Monday, July 31, 2006

Fool's Quest? Has the Endless Quest for a Longer Life Gone Too Far?

The given of this blog is that a goal of living to age 120 is a good thing. It is a quest that is assumed to be life-affirming, laudable, and healthy both for individuals and for society as a whole.

But there is another side. And it is a side that I must say I have not given enough attention to, probably because it calls into question the whole premise not only of this blog but of my personal longevity goals. It is a side that Ms. Meryl Comer, pictured here, knows all too well.

We all have a tendency, I think, to get so vested in our own ideas and life choices that we don't want to hear anything suggesting that we might, gulp, be unwise or even dead wrong. We fight any such suggestion as if our life depends on it which of course it does.

Unfortunately, most of us have learned how to successfully ignore, deny, and dismiss arguments and facts as plain as the nose on your face if they don't fit into our way of thinking. We hear nothing; we see nothing; we learn nothing; we change nothing. That's always easier than running the risk of having your big idea -- and your life -- smashed like cheap crockery.

A couple of chance events happened that have set me rethinking whether my big idea -- making a conscious effort to live to age 120-- is a such good idea. The first was a PBS segment on the The News Hour with Jim Lehrer. It was about a brilliant physician  and scientist, Dr. Harvey Gralnick, who has Alzheimer's, and his wife, Meryl Comer, who has been taking care of him for 12 years.

She is 62 and full of vitality. He is 70 and dead in every respect except that he is still warm and breathing. He cannot speak, feed himself, go to the toilet alone, dress, or bathe. He depends on his wife for all these things and it takes nearly all of her time and her energy. She worries that she will run out of energy and die before he does.

The other chance event is that immediately after seeing the PBS segment about this couple, I happened to visit a blog by a midwest physician who goes by the name of Dr. Bob. The blog is and the good doctor is highly thoughtful and articulate in his discussion of medical issues.

While browsing blogs, my digital space craft alighted on Dr. Bob's blog just as he was calling into question the mindless pursuit of longer life. "Mindless pursuit?" He's calling my big idea a mindless pursuit?

How can one live life to the full without living it to the full; that is, without living it to the outer limits of the human life span? Shouldn't everyone pursue a long, long, long life?

Not necessarily, writes Dr. Bob. He questions whether our continually striving for a longer and longer life span is an absolute good. He admits that this "may seem a bit odd coming from a physician, whose mission it is to restore and maintain health and prolong life. But ... I find myself increasingly ambivalent about this unceasing pursuit of longer life."

Dr. Bob notes that long life and good health have traditionally been considered blessings and he agrees that they still are and should be. But his problem is that long life seems to have "become a goal unto itself–and from where I stand is most decidedly a mixed blessing."

Now, if ever there was an example of such a mixed blessing, it is that of Dr. Gralnick and his wife and caretaker, Meryl Comer. They put a human face on the daily agonies and heartbreak that rapidly increasing numbers of people must cope with as we live longer and longer.

From my living room, I and the rest of the PBS TV audience meet Ms. Comer and Dr. Gralnick and enter (intrude upon?) their lives. I see how Ms. Comer, who gave up a high-powered career as a TV newswoman to care for her husband, begins each day. Crouching in the dim morning light, she empties her husband's urine bag. Then she removes his catheter and helps him out of bed.

"OK," she says, "I'm going to swing your legs around, Harv."

I watch as Ms. Comer struggles to get her husband into the shower, bathes him, shaves him, and helps him get dressed. She does it all lovingly, calling him "hon" and talking softly to him. He does not respond.

From his eyes, she gets an occasional inkling that he knows that someone is there, a familiar presence. But he is not aware that the person is his wife of 26 years. Dr. Gralnick is in the final stages of Alzheimer's when most normal human interaction ceases and patients completely withdraw into themselves.

Divorced and with a young son, Ms. Comer married Dr. Gralnick in 1980 when he was at the peak of a prestigious career as a physician and scientist at the National Institutes of Health. Tall, handsome, successful, a respected specialist in blood-related cancers, Dr. Gralnick had it all.

At the time, Ms. Comer was also riding high as a TV newswoman. Bright, beautiful as a model, exuding glamor out of every pore, she routinely interviewed the power elite: business leaders, Washington political figures, and even presidents. PBS shows a clip of her interviewing President Jimmy Carter and reporting on special assignment from Tokyo.

For 15 years, they were quite a power couple. Then Dr. Gralnick was diagnosed with early onset Alzheimer's and everything changed. He was only 58 and Ms. Comer was 50, young to be suddenly old and thrust into physical and emotional lives usually seen with people 20 and 30 years older.

Now in 2006, in the comfort of my living room, I watch as human tragedy plays out the final, horrifying chapter. Determined to let us see the horror up close so that we might understand, Ms. Comer records a typical nighttime calamity when her husband falls out of bed and can't get up.

We see him sitting stuporously   on the floor while Ms. Comer struggles to lift her six-foot, two-inch, 200-pound husband. "I'm going to try to get you up, Harvey," she says. "I'm going to get behind you, lovey. Harvey, sit up for me."

"No, no, no, no, no," he says, determinedly.

"Harvey, please help me, love. Harv, I can't do it. Here, I'm going to call the fire department. OK, honey? I've got to call somebody to come help us."

Ms. Comer says she gets a staggered four hours of sleep most nights. She is exhausted most of the time. "Think of an 80-year-old woman doing this to an 85-year-old man," she says.

Still, she is determined that her husband's life be as ordered and as normal as possible, with meals at regular times and a daily shower. She hires nurses and other aides to help her out and feels lucky that she can afford to do so.

What if she were poor or sick or just plain overwhelmed, as anyone caring for an Alzheimer's-striken spouse could easily be? Multiply it all by scores and stamp all humanity from two human lives.

As often happens with Alzheimer's patients, Dr. Gralnick has become paranoid, delusional, and occasionally violent. All personal care has become a confrontation, Ms. Comer says. "When the mind's dementing, they don't understand personal care, so they take it as if you're attacking them. I had my front teeth knocked out in the hospital."

She had come to the hospital early to bathe him, shave him, and dress him. He punched her in the face. "I missed the left hook," she said, "so to speak."

Ms. Comer resists putting her husband in a nursing home, where on average half of the patients have Alzheimer's. Partly it is because of costs. Top-flight nursing homes with private-duty nursing range from roughly $100,000 to $200,000 a year. Medicare pays nothing for long-term care and Medicaid pays only for low-income people who have exhausted their assets.

The other reason is that Ms. Comer doubts that her husband would get high-quality care in even supposedly top-notch facilities. While massaging and powdering her husband's feet, she says, "In the facilities, his feet would get infected and swell up because he was walking in his own urine at night. We haven't had any problems here."

What is Ms. Comer's greatest hope? "I hope that I don't wear out. Caregivers have a very bad rate. They tend to die before patients because of the intensity. So my wish for Harvey is that I just don't wear out or give up."

Meanwhile, they'll manage as best they can. She smiles at her husband and kisses him and says softly, "That's all we can do. As good as it gets, Harv."

Now in raising questions about the quest for longer and longer longevity, Dr. Bob was not talking about Dr. Harvey Gralnick and Ms. Meryl Comer. He may never have heard of them. But as a physician, he has been involved, up close and real, with many other patients facing similar struggles. And however different patients may be, the issues are remarkably the same.

Dr. Bob writes:

"Many of the problems with which we battle, which drain our resources struggling to overcome, are largely a function of our longer life spans. Pick a problem: cancer, heart disease, dementia, crippling arthritis, stroke — all of these increase significantly with age, and can result in profound physical and mental disability.

"In many cases, we are living longer, but doing so restricted by physical or mental limitations which make such a longer life burdensome both to ourselves and to others. Is it a positive good to live to age 90, spending the last 10 or more years with dementia, not knowing who you are nor recognizing your own friends or family?

"Is it a positive good to be kept alive by aggressive medical therapy for heart failure or emphysema, yet barely able to function physically? Is it worthwhile undergoing highly toxic chemotherapy or disfiguring surgery to cure cancer, thereby sparing a life then severely impaired by the treatment which saved that life?

"These questions, in some way, cut to the very heart of what it means to be human. Is our humanity enriched simply by living longer? Does longer life automatically imply more happiness–or are we simply adding years of pain, disability, unhappiness, burden?

"The breathlessness with which authors often speak of greater longevity, or the cure or solution to these intractable health problems, seems to imply a naïve optimism, both from the standpoint of likely outcomes, and from the assumption that a vastly longer life will be a vastly better life.

"Ignored in such rosy projections are key elements of the human condition–those of moral fiber and spiritual health, those of character and spirit. For we who live longer in such an idyllic world may not live better: we may indeed live far worse.

"Should we somehow master these illnesses which cripple us in our old age, and thereby live beyond our years, will we then encounter new, even more frightening illnesses and disabilities? And what of the spirit?

"Will a man who lives longer thereby have a longer opportunity to do good, or rather to do evil? Will longevity increase our wisdom, or augment our depravity? Will we, like Dorian Gray, awake to find our ageless beauty but a shell for our monstrous souls?"

Notice that Dr. Bob is not telling us what we should think or how we should answer these questions in our own lives. He does not predict social mayhem in the future if people like me persist in pushing toward the longest possible life.

He's just raising questions. He's just asking us to step back a bit from notions about human health and longevity that may be too beloved for our own good and for society's. It's a wise man who does not tell, but asks.

Possibly wiser is the one who listens with mind open wide, and learns.

Finally, Dr. Bob tells us a story, about a physician friend, "a good man who died young." Matt was a "tall, lanky man with sharp bony features and deep, intense eyes. He was possessed of a brilliant mind, a superb physician, but left his mark on life not solely through medicine nor merely by intellect."

Dr. Bob writes:

"A convert to Christianity as a young adult, Matt embraced his new faith with a passion and province rarely seen. His medical practice became a mission field. His flame burned so brightly it was uncomfortable to draw near: he was as likely to diagnose your festering spiritual condition as your daunting medical illness–and had no compunction about drilling to the core of what he perceived to be the root of the problem.

"Such men make you uneasy, for they sweep away the veneer of polite correction and diplomatic encouragement which we physicians are trained to deliver. Like some gifted surgeon of the soul, he cast sharp shadows rather than soft blurs, brandishing his brilliant insight on your now-naked condition.

"The polished conventions of medicine were never his strength–a characteristic which endeared him not at all to many in his profession. But his patients–those who could endure his honesty and strength of character–were passionate in their devotion to him, personally and professionally. For he was a man of extraordinary compassion and generosity, seeing countless patients at no charge, giving generously of his time and finances far beyond the modest means earned from his always-struggling practice.

"The call I received from another friend, a general surgeon, requesting an assist at his surgery, was an unsettling one: Matt had developed a growth in his left adrenal gland. His surgery went deftly, with much confidence that the lesion had been fully excised.

"The pathology proved otherwise: Matt had an extremely rare, highly aggressive form of adrenal cancer. Fewer than 100 cases had been reported worldwide, and there was no known successful treatment. Nevertheless, as much for his wife and two boys as for himself, he underwent highly toxic chemotherapy, which sapped his strength and left him enfeebled.

"In spite of this, the tumor grew rapidly, causing extreme pain and rapid deterioration, bulging like some loathesome demon seeking to burst forth from his frail body. I saw him regularly, although in retrospect not nearly often enough, and never heard him complain; his waning energies were spent with his family, and he never lost the intense flame of faith.

"Indeed, as his weakened body increasingly became no more than life support for his cancer, wasting him physically and leaving him pale and sallow, there grew in him a spirit so remarkable that one was drawn to him despite the natural repulsion of watching death’s demonic march.

"Matt died at age 38, alert and joyful to the end. His funeral was a most remarkable event: at an age in life where most would be happy to have sufficient friends to bear one’s casket, his funeral service at a large church was filled to overflowing–thousands of friends, patients, and professional peers paying their respects in a ceremony far more celebration than mourning.

"There was an open time for testimony–and such a time it was, as one after another took to the lectern to speak through tears of how Matt had touched their lives; of services rendered, small and large, unknown before that day; of funny anecdotes and sad remembrances which left not one soul of that large crowd untouched or unmoved.

"A journey such as his casts critical light on our mindless pursuit of life lived only to live long. In Matt’s short life he brought more good into the world, touched more people, changed more lives, than I could ever hope to do were I to live a century more.

"It boils down to purpose: mere years are no substitute for a life lived with passion, striving for some goal greater than self, with transcendent purpose multiplying and compounding each waking moment. This is a life well-lived, whether long or short, whether weakened or well.

"Like all, I trust, I hope to live life long, and seek a journey lived in good health and sound mind. But even more–far more indeed–do I desire that those days yet remaining–be they long or short–be rich in purpose, wise in time spent, and graced by love."

So, having looked in upon the terrible ordeal of Dr. Harvey Gralnick and Ms. Meryl Comer, having considered the great and wise questions raised by Dr. Bob, having heard the story of Dr. Matt's short and glorious life, what have I got to say for myself? How do I plea?

Before preparing this post, I could have pled ignorance and continued my blissful, smug quest for the longest life humanly possible. If only Dr. Bob had simply attacked my big idea, I could have attacked him back. We could have had a splendid little war and then settled back into our old mindsets.

But no, he has to pose questions, so incisive that they cut through intellectual barriers like butter, so thoughtful that they wake up soporific brain cells, so mannerly that they make any response other than reflection simply bad form.

Dr. Bob, enough with the questions, already. I surrender. You win. As of now, I am changing my big idea. Before all your questions and before Dr. Harvey Gralnick and Meryl Comer and before the story of Dr. Matt, I was on a bold quest to reach age 120 come hell or high water.

Now, my mind having been pried open -- no small feat -- my new big idea is this: To live as many years as I can and still remain a human being; and if that number is 120, great; if it is 68 -- my age now -- fine, because it has already been one hell of a ride. Already, I cannot die young. And whatever time is left now is pure gravy.

So long and keep moving.

NOTE: My novel, State Kid: Hero of Literacy is now available on Amazon and for the Nook.

Billy Stone was a foster child.

He ran away from abuse.

He went to juvenile prison.

He went up from there.

And he did it his way.

With the power of the written word. 

Amazon E-Books by George Pollock

 "State Kid: Hero of Literacy" is fiction based on his  real-life experiences  growing up in foster homes; "Last Laughs," is the true story of how five foster kids (he and four younger siblings) found their way in life and each other. "Killers: Surprises in a Maximum Security Prison," is the story of his being locked up for 23 hours with killers in a maximum security prison;  "I, Cadaver" is about his postmortem adventures and mischief in the anatomy lab at UMass Medical School. “A Beautiful Story” demonstrates the art and process of creative writing as a 16-year-old boy goes all out to write a story that literally saves his life;  "A Long, Happy, Healthy Life,"  is about how to live the title every day; and "Unlove Story," Writing anonymously as "Elvis," a husband, dumped after 38 years of marriage, lets it all out on love, marriage, life, everything. A guy doing this? It's unheard of.
   For the Nook:

A Beautiful Story
A Long, Happy, Healthy Life
I, Cadaver
State Kid
Unlove Story



At December 31, 2006 8:26 PM, Anonymous Anonymous said...

What is Ms. Comer's greatest hope? "I hope that I don't wear out. Caregivers have a very bad rate. They tend to die before patients because of the intensity. So my wish for Harvey is that I just don't wear out or give up."

A friend called me up last July and said: "Harvey is on TV. He has Alzheimer's." I turned on the TV and I was horrified. I just could not believe it. Harvey? Not Harvey... No, no, no. That was just not possible.

You see, in July 1970 Harvey and his son Mark who were our best friends spent part of our honeymoon with us.

Tom and I had married on July 2, 1970. We had a big house in Rehoboth for the length of our honeymoon and we invited Harvey and Mark to join us for a couple of days, which they did. We had such a great time just the four of us.

The clearest image I now have of Harvey is one Christmas when Tom and I were sitting on the couch and Harvey was standing next to the Christmas tree talking about his latest trip to Europe where he had been presenting a paper. His work was his life. He just thrived on it. He had such incredible vitality.

Harvey was a very busy man. So were we. We lost touch partly also because something was wrong, very wrong with Tom. We did not know what it was, but we knew it was there, ever present, too present.

Then on October 11, 1995, just days shy of my retirement at The World Bank, Tom called me and said: "I have Parkinson's."

Listening to Meryl Comer I knew too perfectly well what she was talking about, especially when she said: "My wish for Harvey is that I just don't wear out or give up."

Tom died on November 15, 2006. I am still alive, but I am burned out.

Eventually, I will write about my experiences with Sunrise, a greedy corporation; a just as greedy nursing home and a hospice which I deem to be not too good either. Eventually, I will take my writings to Capitol Hill and Richmond.

Why? Because I am in a Parkinson's support group on the Internet. Meryl's experience -- as well as mine -- pales compared to what some caregivers in that support group go through.

And the world stands by and has no idea, no idea at all what it is like to be in Meryl's words "A Prisoner of Alzheiemr's (POA)" or a prisoner of any and all incurable diseases, be it Alzheimer's, Parkinson's and dementia, or any other similar disease.

As time goes by the number of Azheimer's, Parkinson's, dementia , et al, grows and growns and grows -- and so, unfortunately, does the number of caregivers.

Without the doctors, nurses, and CNAs coming from at least 24 different countries, many of them Muslims, the health care system in the US is sure to collapse.

Greta Swinnen Crais


Post a Comment

Comments welcome.

<< Home