My local community theatre recently produced The Belle of Amherst. The actress playing Emily Dickinson brilliantly captured the wistfulness of the poet as I had always imagined her from looking at her daguerreotypes. Emily reads this poem in the second act.
Because I could not stop for Death —
He kindly stopped for me —
The Carriage held but just Ourselves —
We slowly drove — He knew no haste
And I had put away
My labor and my leisure too,
For His Civility —
We passed the School, where Children strove
At Recess — in the Ring —
We passed the Fields of Gazing Grain —
We passed the Setting Sun —
Or rather — He passed Us —
The Dews drew quivering and Chill —
For only Gossamer, my Gown —
My Tippet — only Tulle —
We paused before a House that seemed
A Swelling of the Ground —
The Roof was scarcely visible —
The Cornice — in the Ground —
Since then — ’tis Centuries — and yet
Feels shorter than the Day
I first surmised the Horses’ Heads
Were toward Eternity —
This week, Death kindly stopped for a colleague of mine and a former patient. Both these people had lived good lives, filled with purpose and meaning, and replete with love and joy. In their last days they had also struggled with shuffling off their mortal coil. In stopping for them, Death ended what those of us who knew them considered suffering.
One of the nascent truths of aging in the 21st Century is that Death is waiting longer and longer to stop. Not all that long ago life expectancy was a mere 64 or 65 years. Since I will be 66 in a few weeks, that benchmark seems awfully young. Because I work with older adults, I have seen the incredible variability in functioning and staying engaged that cannot be reduced to chronological age. I know people who are in the 80’s who are younger than people in their 60’s!
Chronological age is only one measure of “age-ing”. Birth is the onset of life, and Death is the terminus. What happens in between needs to be measured by more than just the passage of time! As a culture we seem to place great value on the first part of the arc. For whatever reason, we have developed a bias against getting old. Because that bias is focused on youth and staying young, aging has become something to put off, delay, forestall, and deny. As the inevitability of aging and death occupies more of our consciousness, fear and loathing frequently appear.
Ours is not a culture that values old people or embraces death as a natural extension of life. Yes, there are those who are aware and many who have written about it (Emily Dickinson, op cit), but these are not common. One of the consequences of having so many Boomers aging en masse is that we will collectively be forced into reckoning with this. I suspect it will be a huge shift in consciousness, perhaps akin to the Age of Aquarius.
Denying that we will die just doesn’t seem to be a useful strategy for me. Adding years to my life, if that life is filled with physical limitations, pain, or suffering, doesn’t make sense as a goal. Sustaining life, when there is no hope of recovery seems cruel. I don’t have any attribution for this quote, but it brings this topic into perspective. “Nobody gets off this planet alive.”
Because of the age group I work with, I get to have lots of conversations about quality of life when fewer years remain. I am so grateful for these conversations. What I have learned is that there are very few places where death can be talked about frankly and openly. Here in the United States, we have, in just a few generations, taken death out of the house and sequestered it in hospitals and nursing homes. Dying in a hospital is a clinical protocol. Dying in a nursing home is less formal, but still filled with strangers. One alternative gaining in popularity is hospice.
As it has evolved, hospice in the United States today is actually an extension of our medical system. Those who are eligible for Medicare will find services provided by hospice are reimbursed including pharmaceuticals (for comfort care), medical equipment, and access to care. Hospice offers a compassionate alternative to the “full code” approach of keeping someone alive using all means available.
In order to access these services, you need to be diagnosed with a terminal illness that has a life expectancy of 6 months or less. Few people, however, access hospice early on. Sadly, (at least in my mind), the average hospice stay was only 23 days back in 2015. As we approach the end of our shelf life, odds are that more and more of us will be living with chronic, life-limiting illnesses. There are not enough beds in our hospitals and nursing homes to care for us. I can say with some assurance that more hospitals and nursing homes will not be built to accommodate the Boomer surge. Given that, it makes practical sense to explore other options.
I cannot stress enough the value of beginning a conversation about what is important to you as age, especially as it concerns how you want to die. One essential piece of this is completing a POLST. (https://polst.org/). This will let your family members, friends, emergency personnel and treatment providers know and understand your wishes.
If you are like Emily Dickinson, you may not be stopping for Death. But Death will, kindly or unexpectedly, someday stop for you.