Jodi, the daughter of a dear old patient of mine, called to discuss her mother’s misery. Her mother is in her 80s and no longer enjoys life. She has a bad heart, bad lungs and a very bad back. Her back pain keeps her awake at night. She moves from the bed to the chair and back again. She can’t get comfortable doing anything. The surgeons are helpless; she is not a candidate for any procedure. The pain specialists are running out of tricks. How old is too old? Only the patient who has lived too long really knows.
In olden times (the first 10 years of my practice), patients died from natural causes, such as pneumonia, heart attacks or heart failure, kidney disorders and cancer. Over the last 30 years, my profession has gotten much better at rescuing people from death. Death is reversible. Often, the patient who would have died just 20 years ago gets a new lease on life. Others are not so lucky.
Sometimes the cost of rescuing someone from death is tragic. It is as if we are playing tug-of-war, with death gripping one side of you and life and your doctors holding onto the other. Sometimes we only bring back part of you. During a heart attack, heart muscle dies. If enough dies, the quality of your life can be seriously lessened. “Quality of life” is a term doctors often use. Like the question, “How old is too old?”, “quality of life” is in the eyes of the beholder. While one patient is content to lie in a nursing home bed and count ceiling tiles, another is not.
So, what is the answer? How old is too old? What does quality of life mean? Since only you can answer that question, your doctor and family need to know what you want. Just as “Doc, did I kill my father?”, discussed the importance of “advanced directives” and their ability to speak for you when you no longer can, sharing your thoughts about how you want to live your life and how you want to die with your family and physician can help them help you through tough times. As we age, we all come closer to death. An important part of life is facing that prospect, answering the tough questions, knowing when to hold on and knowing when to let go.
If the answer to “How old is too old?” is now, hospice can help. Hospice is not just for cancer patients. Hospice helps people who are dying do so in dignity. If the answer is “not yet”, then make sure your care team knows that they should do everything they can to support you.
How old is too old? You tell me!