dying

AUTUMN LEAVES

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“Aren’t they beautiful!” says Bill.  “They’re just beginning to turn color.”

The autumn leaves of New England are indeed celebrated for their glorious yellows, oranges and reds during the week or two in early October when they flame into brilliant color before falling to the ground to be swept up, bagged and disappear. (Or else to disintegrate into mulch in heavily forested preserves.) I hear enterprising touring companies in England even organize one-week trips abroad to come look.  (Although in my view that’s a waste of a cross-Atlantic journey.  How long can you look?)

We live three states south of Vermont and New Hampshire, where most of the publicized beauty takes place. So what happens here happens several weeks later.  But Bill’s right. (Even though his enthusiasm for the beauty of it is perhaps a trifle premature.)  It’s beginning.  Now that he’s brought my attention to it, I notice it whenever I step out the door:

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It’s also across the way, where our neighbors live, and where it’s even more pronounced:

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Should I be glad we”re soon to have a feast for the eyes whenever we raise them upward?  Or is there something melancholy in this last gorgeously defiant display before the fading of the year?

I suppose it depends on where you stand on life’s arc and how steady your footing.  Now that I’m 83 and — yes, let’s be candid — on life’s downward chronological slope, I can’t help feeling somewhat sad when I see all this dying beauty. And also can’t help hoping I’ll still be around to see it (however sad my feelings) when it returns again and again.

So here’s to years and years more autumn leaves!  Bring them on in all their splendor!  I’m ready.

Autumn on McComb Road

HOW WE DIE

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Dr. Sherwin B. Nuland died on Monday, March 3, 2014, at his home in Hamden, Connecticut.  He was 83.  The cause of his death was prostate cancer.

I had never heard of Dr. Nuland until news of his death was reported in the main section of The New York Times.  I don’t as a rule make a practice of reading obituaries, so I might never have learned about this man if he had not been important enough in his field for the Times editors to take him out of the obituary section and place him in the news.  They did it because after he had retired as a surgeon at Yale-New Haven Hospital and as clinical professor of surgery at Yale University, where he also taught bioethics and medical history — he wrote a celebrated book.  It is called How We Die.

How We Die won the National Book Award for nonfiction in 1994 and was a finalist for the Pulitzer Prize in nonfiction in 1995.  It has sold 500,000 copies worldwide, and continues to sell.  At a time when the goal of medicine is to prolong life as long as possible by means of aggressive treatments that usually intensify and prolong the suffering of patients while depriving them of an easier death, Dr. Nuland’s goal was to demythologize death, to make it less frightening, and to encourage the dying to make decisions regarding their care with more reasonable expectations.

In July I will be 83. Having nearly arrived at that age, this description of the book was necessarily of interest to me — of sufficient interest that I pulled my ostrich head from the sand long enough order it from Amazon.  Not having yet received it and read it, or read as much of it as I can bear, I now fall back on the obituary itself to tell you more of what’s in it.  [It appeared in print on March 5, 2014 on page A20 of the New York edition of the Times.]

To Dr. Nuland, death was messy and frequently humiliating, and he believed that seeking the good death was pointless and an exercise in self-deception.  He maintained that only an uncommon few, through a lucky confluence of circumstances, reached life’s end before the destructiveness of dying eroded their humanity.

‘I have not seen much dignity in the process by which we die,’ he wrote. ‘The quest to achieve true dignity fails when our bodies fail.’  [Italics added.]

In ‘How We Die,’ published in 1994, Dr. Nuland described in frank detail the processes by which life succumbs to violence, disease or old age.  Arriving amid an intense moral and legal debate over physician-assisted suicide — perhaps the ultimate manifestation of the concept of a dignified death — the book tapped into a deep national desire to understand the nature of dying, which, as Dr. Nuland observed, increasingly took place behind the walls of the modern hospital….. The issue [of physician-assisted suicide] has only intensified since the book was published, and has been discussed and debated in the medical world, on campuses, in the news media and among politicians and government officials engaged in health care policy.

‘The final disease that nature inflicts on us will determine the atmosphere in which we take our leave of life,” he wrote, “but our own choices should be allowed, insofar as possible, to be the decisive factor in the manner of our going.’

Beyond its descriptions of ruptured embolisms, spreading metastases and bodily functions run amok, ‘How We Die’ was a criticism of a medical profession that saw death as an enemy to be engaged, frequently beyond the point of futility.

In chiding physicians, Dr. Nuland pointed the finger at himself, confessing that on more than one occasion he persuaded dying patients to accept aggressive treatments….One of those patients was his brother, Harvey, an accountant who died of colon cancer in 1990 after receiving an experimental treatment with no reasonable chance of success.

Looking back on that episode, Dr. Nuland wrote that he had mistakenly tried to give his brother hope, failing to acknowledge that disease, not death, was the true nemesis. [Italics added.]

…. In its concluding chapter, Dr. Nuland confessed that he, like many of his readers, desired a death without suffering ‘surrounded by the people and the things I love,’  though he hastened to add that his odds were slim.  This brought him to a final question.

‘And so, if the classic image of dying with dignity must be modified or even discarded,’ he wrote, ‘what is to be salvaged of our hope for the final memories we leave to those who love us?  The dignity we seek in dying must be found in the dignity with which we have lived our lives.’

Dr. Nuland’s death was reported by his daughter, Amelia Nuland. She added that he himself had said he was not ready for his own death. “He told me,” she said, ” ‘I’m not scared of dying, but I’ve built such a beautiful life, and I’m not ready to leave it.’ ”

If you want to know more of what’s in Dr. Nuland’s book without buying it yourself, let me know, so I can revisit this painful (but ultimately unavoidable) subject another time — after I’ve read it, or at least some of it.

Getting old isn’t always a blog-ful of laughs.

WORDS FROM THE WISE

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Because it’s good blog etiquette to repay visits, I occasionally find myself at the blog of a twenty-something.  That’s a surprise.  When I began, I thought a blog with “Getting Old” in its title would be of interest, if any, only to boomers and beyond.  Apparently not always so.

The other surprise, which comes after I make an encouraging comment during the visit, is that the reply invariably expresses gratitude that someone with so much experience and wisdom has said something favorable.

Oh my!  Living a long time does, I suppose, provide some experience of what worked, and what didn’t, in one’s own life.  Which the person who lived the life can learn from or not, as the case may be.  But “wisdom?”   [The word always makes me think of Confucius.]  It’s what you think other people have when they’re older than you.

As my father used to say, “I have news for you.”  There isn’t any such thing. The only wisdom we oldsters might possibly offer the young (if they asked, which they don’t) is, “Don’t be such a damn fool.”   But who’s to say who’s a fool?

So lacking any wisdom of my own, even after all these years — I have looked elsewhere to find it for these younger visitors who expect it of me.  Looked — to be specific — in The Beacon Book of Quotations by Women, compiled by Rosalie Maggio. (Beacon Press Boston © 1992).  I guess I sort of agree with most of the ones I’ve chosen. Well, sometimes I do.  But not always. That’s just the way it is with wisdom. Sometimes it applies, sometimes it doesn’t. And sometimes, who knows?  Holler when you’ve had enough.

[On Experience]

“Experience is what you get when you’re looking for something else.”  Mary Pettibone Poole, A Glass Eye at a Keyhole (1938)

“Experience is a good teacher, but she sends in terrific bills.” Minna Thomas Antrim, Naked Truth and Veiled Allusions (1902)

“A rattlesnake that doesn’t bite teaches you nothing.” Jessamyn West, The Life I Really Lived (1979)

“Experience isn’t interesting till it begins to repeat itself — in fact, till it does that, it hardly is experience.”  Elizabeth Bowen, The Death of the Heart (1938)

“I have come to the conclusion, after many years of sometimes sad experience, that you cannot come to any conclusion at all.” Vita Sackville-West, In Your Garden Again (1953)

[On Complacency]

“Unhurt people are not much good in the world.”  Enid Starkie. In Joanna Richardson, Enid Starkie (1973)

[On Dying]

“She’d been preoccupied with death for several years; but one aspect had never before crossed her mind: dying, you don’t get to see how it all turns out.”  Anne Tyler, Dinner at the Homesick Restaurant (1982)

[On Concealment]

“There is nothing that gives more assurance than a mask.” Colette, My Apprenticeships (1936)

[On Life]

“Life itself is a party; you join after it’s started and you leave before it’s finished.” Elsa Maxwell, How to Do It (1957)

“Life seems to be a choice between two wrong answers.” Sharyn McCrumb, If Ever I Return, Pretty Peggy-O (1990)

“It begins in mystery, and it will end in mystery, but what a savage and beautiful country lies in between.” Diane Ackerman, A Natural History of the Senses (1990)

“You are dipped up from the great river of consciousness, and death only pours you back.” Dorothy Canfield Fisher, The Bent Twig (1915)

“Life offstage has sometimes been a wilderness of unpredictables in an unchoreographed world.” Margot Fonteyn, Margot Fonteyn: Autobiography (1976)

“It’s not true that life is one damn thing after another — it’s one damn thing over and over.” Edna St. Vincent Millay, in Allan Ross Madougall, Letters of Edna St. Vincent Millay (1952)

“Life is something to do when you can’t get to sleep.” Fran Lebowitz, in Observer (1979).

“That it will never come again / Is what makes life so sweet.” Emily Dickinson (c. 1864), published in Bolts of Memory (1945)

“Life is better than death, I believe, if only because it is less boring, and because it has fresh peaches in it.” Alice Walker, “Only Justice Can Stop a Curse,” In Search of Our Mothers’ Gardens (1983)

[On Lovers]

“The absolute yearning of one human body for another particular one and its indifference to substitutes is one of life’s major mysteries.” Iris Murdoch, The Black Prince (1973)

“In a great romance, each person basically plays a part that the other really likes.”  Elizabeth Ashley, in San Francisco Chronicle (1982)

“Secretly, we wish anyone we love will think exactly the way we do.” Kim Chernin, in My Mother’s House (1983)

“This was life, that two people, no matter how carefully chosen, could not be everything to each other.” Doris Lessing, “To Room Nineteen,” A Man and Two Women (1963)

“No partner in a love relationship [whether homo- or heterosexual] should feel that he has to give up an essential part of himself to make it viable.” May Sarton, Journal of Solitude (1973)

[On Lying]

“Never to lie is to have no lock to your door.” Elizabeth Bowen, The House in Paris (1935)

[On Marriage]

“The deep, deep peace of the double-bed after the hurly-burly of the chaise-longue.” Mrs. Patrick Campbell, on her recent marriage, in Alexander Woollcott, While Rome Burns (1934)

“The very fact that we make such a to-do over golden weddings indicates our amazement at human endurance.  The celebration is more in the nature of a reward for stamina.” Ilka Chase, Free Admission (1948)

“A man in the house is worth two in the street.” Mae West, in Belle of the Nineties (1934)

[On Memory]

“Sometimes what we call ‘memory’ and what we call ‘imagination’ are not so easily distinguished.” Leslie Marmon Silko, Storyteller (1981)

“I think, myself, that one’s memories represent those moments which, insignificant as they may seem, nevertheless represent the inner self and oneself as most really oneself.” Agatha Christie, An Autobiography (1977)

[On Men]

“The only time a woman really succeeds in changing a man is when he’s a baby.” Natalie Wood, in Bob Chieger, Was It Good For You, Too? (1983)

[On Survival]

“Misfortune had made Lily supple instead off hardening her, and a pliable substance is less easy to break than a stiff one.” Edith Wharton, The House of Mirth (1905)

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That’s about it for today.  Which one did you like best?  Let us know.

Don’t ask me which I like best, though.  I vote for cats.

“Dogs come when they’re called; cats take a message and get back to you.” Missie Dizick and Mary Bly, Dogs Are Better Than Cats (1985)

 [Ed. Note: Dogs are definitely not better. Just different.]

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