Sing Out, Dr. Ezekiel Emanuel

I don’t know how I missed Dr. Ezekiel Emanuel’s essay “Why I Hope to Die at 75.” I just happened to find the PBS link to Judy Woodruff’s interview with him about the provocative article.

So my wife, Sena, and I were talking about it this morning and she said Dr. Emanuel’s idea made her think of the 1971 movie, “Harold and Maude.” I remember this as a Freshman English class field trip to an Austin, Texas movie theater, led by my very idiosyncratic teacher, Artie Hicks.

Maude’s cutoff age was 80, as you probably recall. Harold was horrified when he learned of Maude’s suicide, though he’d simulated suicide several times during the movie.

But to be fair, there are critically important differences between Maude’s view and Emanuel’s position on aging. I have wondered about my own career trajectory as a consulting psychiatrist.

My firetruck

An early record of Dr. Amos’s decline into his dotage–a sort of second childhood.

 

I’m a doctor and I’ve seen a lot of what modern medicine can do for people. I’ve also seen what it can do to them. That’s probably just an example why many health care professionals think Dr. Emanuel has got it right. After he turns 65 he’ll never have another colonoscopy. I’ve had one colonoscopy, a kind of 50th birthday present. I’m not going to tell you how long ago that was. And I can’t tell you how it went because I got delirious during the procedure and stayed that way long enough that I vowed never to undergo another one. Two words: Versed and Demerol.

Sena remembers it. I guess I’m even funnier delirious than when I’m clear-headed.

On the other hand, while I will never remember my colonoscopy, I’ll never forget what a rheumatology colleague taught me about how to talk to families of aging, medically ill patients hospitalized on our medical-psychiatry unit back when we were co-attendings. He told them that when an older person gets sick with a serious medical illness late in life, modern medicine can often do more to him than for him.

That’s the short version. My colleague had a much more eloquent speech that I’m not talented enough to emulate, but which I try to give on the rare occasions when I feel called upon to do so.

So Sena and I discussed tangents of Emanuel’s theme for most of our walk through the Clear Creek Greenbelt walking trail. We got into this philosophical debate about how a “natural” place like that should look. She believes that nature should be maintained by cutting down diseased trees and cleaning out the creek where it’s full of deadfall from the banks. Of course I replied that, technically speaking, doing that is not natural; nature is defined as much by disease and death as it is by beauty. We want natural beauty, as long as the ugly parts are trimmed and dredged away.

So is Emanuel’s method of eschewing medical interventions beginning at age 75 the “natural” way? It’s true that pneumonia was the old man’s friend–before the era of antibiotics. And if the hip is causing excruciating pain, why not replace it, even if you’re 80, especially if pain management involves exposure to opioids, which can themselves cause excruciating sorrow?

On the other hand, I’ve seen a lot of suffering elderly patients in the general hospital and the critical care units, much of it in the name of improving quality of life as well as the quantity.

I haven’t been to a doctor in a while, not since my last bout of trigeminal neuralgia–something which, by the way, tends to happen to “older” people. Hey, I’m way younger than 75. Dr. Emanuel has a right to his own opinion, so let him sing out.

 

 

 

 

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