“Threescore and ten I can remember well:
Within the volume of which time I have seen
Hours dreadful and things strange; but this sore night
Hath trifled former knowings.” From Macbeth by William Shakespeare
As I head towards completing my allotted three score and ten, I stop and often wonder at our present attitudes to life, living and the inevitable other, the end of life and death. Of course, the adage probably is not valid today as 70s almost seems to to be the new 50s – or is it 40s?? I work closely with a senior colleague who puts in a 8-10 hr working day on a daily basis – and he is in his mid-80s. This morning I read that Ram Jethmalani, stepped off a flight from UK or USA at 3.30 am and appeared in court at 11 am for Jayalalitha in her bail plea – and he is 92!!! I am sure that many lived to ripe old age even in bygone years – my paternal grandparents, born in the 1870s or so, and 1900 born maternal grandmother lived to 90+. But then, a large number of others were lost to diseases, such as my maternal grandfather to typhoid in 1935, when he was in his early 40s. So, the old adage would be that longevity runs in the family – and I am sure there is a genetic component to longevity.
But, today’s longevity is a credit to modern medicine. In spite of the deteriorating choices in life style and the increasing pressures of modern living, life spans are expanding with the assistance of chemicals (in the form of drugs), biologicals (such as vaccines, and organs to replace failing ones) and plastics (in the form of stents, pacemakers etc). And continuing advances in medicine is promising us the golden age of personalized health care – where if we get our genetic kundalis done (the full genome at what ever is the cost), treatment can be tailored to each individual, presumably ensuring further years of life.
So, it seems that 3 score and ten is out – and since the median life expectancy is 78 in USA and 66 in India, probably we are heading towards 4 score and ten. Certainly, the median age of my acquaintances, is growing as I am. And news of the passing away of friends and acquaintances is not so uncommon any more. But what disturbs me is how rarely we hear of anyone – irrespective of age – passing away in their own beds at home. The same medical advances, and the commerce driven health care system is promising everyone eternity!! It is no longer, considered appropriate for doctors to say ‘Enough is enough’ to any patient. And this is part of a societal change, since the doctor is wary of how the kin of an elderly person for whom such an advice would be appropriate, would take it. And the kith and kin who are placed in the position of having to take such decisions are ill informed and unprepared to face the realities.
Death has become this ‘ogre’ in the room, and no one wants to face it. This leaves so many of the elderly breathing their last in some strange ICU among strangers, and the kin picking up the bills that they, very often, cannot afford. To talk of death has become unfashionable and to write a will is considered inauspicious. Medical trainees only see death in the ICUs or emergencies, there is no discussion on end of life issues. In this scenario I am happy to see that some public discourse has started on the issue of a living will. Will personalized medicine be able in the future to predict our life span?? Which way are we headed?
My father used to say in his later years “I read the Obituaries in the paper first, as I know more people in them than among the actual news makers”. And when he died 3 decades ago at the age of 73, we mourned his loss but never felt that he was too young to go. Maybe the ‘3 score and ten’ was still acceptable then – death is a necessary part of the cycle of life. What set me thinking on this was more specifically the article by Ken Murray on why dying is easier for doctors. Not just doctors, we all need to discuss these issues within our homes, especially in those with the elderly. We need to develop mechanisms for domestic support for the last difficult days and honor the wishes of the elders. It is a pity that common scene from older Hindi cinema of ‘the absentee son dashing home to give Ganga jal to the dying mother’ has now become a part of history. While I do hope to live many ore healthy and useful years, I think I am prepared to face what is on my plate….. but then who knows till it is actually placed before you!!! I can only hope I live iup to my own expectations of myself.