They even called some colleagues over to witness the wonder of it all as they progressively increased the treadmill’s speed. Suddenly however, they realized I was approaching cardiac arrest. In panic, they shut down the machine, rushed me to a nearby couch and urgently sent for the emergency doctor to attend to me lest I expire.
Episodes like those led me to see the truth of Illich’s argument. I concluded, “These guys don’t know what they’re doing. Much of it just doesn’t make sense. I have to make my own decisions here.”
Eventually, I did. After obtaining a second opinion from an elderly Asian physician who explained my options, I decided to “self-medicate” in the sense of changing my diet, committing to a rigorous daily exercise program, and (most importantly) meditating twice each day for half an hour. And here I am, still alive, healthier than most of my physicians and telling the tale. The Asian doctor just mentioned had given his presumed medical authority straight back to me. His crucial question was, “What do you think?”
My Current Situation
Of course, I was carrying all of that in my mind when three weeks after my 80th birthday, and following the direction of my primary care doctor, I reported to the Norwalk (CT) Hospital’s emergency room complaining of extended heart palpitations, skin sensitivity, and shortness of breath. I thought I might have COVID-19.
Instead, following a COVID test, a couple of x-rays, a CT scan, two ultrasounds, an electrocardiogram, an echocardiogram, and innumerable blood tests, it was determined that I have blood clots probably caused by my recent 12-hour, single day drive from Canadian Lakes Michigan to our home in Westport Connecticut. The condition was aggravated by my chronic atrial fibrillation. Together, those inputs caused my shortness of breath and unusual fatigue. And, yes, I would have to submit to a regime of three medicines taken twice a day for “the rest of my life.”
Suddenly, this very healthy and strong person (me!) was rendered “sick” and reduced to invalid status.
So, I spent those five days hospitalized and ingesting intravenous drips containing various formulations of blood thinners and heart tranquilizers.
The doctors’ problem was determining the correct dosages of the three prescribed medicines. We experimented daily with blood thinners and heart calmers. The therapies worked while my body was at rest. But as soon as I started moving around, the heart irregularities and shortness of breath returned (though I hardly noticed). My heart continued to race at times even as the blood clots dissolved themselves. (This was natural, I was told, even without Heparin or its equivalent.)
With their alternatives apparently exhausted, an excellent pair of very bright and articulate staff physicians (and teachers in the medical school) with stellar bedside manners suggested a procedure reminding me of the term “iatrogenic.” They wanted to shock my cardiac system back into normalcy. According to the procedure, (1) I’d be sedated, (2) swallow a miniaturized scanning device in search of a possible clot in my heart, and if none were found, they’d (3) give my heart a normalizing electric shock and hope for the best.
Hmm. I wondered what Ivan Illich would say about all of that. I didn’t know. But I recalled his distinct suggestions that:
- The less apparent the causes of one’s symptoms
- The more exotic and complicated their diagnosis and anticipated cure
- The more “sophisticated” the technology
- And the more numerous the medications involved,
the less likely it is that a given therapy is on the right track.
Thinking like Illich, I wondered: given my age, does it make sense any longer to take such life-prolonging measures for someone who up to a few days before had been progressing quite nicely as far as his health was concerned? (I was taking only one med each day – for enlarged prostate. I walked four miles seven days a week at a rate of 14:30 minutes per, did 40 pushups midway through each of those walking sessions, and played golf regularly with great enjoyment – especially with my two sons. That along with the healthy diet provided me for the last 44 years by my gourmet vegetarian wife were keeping me quite healthy.) Why not continue trusting my body and Life itself to give me a few more relatively healthy years – or not? At 80, it’s been a good run. Who could ask for more?
Enter Ezekiel Emanuel
In asking that question, I was reflecting what I had read six years earlier in an Atlantic Monthly article written by University of Pennsylvania oncologist and medical ethicist, Ezekiel J. Emanuel. The article was called “Why I Hope to Die at 75.”
There (writing at the age of 57) Emanuel wrote that statistical concerns about physical and mental decline among aging Americans had inspired him to conclude that “Once I have lived to 75, my approach to my health care will completely change. I won’t actively end my life. But I won’t try to prolong it, either.”
Practically speaking that would mean, he said, no regular doctor visits, no colonoscopies, cancer screenings, cardiac stress or PSA tests, no pacemaker or implantable defibrillator, no heart-valve replacement or bypass surgery, no hospitalizations – nothing curative; only palliative medical procedures.
In Emanuel’s opinion, death according the natural lifespan of a post 75-year-old body is far preferable to the indignities of artificially prolonged life with its probabilities of immobility and mental decline.
I was convinced that Emanuel’s diagnosis of my “condition” would be that there is really nothing wrong with me at all. Despite appearances, I’m simply old. My body parts including my fibrillating heart and sometimes gasping lungs are showing normal signs of wear and tear.
It’s all part of life’s wonderfully mysterious process.
I found myself agreeing with that position. After all, I’ve already led a full productive life. Everything from now on is gravy.
So, once I’ve consumed my present supply of meds (to appease my family members), and after my next appointment with my cardiologist (for the same reason), I plan to swear off the whole thing. I’m going to follow Emanuel’s advice.
As it has turned out, my time in the Norwalk hospital was a great gift – almost a spiritual retreat. The experience provided me time to focus on the topics I’ve raised here – the nature of U.S. medical care, the advisability of adopting curative (vs. palliative) measures after the age of 75 or 80, and other end-of-life issues.
Like Emanuel I’ll forge ahead without any exotic interventions whatsoever. If the heart attack comes, I’m ready to go. As I said, it’s been a good run.
If a stroke comes, same story. And should I become disabled, I’ve clearly asked my family members to simply put me in a nursing home without any life-extending treatments and let me die. Absent those medicines and treated only with palliatives, my life’s end will probably come quickly and painlessly.
Meanwhile, I’ve resolved to continue enjoying life, writing for social justice, following my spiritual practices, and concentrating on lowering those frustrating golf scores rather than my unfathomable heart rate.