My doctor is so old that it crosses my mind, often, that he might collapse right there in front of me and I’d have to resuscitate him in his own exam room. He's in his eighties. Sometimes when I'm talking he drops his chin to his chest and closes his eyes. I can't tell if he's resting or thinking, but just when it's getting unnerving he'll straighten up and offer a relevant reply. He takes a lot of vacation time, but when he's in the office, golden with an Arizona golf tan, it's clear that he's enjoying himself. "I'm going to practice as long as they'll let me," he told me once.
Turns out he's part of a substantial cohort. Pamela Fayerman's article "How old is too old when it comes to physicians?" in the Vancouver Sun notes that "there are 1,724 doctors over the age of 65 practising in BC, including 174 between the ages of 75 and 79, and 90 aged 80 and over." According to the article, Dr. Ailve McNestry, deputy registrar of the College of Physicians and Surgeons of BC, cites these as the reasons doctors work past typical retirement age: "[T]hey derive much satisfaction from it, their identities are wrapped up in their professional lives, and they need or want the income."
I've always planned to work well into my senior years, too, as does Pete. The idea of retiring at 60 or 65 doesn't appeal to me in the least. Medicine's interesting and collegial, and I never doubt on the drive home that I've done worthwhile work. When our financial advisor asks when we plan to retire (and I found it very disheartening that we began to discuss this at our very first visit, when I was barely in practice), and we tell her that we plan to just gradually wind down as we need to, it's clear that's not the answer that she's looking for. She pauses politely and says, "For the sake of argument, let's assume you retire at 65. With your current RRSP contributions . . . "
But then I read the best thing I've come across in a while, and it changed my mind about working into my eighties, because I came around to the author's conclusion that I only want to live until my mid-seventies. I read "Why I hope to die at 75" by Ezekiel Emanuel, an oncologist and bioethicist, in The Atlantic.
His line of thinking, roughly, is this: Americans are obsessed with cheating death and extending life, and overlook the costs of age-related disability. We (because I don't think Canadians are all that different in this respect) pull out all the stops to maximize the quantity of life, while ignoring its quality. He's not advocating for suicide or euthanasia - in fact, he's actively opposed to both - but proposes that at a certain age we refuse efforts to extend life, be it by screening for prostate cancer or treating pneumonia.
He makes the point that "over the past 50 years, health care hasn't slowed the aging process so much as it has slowed the dying process . . . [T]he contemporary dying process has been elongated. Death usually results from the complications of chronic illness - heart disease, cancer, emphysema, stroke, Alzheimer's, diabetes."
He settles on the age of 75 as the ideal life expectancy because typically at that age one has made their contributions to society, raised their children and met their grandchildren, but mental and physical decline has not yet picked up enough momentum to become debilitating.
Both of my grandparents died earlier this year, in their nineties. For the past decade, whenever people asked about them I'd answer, "They live in a little condo in New West," and I'd silently correct myself: "They're dying in a little condo in New West." It was awful to witness their deterioration.
And yet, no one questioned that Oma's kidney infection should be treated. Except the doctor in me, very quietly, feeling like a heartless pragmatist. "She's going to die of something - why not this?" I thought (and said, but only once, and not to Oma). My grandparents gave up their classic Dutch plates of cheese and sausage, which they'd enjoyed their entire lives, in their eighties, because their doctor warned them that their cholesterol was high. When Opa had a suspicious chest x-ray at 93, no one thought twice about organizing a bronchoscopy. And even with a granddaughter urging them to organize a DNR, Opa's final hours involved an all-out resuscitation attempt on the living room floor of that little New West condo. I wish their doctor had had a conversation with them ten or twenty years ago, ensuring that they understood that they had the choice to decline medical intervention. Maybe they wouldn't have chosen anything different.
Besides Emmanuel's practical suggestions regarding curtailing investigations and treatments at a certain point in one's senior years, I appreciate his ideas around stepping back and considering one's life and its purpose:
"Many of us have suppressed, actively or passively, thinking about God, heaven and hell . . . We also avoid constantly thinking about the purpose of our lives and the mark we will leave. Is making money, chasing the dream, all worth it? Indeed, most of us have found a way to live our lives comfortably without acknowledging, much less answering, these big questions on a regular basis.
But 75 defines a clear point in time: for me, 2032. It removes the fuzziness of trying to live as long as possible. Its specificity forces us to think about the end of our lives and engage with the deepest existential questions and ponder what we want to leave our children and grandchildren, our community, our fellow Americans, the world."
I've never been one to think much beyond the next five or ten years, partly because it's difficult to plan for a future that could extend to age 75, or 85, or, given my family's outstanding longevity, more than 100. If I'm gunning for 75, things become more concrete and planning becomes a whole lot easier. For the first time, I feel excited at the prospect of mapping out my remaining (35, God willing) years.
But then I watched "Elaine Stritch: Shoot me."
It's a 2014 documentary on the Broadway legend, in her late eighties and still working, on 30 Rock and doing live shows. She was mesmerizing - smart, funny, and poignant, especially with respect to aging.
She was fortunate - and unusual - in that she lived a very rich life until the very end, and then died in her sleep. Still, the idea that she might have resolved to die by 75 seemed ridiculous, even morally repugnant. I have to remind myself: her story is anecdotal evidence, and she's an outlier.
And so my current plan is this: to practice medicine into my seventies, part-time, and then to reject any efforts to extend my life past 75.
The count-down is on: after my annual flu shot this week, thirty-four to go.