ENDURANCE

How can any mentally well human being accept mortality? Is the deterioration of the elderly human brain actually an organic preparation for death? Other old social animals in the wild isolate themselves instinctively before dying. Are our human methods of dealing with aging, death and dying really adaptive, or are they reactions against our own organic instincts?

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My physician annoyed me yesterday during a routine visit. As he gazed at a computer screen with columns and check boxes, he said, "There are just so many tests I can order for you on here." I responded by saying, "At my age, I just want to fix the flat tires as they occur. I am not interested in exploring the great unknown of my functional body." He said, "But you're not old." 

My physician is ten years younger than me. Despite being an oncologist and a specialist in HIV care, he refuses to accept aging research that has shown that having certain cancer treatments and HIV can accelerate the human aging process by as much as 10-15 years. So, by that metric, my 68-yr-old body is actually 78-83 yrs old. I understand that living with this awareness would make his job more difficult, especially when dealing with patients he has known for many years. But isn't that part of being a truly compassionate caregiver?

The word "denial" is overused. It is often used to avoid recognizing that some things about life are terrifying for everyone. Aging, severe illness and death are a few of them.

Living with an ongoing recognition of the inevitability of illness and death, in my opinion, requires a great deal of endurance. That endurance is recognizable in those who have it, regardless of age.

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My work as a phlebotomist and lab analyst in 1970 exposed me to a rare group of leukemic children who were residing in a specialty hospital, part of a Boston medical complex. I was twenty, recently graduated from college.  The children were between 5 and 10 years old mostly. They all had leukemia in various stages of treatment. Some were obviously dying. Others just seemed tired and cranky. Others were just kids, playful and impish.

My first duty every morning, as the newest member of my lab, entailed taking blood samples on the leukemia ward. My crusty female boss, a highly accomplished scientist in her field, was not a person we dared to complain to. So, despite almost nightly bad dreams about this daily task, I soldiered on. 

Most of the children silently held out their arms or fingers for blood to be taken. The younger ones actually smiled when I spoke their names. Many had no hair due to their treatments. Some even had shunts to enable easy access to their circulatory systems. Every day I held back tears as I did my job. I apologized to each one. Some of them tried to comfort me. One child said, "Are you sad, Mister?" and I had to run off the unit to bawl in a stairwell before finishing my rounds. 

These children were teaching me about courage, compassion and endurance. Many of them died during my tenure in that job. My heart sank as I analyzed the daily blood samples and watched their chances of recovery gradually decline. 

After doing that job for a year, I managed to get a science teacher position in a private school for two years.

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I realized I was different from my coworkers. I had been changed by those leukemic children. My tolerance for adolescent characteristics was due to my own youth. However, my students also recognized that I was different. Setting limits in my classes was never very difficult. Nor was having fun with the subject matter.

I found I was impatient with people who took a relatively easy life for granted.  I still am.

After teaching, I went back to health care as a nursing assistant in a small community hospital. This job brought me to the other end of the age spectrum. Most of my patients were old. Back then, patients dying from old age or cancer commonly went to their community hospitals to die. 

I marveled at my own enjoyment of this work. My sleep was peaceful. I got up early and got to work early. The nurses with whom I worked were appreciative of my enthusiasm. Most of them were my parents' age. They were taking care of their parents' generation. 

One patient profoundly guided my work life. A man in his 80's was brought in after a massive stroke which had left him in a coma. His prognosis was terminal. Our unit was not a mass of beeping machines at that time. We still used blood pressure cuffs and mercury thermometers. I was assigned the man in coma. 

I began each of my shifts by bathing the sickest patients. It seemed they needed the attention first after painful and lonely nights. My coma patient was among that group. As I bathed him, I would speak to him. Nobody told me to. I just felt it would be impolite to share physical intimacy with him and not speak. 

Despite being expected to die in a short while, my coma patient remained stable for several weeks. He had been a laborer and was physically fit for his advanced age. Then one morning, after I bathed him, shaved him and groomed his hair, his eyes fluttered open after I posed him in his neatly remade bed. 

His voice was small, weak from disuse. I wasn't expecting to understand him. Most of my stroke patients had lost coherent speech. I moved closer. "Paul," he said, "you are doing what you are supposed to do. You have a gift. Thank you." Then his eyes closed. He died that afternoon.

When I told my older colleagues, veteran nurses in starched whites with school caps, they nodded and grinned. None of them said much in response. The managing nurse of the unit pulled me aside the next day. "Do you appreciate what happened yesterday?" she asked solemnly. I understood she was referring to the coma patient's last words. "I think so, " I said. "Then pay attention to it," she said and walked away.

We never spoke of it again. I applied to nursing school shortly thereafter.

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I have been living with an acute awareness of my own mortality for half a century. It has developed and deepened with my work as a nurse. I have held the hands of very young people, very old people, AIDS patients and cancer patients who yearned to be released from pain. My awareness developed and deepened after delivering the eulogy at my first lover's funeral. My awareness developed and deepened with the deaths of my parents. I held my father's hand after his machines were shut off and his body grew cold. I sat with my unconscious mother on her last living day and evening.

I believe living with an awareness of my mortality has both required and contributed to my psychological endurance. As a young man, I drank, smoked pot and smoked cigarettes, habits all tied to my experiences with death. Then I was trying to defy death by risking my own health. 

In my 30's, I resuscitated a young man who hung himself without any warning in the bathroom of the psychiatric ward where I was on duty. The EMT's lost him on the way to a medical center. That death had a profound effect on me. I stopped drinking and smoking pot. I became much more serious about my relationships. Through that attention to my own life's quality, I grew into what I now consider to be responsible adulthood. 

Any endurance I have developed for the continued aging which lies ahead will not keep me from dying, obviously. If I do not become demented or (more luckily) drop dead, it will, at best, allow me to participate in that process with some independence, dignity and appreciation of anyone who helps me along. And perhaps that will be my contribution to the lives of those who have known me.