End of Life No. 2 -Two of the best friends I ever had were Sue and Max. They immediately came to mind when I started this article. They were both typographers, and as I did for many years, they both smoked incessantly. I managed to quit smoking in 1987, but they continued, despite my protestations, until it killed them. And I think of my father in law, Harry. He lived, sometimes with difficulty, five years past the date doctors said he would surely die from lung cancer. Though I’ve been away from some nasty habits for many years, I carry with me the realization that my years as a smoker, combined with the impact of other nasty habits including an often poor diet, will probably end my life.
Faststats.com, a Center for Disease Control web site, lists the leading causes of death in America as follows:
Heart disease: 616,067
Stroke (cerebrovascular diseases): 135,952
Chronic lower respiratory diseases: 127,924
Accidents (unintentional injuries): 123,706
Alzheimer’s disease: 74,632
Influenza and Pneumonia: 52,717
Nephritis, nephrotic syndrome, and nephrosis: 46,448
Diseases of the heart (28.5%) and malignant neoplasms (cancer 22.8%) dramatically outstrip other causes of death in the US. According to researcher Ben Best, in the past 150 years there has been a dramatic shift from infectious disease and preventable conditions to the degenerative diseases of old age. For example, the rate of death from Alzheimer’s disease climbed by 1,200 % between 1979 and 1998, and is still climbing. Knowing the trends, knowing that my own demise may be degenerative disease associated with age as opposed to a quick and some would say merciful death by influenza or pneumonia, I have had to become more responsible about my behavior. I hate that. It’s not about avoiding death with me. I’ll not be able to do that. It’s all about avoiding unnecessary, even self inflicted suffering, at the end of life by moderating some of the things about living that I most enjoy. This tradeoff mentality may be the most pernicious of my maladies. Preference for this instead of that, what some call desire, is the root of many ills.
On Ben Best’s web page there is a section on the behavioral causes of death. I quote, “A 1993 study by the Carter Center estimated that two-thirds of deaths are due to six risk factors subject to influence by the will: tobacco, alcohol, injury risks, high blood pressure, obesity/cholesterol and poor primary care (prenatal/reproductive). (Only 26% of smokers live to age 80 — in contrast with 57% of nonsmokers [ADDICTION 97:15-28 (2002)] )” We do things that we know to be harmful, or at least potentially harmful, all the time. Tobacco use and poor diet/lack of exercise are the most common and most deadly activities. I quit smoking and drinking, drugs and all that but even though I know eating and exercise could make a huge difference for me down the line, I continue to struggle. A person of deep spiritual commitment and acumen can change habits at will. That’s apparently not me.
We statistically don’t get it right until it’s too late. A study in the “American Journal of Clinical Nutrition 78” (Suppl):526S-532S (2003) concludes after study that “adherence to a vegetarian diet for more than two decades can increase lifespan 3.6 years.” That factor is about mortality, but I’m equally interested in the quality of life issue. Diet is linked to some nasty diseases including diabetes, dementia, heart disease and stroke, all end of life considerations. Can we fool death? No. Can we do things to mitigate the debilitating effects of old age? The data says yes, but anecdotally I’m not totally convinced. I see a lot of people enjoying themselves tremendously, while challenging their digestive systems with massive amounts of sugar, fat and salt. I do it myself. It comes down to quality of life now vs. quality of life later, and unfortunately, because our culture often chooses abandon and oblivion, we don’t have adequate respect for what we are doing to ourselves. The American spirit can sometimes be summed up with the Marlboro man or the slogan, “Beef! It’s what’s for dinner.” We will nearly to a person risk heart disease and cancer tomorrow in favor of taste and satiation today.
Am I contributing to my own demise? Sure. Along with impermanence, I am a manifestation of imperfection. But as I continue to write about end of life issues, to become aware the end game, I am more inclined to compromise, to reach for sesame tofu and coconut rice instead of hamburger. For years I was that vegetarian. It’s much better for me and everyone else if I can return to better habits but as Tom Rush the folk musician sings, “Don’t remind me of my failures. I’ve not forgotten them.”
There’s one last thing to say. For many years my friends had a saying, almost an incantation to justify whatever behavior they continued after knowing better. “Something’s going to kill me.” I’ve said it myself many times. What I don’t always acknowledge is that that something is me, through simply ignoring some of the basic tenets of a responsible life.
In a coming issue of Write to the Bone I will explore what some of our elders are doing to take the sting out of their predicament. For example, Smitty and my dad are going on an adventure to Lake Tahoe, a last fling kind of experience no doubt. It will be interesting to hear all about it. Last week dad fell making coffee. His neighbor fell off of his porch the week before. It’s hard to imagine a week in Tahoe being much more than breakfast and naps but I have to hand it to these guys and I’ll let you all know what transpired.