Longevity has long been the top prayer for most heathens. Everybody wants to go to heaven but nobody wants to die. Even Jesus Christ cried out in the garden of Gethsemane: if only this cup can pass away.
The fear of death remains one of the most potent deterrents in both medieval and modern times. Several justice systems are reluctant to do away with the death penalty for that same reason.
The Latin phrases “Memento mori” and “Carpe diem” are particularly poignant both in their imports and in their inherent self contradiction.Carpe Diem is popularly paraphrased to mean “seize the moment” while “memento mori” warns us to remember that we are mortal.
Recently, a facebook friend asked a seemingly innocent question: “Is death overrated?”
According to the rapper 50cents;”death has gottta be easy,’cos life is hard”. There are millions around the world currently experiencing untold hardship and a palpable sense of worthlessness and hopelessness who would readily agree with that assertion.
A pertinent question must be what constitutes an easy life and what death is considered easy? If there was such a thing as an “easy death”, why are there so many failed suicide attempts. What informs the societal stigmatization of suicide?
Part of this eternal conundrum is the fact that nobody has yet verifiably gone to heaven and returned to live physically amongst us for a CNN/FOX news interview.
Scientists who were alive during the debate on the shape of the earth must have vowed never again to blur the line between faith and reason. After several centuries of being fed the “fact” that the earth was "square" with "four corners" and set on a firm foundation that “cannot be moved“ based on scripture, Galileo Galilei shattered all preconceptions with a single telescope. Modern day astronauts must have been even more amused.
Many mysteries remain unsolved, though, and must keep us humbled. The ongoing raging debate between the evolutionists and the creationists will therefore continue until another “telescope” is invented.
The foregoing is not the real purpose of this write-up…just a teaser for open,fertile minds.
Recently, a 97 year old white female was brought from the nursing home with acute confusion. She had multiple medical comorbidities.That is a fancy way of saying she suffers from many ailments. However, the wonders of modern medicine have so far managed to keep her alive.
Since I was not able to obtain any history from her and the nursing home staff were no help as usual, I could only go by my physical examination. What I found will not be considered unusual by any stretch of the imagination by physicians working in any western health system. What I thought might be useful was to bring it to the notice of the non-medical audience and leave people to make up their own minds.
This elderly female had undergone a right above knee amputation for peripheral artery disease. That means she probably lost her original leg due to poor circulation. It is not unusual for several arteries to become blocked as we age. She now wears a prosthetic limb.
She had also received hip replacement with metallic prosthesis on both sides for severe arthritis. It is not unusual for the elderly to suffer from arthritis due to simple wear and tear degeneration. Think about wearing the same shoes continuously for ninety years.
She wore vaginal pessaries for prolapse.It is not unusual for females with prior multiple births to experience a “hanging down” of their wombs through their vaginal orifice especially if assistance was needed with medical instruments during those births. She had endured stress urinary incontinence for several years for related reasons. That means she often soiled herself with urine if she even laughed mildly.
The fear of death remains one of the most potent deterrents in both medieval and modern times. Several justice systems are reluctant to do away with the death penalty for that same reason.
The Latin phrases “Memento mori” and “Carpe diem” are particularly poignant both in their imports and in their inherent self contradiction.Carpe Diem is popularly paraphrased to mean “seize the moment” while “memento mori” warns us to remember that we are mortal.
Recently, a facebook friend asked a seemingly innocent question: “Is death overrated?”
According to the rapper 50cents;”death has gottta be easy,’cos life is hard”. There are millions around the world currently experiencing untold hardship and a palpable sense of worthlessness and hopelessness who would readily agree with that assertion.
A pertinent question must be what constitutes an easy life and what death is considered easy? If there was such a thing as an “easy death”, why are there so many failed suicide attempts. What informs the societal stigmatization of suicide?
Part of this eternal conundrum is the fact that nobody has yet verifiably gone to heaven and returned to live physically amongst us for a CNN/FOX news interview.
Scientists who were alive during the debate on the shape of the earth must have vowed never again to blur the line between faith and reason. After several centuries of being fed the “fact” that the earth was "square" with "four corners" and set on a firm foundation that “cannot be moved“ based on scripture, Galileo Galilei shattered all preconceptions with a single telescope. Modern day astronauts must have been even more amused.
Many mysteries remain unsolved, though, and must keep us humbled. The ongoing raging debate between the evolutionists and the creationists will therefore continue until another “telescope” is invented.
The foregoing is not the real purpose of this write-up…just a teaser for open,fertile minds.
Recently, a 97 year old white female was brought from the nursing home with acute confusion. She had multiple medical comorbidities.That is a fancy way of saying she suffers from many ailments. However, the wonders of modern medicine have so far managed to keep her alive.
Since I was not able to obtain any history from her and the nursing home staff were no help as usual, I could only go by my physical examination. What I found will not be considered unusual by any stretch of the imagination by physicians working in any western health system. What I thought might be useful was to bring it to the notice of the non-medical audience and leave people to make up their own minds.
This elderly female had undergone a right above knee amputation for peripheral artery disease. That means she probably lost her original leg due to poor circulation. It is not unusual for several arteries to become blocked as we age. She now wears a prosthetic limb.
She had also received hip replacement with metallic prosthesis on both sides for severe arthritis. It is not unusual for the elderly to suffer from arthritis due to simple wear and tear degeneration. Think about wearing the same shoes continuously for ninety years.
She wore vaginal pessaries for prolapse.It is not unusual for females with prior multiple births to experience a “hanging down” of their wombs through their vaginal orifice especially if assistance was needed with medical instruments during those births. She had endured stress urinary incontinence for several years for related reasons. That means she often soiled herself with urine if she even laughed mildly.
She had two bags visible over her abdomen. One was a colostomy bag from a recent surgery for colon cancer. A colostomy bag helps patients store their poop externally while they heal from bowel surgery. Caregivers have to empty the bags at regular intervals akin to going to the toilet.
The other bag was a urine bag hanging from a tube going into her bladder via a hole in her lower abdomen-she had also undergone a separate surgery for bladder cancer with partial resection of her bladder with reconstruction.
The upper abdomen bore old surgical scars for gunshot wounds sustained in the sixties. She still carried several pellets in her abdomen that were never removed. Her breasts, or whatever remained of them, looked strange. I quickly understood from nearby scars that she had undergone removal of both breasts for breast cancer. The strange-looking, out-of-place silicone implants would have instigated derision were they inserted for other, more vain, reasons.
She bore a long diagonal scar across the left side of her back that indicated a remote lung resection for lung cancer. She had her fair share of tobacco indulgence during the “social revolution”.
Although it is unusual for one person to suffer from more than one cancer during one lifetime, some unlucky patients have what we call Li Fraumeni syndrome which predisposes them to multiple cancers especially breast and ovarian cancer.
My physical exam was not over. She also had a metallic rod in her spine for severe compression fractures. Elderly females in particular are at risk of bone thinning and breaking of their back-bones. This leads to the observation of “loss of height” in many older women (lil' old ladies).
She has two electronic gadgets inserted just underneath her skin in the front of her upper chest. Each is not bigger than a knee cap in size. One is a pacemaker to keep her heart beating at a “desirable rate” while another is the “implantable converter-defibrillator” to kick-start her heart were it to suddenly stop beating. The center of her chest already bore midline scars of several bypass surgeries for blocked heart vessels.
Of course, she wore dentures like most people of that age since the natural teeth had long since fallen off. She had her dentures in a glass cup at the bed side at this time, so her mouth was all gum and tongue.
Her arms bore signs of old failed grafts and a more recent, functional one for hemodialysis since she is still on the queue for kidney transplant.Hemodialysis is an artificial way of cleansing the patient’s blood of poisons once the kidneys failed. Patients are simply connected to a machine the size of a coca-cola vending machine, with their whole blood volume cycled through a fine filter up to three times every week.
She had a glass eye on her left side to replace the eye she lost in a bar fight after a collateral stab wound in the marvelous sixties. The right eye had been operated upon for cataract and she now wears an artificially implanted lens in the back of her eye.
The left side of her skull bore no hair. That became apparent once her wig was removed. On closer inspection, it became apparent that she had had a craniotomy for a tumor in the front of her brain with prosthetic cranial plate inserted. She had needed to wear protective helmets while she was still able to move around until her dementia became severe enough to confine her to bed most times in the nursing home and the helmet was no longer practically needed.
Her dementia meant that she no longer recognized close family members, forgot what she had for lunch, often behaved inappropriately e.g. constantly removing her dress and standing stark naked in the common dining room, playing with the poop in her colostomy bag with her bare hands if supervision was lacking from staff etc. She very often spoke to imaginary people and reacted to imaginary images.
The reason why I've gone to extreme lengths to describe this patient is to go back to my opening paragraph. It is also partly to throw some fuel into the fiery debate over sensible medical economics vis-à-vis the concept of quality adjusted life years (QUALYS).In brief, that concept asks the vital question bothering on futility: if we had only one pacemaker left in the world; should it go to the 90-year old or the 35-year old on the queue? Where does prudence stop and ageism begin?
Also, in view of President Obama’s resolve to cut healthcare costs in the coming healthcare reform bill, what constitutes wasteful medical intervention?
Finally, and not the least, would you want to “live long” like this?
NB: The above is a hypothetical patient. The author has broken no patient confidentiality in publishing this article.
Charles Ayanleke MD, MRCPsych, MRCPI is a physician in Cleveland OH, USA.
