Sunday, August 12, 2007

The Dance of Death

I was talking about death with a brilliant young doctor at a party last night. He said the old should just go home and sit down as 'everything is designed to fail at the same time', so fixing one failing system, most commonly the heart, was a very temporary expedient as another was bound to fail soon afterwards. This gave a peculiar poignancy to the nearby spectacle of the late middle-aged groovers who were, as usual, the only occupants of the dance floor, the young having better things to do. Meanwhile, following our conversation, Nick Cohen writes this morning (while kindly plugging my book) about the newly discovered disparities between the life expectancies of the rich and the poor. In rich parts of the borough of Westminster, for example, a wealthy 65-year-old woman can expect to live to 96 and a poor one to 77. The usual suspects - smoking, bad food, lack of exercise - are blamed, but I think, as does Cohen after talking to me, the most important factor is access to the best health care. In Britain we may have thought that the NHS democratised health care and that may once have been true. But now the rich know how to play the system. They master the variety and complexity of what is available so they can demand more from the NHS and, when that fails, they can go private. As a result, parts of Britain are rapidly becoming like Martha's Vineyard or Palm Beach, enclaves of the rich, old and healthy. This division is going to grow ever more extreme as it is now clear that, in a number of areas, medical science is making significant progress after a long period of stasis. These will produce expensive treatments that the rich will demand and pay for. The brilliant young doctor, therefore, may soon find the rich old are not, with good reason, going to sit down and wait for the next system to fail.
The trouble is, of course, we don't really know what to do with them when they stubbornly persist in Staying Alive - one of the songs that, inevitably and poignantly, always causes the most enthusiastic bopping among middle-aged groovers. Today, once again, we hear of shabby treatment of the old in care homes. The truth is that the young (meaning anybody under 50), however well-meaning, are impatient of or disgusted by the old. And they are confirmed in their prejudice by the unfortunate fact that even the most expensive modern medicine, though it may keep you alive, does not, as yet, rejuvenate. Once you're old, you stay old. Most damagingly, cognitive ability declines and nothing more effectively encourages impatience in the young  than elderly forgetfulness or mental incompetence. They might as well, runs the unspoken thought, be dead. This, I suspect, is one reason why the rich old cluster in their enclaves. They are seeking relief from the familiar, withering judgments of their condition, from the dance floor surrounded by the wincing and giggling young.


  1. And also because our whole lives so so defined by the particular youth culture of our generation. Today's young will, of course, embarrass their children and grandchildren (and, ever more frequently, great-grandchildren) with their red-faced bopping to the Arctic Monkeys and whatnot.

    The other evening, in the depths of the high-numbered cable TV channels, I happened upon a re-run of 80s gameshow 3-2-1. Gerry Marsden was performing 'How Do You Do It?' to an audience set of balding boomers. Nostalgia about nostalgia - it was dizzying. He's still at it, and so are they. Is there anything more loaded with bathos than nostalgic pop shows?

  2. Great Sunday morning piece. Thinking of slinking off to slit my wrists to save your 'brilliant' young doctor any bother, God bless him.

  3. Never mind the Arctic Monkeys, Brit. Just yesterday I was trying to imagine what the next couple of generations are likely to make of Grannie's tattoos.

    Just for the sake of argument, let's assume all those excited proponents of extended life can pull it off and that the wonders of science will give us all many more years of relative good physical and mental health. Apart from some desultory challenges to mandatory retirement laws, I see little evidence of anyone suggesting anything useful we will be expected to do with them or, more to the point, any obligations we will be expected to assume to earn our keep. Nobody says: "Great, a second round of child-raising" or "Now you can run the hockey arena and help care for the great grand-kids." Life will be extended, but not, apparently, the years of work and duty. All that is held out is the spectre of many more self-focussed retirement years in a Florida condo or wherever.

    Then there will be the need to hang onto huge amounts of capital to cover the high cost of dying over several years and chronic care. We're a long way from those Victorians went for a walk in November, took a chill and passed on three days later. Grannie doesn't dare pass it down to the generations who need it for education or whatever because she can no longer count on not being exiled to a home if she does. And having been taught by Grannie to live for themselves and "take charge" of their lives, her kids will be increasingly inclined to do, telling themselves it is "for the best". It's very hard to see it working for long without some neo-Calvinist spirit of duty and self-abnegation arising as well as a renewed ethic of inter-generational dependency.

    Bryan, maybe one of the reasons for the earlier deaths of working folks is that, however good the medical care, they see only more work ahead. "I gets weary, and sick of trying...". Is your book available in North America yet?

  4. i remember walking down a street with a friend 20 years older than me; we were accosted by an old woman in a doorway, whose friend had fallen, and couldn't get up. We went into the house, which reeked & had piles of newspapers everywhere, & helped this infirm old lady up, and then went on our way. We were silent for a while, then i said, quite seriously, "do you want me to kill you if you end up like that?" My friend is normally averse to anything resembling violence or seriousness but said, seriously, "yes."

    When not skiving, i spend my working day typing up physiotherapists' reports, which are inevitably often to do with people in their 80s and 90s. They seem only biologically alive: their emotions dim and confused, their cognition impaired, memory gone. Their biological life is extended for years by medicine & care.

    i guess because i don't see death as a bad thing at all, i think people should have the option to take a pill to terminate themselves. It should be a decision, like writing a will, that one can make when still lucid, to be effected on one's behalf perhaps, under certain conditions, e.g. memory or mobility gone, or cognition impaired beyond a certain point.

    The anaethema against suicide & euthanesia suggests that we have no real sense of what it is to be human, beyond the biological. If it is in some way unspeakably monstrous & evil to terminate the irrecoverably braindead or moribund, then why isn't it so to kill animals? What separates the braindead from a sheep?

  5. I think it was Robert Lowell who said that if all of us had a dial on our wrist that we could turn at any time and be instantly, painlessly dead, virtually all of us would use it, and sooner rather than later.
    As for the sheep-braindead question (a no-brainer? arf arf), isn't it simply that, being human, we are bound to regard ourselves as having a special, i.e. human quality and all attendant rights and privileges. If sheep were running the world (rather than only Wales and New Zealand), they'd see things their way and have no qualms about 'putting us down'.

  6. This post reminds me of the summers I spent as a volunteer in nursing homes in Miami, Florida, as a teenager. I worked in two, one private and one public. The private one was more attractive and reeked somewhat less of urine and Pinesol, but it still followed the inexorable script of the poorer public one: Old people came in compos mentis and apprehensive, but within weeks they lost their minds and became as nutty and despairing and incontinent as everyone else.

    This was the most deeply depressing volunteer work I ever did, and I did it because of how much I loved my old grandmother, with whom I spent my summers in Miami. She was in her 80s then and encouraged me to work at the homes as they were within the realm of her own volunteer projects. Now I wonder if there was something she wanted me to see?

    Luckily, she never lost it, lived on her own until way in her 90s (still playing bridge thrice-weekly), and then with my aunt until, after a brief illness, she died.

  7. For the same reason, one should never, ever, have one's washing machine fixed.

  8. death and taxes - the rich will evade them both.

  9. My father, who was insane, evil, and a good GP, once explained that he'd never referred me to a psychiatrist because i'd be instantly banged up in the loony bin. He expanded, with his usual remorselessness: "Wellll, egh, once you go in, you never come out! Don't get better, eghh! Only worse! Heh heh heh!"

    Despite having no psychiatric qualifications, he had run a psychiatric ward in the 60s, feeding terminal loons LSD and reporting their ravings, and spoke from experience. i guess loony bins have this in common with old people's homes: you deteriorate once inside, because your society becomes, well, the insane and moribund. As the doctors feed you LSD, too, your sanity inevitably erodes somewhat.

    We really need a more benevolent system, such as sending the insane and old out to fight monsters, Beowulf style. i'm all for that. People often call my insane & sociopathic & evil: i'll happily be sent out into the wilds to fight the Predator.

    To quote Sgt Barnes from Platoon: "we all gotta die some time."

  10. We treat our old people like shit. You slave your guts out bringing up kids, providing for them, worrying about their welfare and the minute you hit 70 they repay you by flinging you into what is effectively a prison with wallpaper and carpets. And nurses frankly are worse than prison guards.

  11. Oh, Elberry! You are confecting, I believe, but you are pretty funny. Do read the Cavendish chapters of David Mitchell's "Cloud Atlas" and I think you will be laughing VERY hard.

    Also, on the post a few days back about British TV & Yorkshire, I added a post to tell you a joke I think you will enjoy. It involves sheep and Scotsmen.

  12. thank you, Susan, glad to encounter someone as wary of the Scots as myself. Perhaps it was going to uni at Durham, a fort built to defend against their red-haired incursions.

    i'm not actually making the LSD thing up, or the 'you'd be locked up' remark - my father also helped a policeman resolve a hostage situation by injecting a gunman with something from his bag of tricks; he was also attacked by junkies & psychos; bitten by a cobra; had visions of his ancestors; and when he fell asleep driving home from work at dawn his dead ancestors would routinely pilot his car from one motorway to another.

    A true GP, he took it all in his stride: he would wake up on a wholly different motorway, the spirits moving the wheel around before his permanently bloodshot eyes, and whereas you or i would scream and go mad, he, having already gone mad many years ago, would shrug and take over the wheel, directing it to the nearest Little Chef for a huge breakfast of bacon and eggs.

    In many ways he was a difficult father.