Why am I still here?

When other helpers fail and comforts flee,
Help of the helpless, O abide with me.

First there was the cancer diary. Nigella Lawson’s husband John Diamond wrote one, you remember. Since the advent of the self-published blog countless people have died out loud.

Next, boomers started writing about the slow and distressing decline of their parents. You’ll find an example here.

Now those boomers are old enough to write about their own dissolution and are doing so to debunk the myth that too-long life is an unmitigated good thing. In last week’s Spectator magazine Stewart Dakers (77), reflecting that the reaper has changed from terminator to tormentor, dwelt on the horrors of longevity with both dread and splendid prose. Here are just a few extracts:

The existential reality of decline is aggravated by the prospect of total physical and cognitive disintegration, the details of which are well known to us, so we live in physical discomfort and mental terror. Old age has graduated into a form of pre-traumatic stress disorder.

We are a waste of space on a seriously overcrowded planet. We are in the way and those who are most impeded are the young. We can see this and are, of course, ashamed of ourselves.

My advice to young people is simple. Eat, drink, even smoke, and be generally merry, because that way you might be spared too many days of misery for yourself and your friends and family. Live short and prosper.

Old-age rational suicide will be with us any day now, just you see.

Carpe diem

Posted by Richard Rawlinson

Some of us enjoy our jobs; the social and creative buzz, and the income. Some of us also look forward to retirement; liberation from work routine, and time to pursue other interests, be it camper van touring or attempting a novel. But anecdotes about retirees reveal pros and cons.

Retire too early and the planned escape from stress can be replaced by loss of identity and boredom. For some, alcoholism ensues resulting in mental and physical sickness leading to early death.

Retire too late and limitations of natural ageing, from weakened immune system to impaired memory and diminished bladder control, can mar enjoyment of leisure time.

These potential setbacks can also be joined by any number of external forces derailing dreams of riding off into the horizon of the golf course in a buggy. The spouse might need extensive care following a stroke, for example.

Good advice seems to be to retire ‘slowly’ by working part-time in some form, or taking a hobby job such a volunteering for a charity. It also seems sensible to not put off doing things until retirement, assuming that only then will you have more time for family and friends, travel, exercise, oil painting and learning Spanish.

This random musing is triggered by noting how many British Prime Ministers died soon after leaving office: Sir Robert Peel and William Gladstone (four years); Ramsay McDonald (two years); Lord Salisbury (one year), Andrew Bonar Law and Neville Chamberlain (six months). Others, such as William Pitt the Younger and Lord Palmerston died while in office.

Then again, several lived 10 to 30-plus years after retiring: Winston Churchill, Harold Macmillan, Alec Douglas Hume, Edward Heath, Harold Wilson, Margaret Thatcher.

Meanwhile, John Major, Tony Blair and Gordon Brown are still alive.  

More PM deaths here.  

Longevity may not be all bad after all

An article in the New York Times reviews a new memoir about caring for an elderly relative in this age of protracted dying. It is“The Fifth Season: A Daughter-in-Law’s Memoir of Caregiving,” by Lisa Ohlen Harris. It’s about “the pressures of having Jeanne, the active mother-in-law who moved in to help with the kids and the mortgage, suddenly get sick and then sicker.”

The reviewer, Paula Span, writes: The Fifth Season” shows how doctors’ evasiveness, patients’ hopefulness and their families’ hesitance to discourage them combine to keep very frail people undergoing futile treatments, and then more of them. Year after year, Jeanne gets weaker and sicker. Yet it still comes as a shock when Ms. Harris sees the doctor’s notes that say how poor Jeanne’s prognosis is.

“I finally realized that the experts, all these specialists, the ones who are supposed to be the educators of their patients, have been looking at Jeanne and seeing a dying woman … But they kept sending us … on wild goose chases, despite the mass of physical ailments signaling that Jeanne is at the end of her life. Why the hell didn’t anybody speak up?”

Span observes: These are the stories my fellow baby boomers feel compelled to tell one another. In the wrong hands, the stories can become maudlin or simply tiresome, but Ms. Harris’s are the right hands. “The Fifth Season” is brief, potent and gutsy.

[These stories] are cautionary tales, full of anger and love — and warning. They are bulletins from the front, meant to guide those following behind.

An article in the Sunday Times notes: At present, an average of three months is being added to life expectancy each year. It is estimated there may be 1 million centenarians in the world by 2030.

The Ministry of Defence centre of development, concepts and doctrine is worried about this, and about the likelihood of the discovery of a means of preventing the effects of getting old. It predicts a terrifying dystopia: a potential “strategic shock” that would put huge pressure on the supply of food, pensions, healthcare and jobs.

Such a discovery, it adds, could fuel tensions within countries because access to a cure would be “highly unequal” and restricted to the wealthiest people in the richest nations. “The whole fabric of society would be challenged and new norms and expectations would rapidly develop in response to the change.”

But it may not be half as bad as they dread.

Richard Faragher, a professor of biogerontology and chairman of the British Society for Research on Ageing, said it was “reasonably plausible” to expect a treatment for ageing by 2040.

Scientists have already been able to slow the ageing process in animals. A drug called rapamycin was found to extend the life of female mice by 14% and male mice by 9%.

“It’s straightforward technology and possibly one of the bigger kept secrets,” Faragher said. However, he challenged the view that such a medical breakthrough would bring chaos.

“Interventions in the ageing process reduce the incidence and/or severity of multiple age-associated diseases and problems,” he said. “Thus you would end up with healthier, happier old people for less money. You will not end up with immortal people.”

When death is no longer the worst thing that can happen to you

It’s not the worthy efforts of the members of the Dying Matters coalition that have raised awareness of the need to talk about death and dying. What’s actually got more and more of us talking is our personal experiences of the difficult and protracted end-of-life suffering of members of our families. Alongside twenty-first century death agony, extinction is the least we have to fear. Bring it on, goes up the cry, as, just this week, the Falconer Assisted Dying Bill passed its first reading in the House of Lords, Vermont became the fourth state in the USA to legislate for assisted suicide (let’s call it what it is, shall we, Charlie?) and in liberal (if that’s the right word) Switzerland an 80 year old woman in perfectly good health appealed to the European Court of Human Rights to be allowed to go now rather than get any older. She’s had enough, thanks. 

Live issues in this debate are: 1) what constitutes suffering; 2) the right of the state to limit personal autonomy and an individual’s right to self-determination; 3) the duty of doctors to write a prescription for those who ask for a chemical exit; and 4) the protection of those going through a depressive patch or who are susceptible to duress from predatory relatives, etc.

Over time, of course, this is going to reconfigure attitudes to funerals. 

In the context of all this, I was struck by the following letter in last Sunday’s Sunday Times:  

It isn’t just dementia that thwarts our plans. I also dread the disease that robbed me of my mother, and the thought of my daughter changing my nappies and enduring tyrannical rages  and repeated conversations fills me with dismay.

So strong are my feelings that five years ago I wrote a detailed advance directive,  had it witnessed, shared it with my family and lodged a copy with my GP. I take little comfort from this as it  appears that some people — who do not know me but  have some religious or ethical opinion — are insisting they have more rights over my  body than me.

Why should the limited resources of this tiny planet be used on my dribbling, deranged shell when I’ve requested otherwise?

Sue Parkes, Halesowen, West Midlands

The biggest social issue coming down the pipe

From an article in last Sunday’s Sunday Times: 

You may not be part of Britain’s 6.4m-strong army of carers yet, but if your parents are still alive, the dilemmas surrounding how to look after them as they get older will surely come.

Future Identities, a government report published last week, drew attention to what one expert calls the biggest issue we face as a society. Because women are giving birth later in life, the baby-boomers’ time-poor children are increasingly being hit with a double whammy: they are having to care for their own offspring and their elderly parents simultaneously.

Christopher Lambert’s story is typical of this so-called Sandwich Generation. “My son was five, I was 58 and my dad was 87. I’d divorced my wife and was living back with Dad as his main carer,” he says. “My son would come at weekends, which was supposed to be our ‘special time’. It was bedlam. Dad would be screaming, ‘Breakfast! Breakfast!’ My son would be yelling, ‘Dad, Dad, you said you’d . . .’

“I felt trapped in the middle, the only grown-up. I remember being out in the garden and Dad collapsing on the ground and my son wanting to play football and me saying, ‘Let’s play looking after Grandpa,’ and he’d say, ‘No, that’s boring and he’s smelly.’ I was at my wits’ end.”

The feelings of conflicted loyalties, divided between the parents who raised you and the children who need you to raise them, are so common that more than 4 in 10 Sandwich Generation carers are struggling to cope or at breaking point, according to a recent survey by Carers UK.

The problem will only intensify as the postwar baby-boomers enter their seventies — by 2022 there will be a 20% rise in over-75s (up from 5.1m to 6.6m). “People live longer now with severe disabilities who would have died years ago,” says Helena Herklots, chief executive of Carers UK. “A revolution is required in family care akin to the new understanding we have around working parents, as in the future so many of us will be juggling work around elder care and children.”

The forecast is also for the number of children aged under 16 to increase from 11.8m now to 13.2m in 2022, exacerbating the Sandwich Generation squeeze.

Source (£)

Actuarially, we’re all dying younger — just — perhaps

From The Actuary, 24 January 2013:

The total number of deaths in England and Wales in 2012 was 499,000 – 15,000 more than in 2011 and in excess of the total for any of the three previous years.

Mortality worsened by 1% over last year for the combined male and female population – after a 3.8% improvement in 2011.

Men’s mortality improved by 0.2% and women’s worsened by 2%. This was significantly less than the average annual improvements of 2.8% for men and 2.2% for women seen over the 10 years to 2011.

Read the whole article here

Journey’s end recedes

As medicine, diet, lifestyles etc reconfigure the landscape of dying by enabling us to live longer / enjoy extra twilight years (not me, I smoke), our relationship with death is altering. When death cuts a life cruelly short it is held to be a Bad Thing; when it brings to a merciful close a too-long life it is held to be a Good Thing. And the balance is shifting in favour of the latter — viz the recent and growing assisted dying movement. Lives are still cut cruelly short, but fewer than ever before. 

Stats produced by the International Longevity Centre UK, reported in the Sunday Times, may induce in some a sentiment which chimes with that of Leslie Sarony in his song, Ain’t It Grand To Be Blooming Well Dead.

More than a third of babies born today will live to a hundred, the report suggests. It’ll take them til they’re 52 to pay off their university debt and til they’re 61 to pay off their mortgage. Marriage will come later at age 33.

Retirement will not start until they are 70.


Ready, steady, gone.

“Most of us do not want to die in the ICU tethered to tubes — not the quality of life we expect. Yet only 30 percent of us have made arrangements to prevent this from happening. Death and dying is a tough subject for us to broach. Be aware that very few of us will die in our sleep — most have a slow sometimes excruciating decline to death.

“I bet you didn’t know that less than one in seven CPR recipients live to leave the hospital (don’t feel bad, many doctors don’t know this). Other studies show that few elderly patients or patients with cancer live to leave the hospital after CPR. Despite the fact that CPR was developed to resuscitate patients in cardiac arrest, CPR is mandatory to rescue the terminally and critically ill, unless there is an advanced DNR directive. One in five people die in intensive care with the last few months of life being expensive, painful, and futile exercises in medical care.”