I've reached the age where I don't produce much that others would consider all that valuable. I do my volunteer work, but it doesn't add up to 40+ hours/week. It is far less skilled than the work I once did, removing, rearranging, rebuilding and resurfacing things on the human body. I think about how many years are left and keep scanning for the next "big thing" that will fill those years in a "productive fashion". I pray that I'll die with my boots on, rather than accept years of increasingly intense support for a life that is further and further restricted. I have been witness to a few medically assisted and planned exits. I've spoken with a few persons who are actively pursuing the permission and even more who have contemplated it.
I've supervised apprentices all of my working life. When I stopped working 60+ hours/week and stopped taking home a paycheck, suddenly, most of the world was no longer interested in what I had learned. I am still learning, perhaps not at the rate I once was, but as long as the brain cells fire, new knowledge creeps in.
I know that " extending life" occurs at the back end. One doesn't prolong one's youth. If you're lucky, longevity increases the length of your working career instead of simply increasing the length of your senescence. Postponing debility and senescence is a laudable goal. Once we hit the nursing home, it's time to ask whether our we are truly living or simply waiting to die. I subscribe to a few blogs and like responding; I'm sometimes amazed to learn how old some of my co-respondants are. They have obviously not stopped living, but they probably have stopped skiing, running, building houses, etc. In this post-modern age, being an active part of conversations where younger people also congregate may be the proper frontier of increasing longevity. As our virtual lives grow, perhaps we can learn to honor and appreciate those who remember "how it was back then".
Well said - you are still incredibly sharp :-). When you retire you lose an identity that is meaningful and well earned. You go from He/She is to he/she was. I wanted to be a doctor since I was very young and I work daily to remain on the cutting edge of that career. Soon my ability to contribute will end. Then what? I fear that future and am not sure I want to extend my elder years unable to contribute, visiting doctors regularly addressing my age-induced diseases. I have a close friend (retired ED doc) well into his 90’s who is mentally sharp (amazing really), yet lies in SNF bed awaiting to die. Modern medicine extended his life, but for what? I have my medical students and residents ask each elderly patient they see to find out something about their lives. When asked, their eyes widen. A smile forms and stories start flowing. Life is good, until it’s not. Thanks.
As an inpatient nurse I enjoy working with the many elderly patients that are admitted. Often they need suppirt to get through a CHF exacerbation or a bout of pneumonia so the can get back to a life they enjoy. However, there are so many cases where we are performing miserable interventions in order to lengthen a miserable existence. Putting a feeding tube and catheter in a patient with dementia, which then requires restraints so that the patient won't pull them out for instance. Once they are stable we send them back to a nursing facility. Having to code one of these frail human beings feels cruel. I had to do this recently and found it so sad that the woman was not able to pass peacefully surrounded by loved ones. The family took comfort in knowing they had done everything possible. I did not.
Ed, so happy to picture your 86 year old father-in-law on a sunny golf course!
I believe EM practice drops us into concentrated life with babies and grandpas and everything in between and the joy of it always came from addressing the problem,skillfully managing the bedlam and recognizing the awesome responsibility of it all. The life and death decisions are important. Yes. But conversation, a turkey sandwich and toenail clipping for a wizened old gentleman living alone feels more important sometimes. Eyes light up.
We do devalue our elders. My mom lost her mom early and she would dress up my sisters and I to visit ladies at the nursing home. We painted their nails and lotioned them up with a hand massage, dressed in our spring coats. Mom would ask them questions and hear about their lives.
My daughter is a vet. She cries with families every day as they love their pet too much to let them suffer.
I just always tried to remember the awesome responsibility of holding a valued life in my hands. I fear so many other things are at play these days...money, resources, time, data, contracts, reviews and customer service, incentive compensation...pushing and pulling.
Sadly, the wisdom of the aged is scarcely recognized anymore. Our eyes and ears are filled with memes, twitter messages, tiny video snippets, instagram photos, Youtube videos and Netflix entertainment. We have all (yes, even the elderly) succumbed to abbreviations as a substitute for conversation. We pick and peck at a keyboard in lieu of writing in our own unique script, in any color of the rainbow. We avoid talking; instead we load our communication devices with invitations to "leave a message" or "text first if you're not on my contact list". We have stopped eating together at conventional mealtimes, are unlearning how to celebrate holidays. Our traditional gathering places and venues are suffering a slow death of waning participation. How is wisdom passed other than by stories? How are stories received if not by conversation over the remains of a meal? If the generations don't intermingle, where is the continuity? Each generation is left to learn by experience, sometimes bitter, what could have been learned by listening to the counsel of elders. We've substituted curated wisdom for instant access to endless unfiltered information, without a "truth" filter. It's rapid-fire, amazingly clever and yet it leaves us lonely, bereft, lost in a crowd of people who don't tune into one another.
As a retired hospice chaplain, I find that my bias is toward emotional and spiritual quality of life...more than prolonging life as such or emphasizing activity. People are lonely. People are abandoned. A half hour of eye contact and conversation can be tremendously healing.
I've reached the age where I don't produce much that others would consider all that valuable. I do my volunteer work, but it doesn't add up to 40+ hours/week. It is far less skilled than the work I once did, removing, rearranging, rebuilding and resurfacing things on the human body. I think about how many years are left and keep scanning for the next "big thing" that will fill those years in a "productive fashion". I pray that I'll die with my boots on, rather than accept years of increasingly intense support for a life that is further and further restricted. I have been witness to a few medically assisted and planned exits. I've spoken with a few persons who are actively pursuing the permission and even more who have contemplated it.
I've supervised apprentices all of my working life. When I stopped working 60+ hours/week and stopped taking home a paycheck, suddenly, most of the world was no longer interested in what I had learned. I am still learning, perhaps not at the rate I once was, but as long as the brain cells fire, new knowledge creeps in.
I know that " extending life" occurs at the back end. One doesn't prolong one's youth. If you're lucky, longevity increases the length of your working career instead of simply increasing the length of your senescence. Postponing debility and senescence is a laudable goal. Once we hit the nursing home, it's time to ask whether our we are truly living or simply waiting to die. I subscribe to a few blogs and like responding; I'm sometimes amazed to learn how old some of my co-respondants are. They have obviously not stopped living, but they probably have stopped skiing, running, building houses, etc. In this post-modern age, being an active part of conversations where younger people also congregate may be the proper frontier of increasing longevity. As our virtual lives grow, perhaps we can learn to honor and appreciate those who remember "how it was back then".
Well said - you are still incredibly sharp :-). When you retire you lose an identity that is meaningful and well earned. You go from He/She is to he/she was. I wanted to be a doctor since I was very young and I work daily to remain on the cutting edge of that career. Soon my ability to contribute will end. Then what? I fear that future and am not sure I want to extend my elder years unable to contribute, visiting doctors regularly addressing my age-induced diseases. I have a close friend (retired ED doc) well into his 90’s who is mentally sharp (amazing really), yet lies in SNF bed awaiting to die. Modern medicine extended his life, but for what? I have my medical students and residents ask each elderly patient they see to find out something about their lives. When asked, their eyes widen. A smile forms and stories start flowing. Life is good, until it’s not. Thanks.
As an inpatient nurse I enjoy working with the many elderly patients that are admitted. Often they need suppirt to get through a CHF exacerbation or a bout of pneumonia so the can get back to a life they enjoy. However, there are so many cases where we are performing miserable interventions in order to lengthen a miserable existence. Putting a feeding tube and catheter in a patient with dementia, which then requires restraints so that the patient won't pull them out for instance. Once they are stable we send them back to a nursing facility. Having to code one of these frail human beings feels cruel. I had to do this recently and found it so sad that the woman was not able to pass peacefully surrounded by loved ones. The family took comfort in knowing they had done everything possible. I did not.
Ed, so happy to picture your 86 year old father-in-law on a sunny golf course!
I believe EM practice drops us into concentrated life with babies and grandpas and everything in between and the joy of it always came from addressing the problem,skillfully managing the bedlam and recognizing the awesome responsibility of it all. The life and death decisions are important. Yes. But conversation, a turkey sandwich and toenail clipping for a wizened old gentleman living alone feels more important sometimes. Eyes light up.
We do devalue our elders. My mom lost her mom early and she would dress up my sisters and I to visit ladies at the nursing home. We painted their nails and lotioned them up with a hand massage, dressed in our spring coats. Mom would ask them questions and hear about their lives.
My daughter is a vet. She cries with families every day as they love their pet too much to let them suffer.
I just always tried to remember the awesome responsibility of holding a valued life in my hands. I fear so many other things are at play these days...money, resources, time, data, contracts, reviews and customer service, incentive compensation...pushing and pulling.
You may not be able to ski any more, but that doesn't mean your life is on hold or empty. There are many things the elderly can do. Don't focus on what they can't do and label them useless. Hans Duvefelt in his blog suggested healthcare needed to hire professional grandmothers <https://acountrydoctorwrites.blog/2023/02/10/what-healthcare-needs-today-is-professional-grandmothers-to-offload-burned-out-doctors-by-delivering-common-sense-advice-that-medical-assistants-arent-allowed-to-give/>. :)
Sadly, the wisdom of the aged is scarcely recognized anymore. Our eyes and ears are filled with memes, twitter messages, tiny video snippets, instagram photos, Youtube videos and Netflix entertainment. We have all (yes, even the elderly) succumbed to abbreviations as a substitute for conversation. We pick and peck at a keyboard in lieu of writing in our own unique script, in any color of the rainbow. We avoid talking; instead we load our communication devices with invitations to "leave a message" or "text first if you're not on my contact list". We have stopped eating together at conventional mealtimes, are unlearning how to celebrate holidays. Our traditional gathering places and venues are suffering a slow death of waning participation. How is wisdom passed other than by stories? How are stories received if not by conversation over the remains of a meal? If the generations don't intermingle, where is the continuity? Each generation is left to learn by experience, sometimes bitter, what could have been learned by listening to the counsel of elders. We've substituted curated wisdom for instant access to endless unfiltered information, without a "truth" filter. It's rapid-fire, amazingly clever and yet it leaves us lonely, bereft, lost in a crowd of people who don't tune into one another.
As a retired hospice chaplain, I find that my bias is toward emotional and spiritual quality of life...more than prolonging life as such or emphasizing activity. People are lonely. People are abandoned. A half hour of eye contact and conversation can be tremendously healing.