Death and a Private Theory of Aging

“My mother is dying,” Marty said to me.

Marty is Martin Berkowitz, a distinguished psychotherapist and a friend of many years. The late-afternoon sounds of a mid-Wilshire bar surrounded us; on the table between us, his Scotch, my beer and his mother’s lingering struggle with mortality.

Sadie Berkowitz’s passage is one of those modern affairs: Last year, at 89, heart disease finally took her from her comfortable Fairfax District apartment and into a convalescent hospital. Two weeks ago, a stroke deprived her of consciousness and the ability to feed herself.

Suddenly, medical technology, for so long the guarantor of her active old age, had become not a lifeline, but a tether. I do not share the fashionable antipathy toward doctors and medical science. I suspect that modern medicine--and particularly American medicine--has done more to liberate mankind from ancient suffering than all political ideologies combined.

But just as our compulsions ultimately overcome even our best ideas, biology ultimately overcomes even our most striking accomplishments. The difficulty we have accepting that is not so much a consequence of the medical profession’s hubris as of our culture’s insistence that everything--even death--is a problem to solve.

So long as we persist in that, the rhetoric of choice will refuse to yield to the inevitable. And good and thoughtful people, like Marty, will endure this special anguish.

“My mother is dying,” he said, bemusedly.

“That’s it. I was prepared for that abstract fact, but not for the way it has worked itself out in detail.

“I’ve watched her condition deteriorate. She’s just slightly above a vegetative state. She cannot swallow easily, actually just a little bit. So, the doctors, who are very conscientious people, begin to offer you options: You can feed her with a tube and keep her hydrated, they say.

“They ask, ‘Do you want to continue her medication?’ Like most elderly people, she takes a lot of different drugs for her heart, her blood pressure and other things. I asked whether she’d feel any pain. They don’t know. So, I said continue the medication.

“When they asked us about whether to continue feeding her, my brother and I had a short discussion and found we agreed. But I have to tell you that when I went back and told the doctor what we’d decided, the thought went through my mind, ‘You’re killing your mother.’

“I promptly went home and went to bed. I couldn’t face anything.

“I actually regressed to some extent. My mother was always a very severe woman, and I grew up being rather afraid of her. I told Jan, my wife, that I had this bizarre thought, a fantasy really, that when I die, my mother will be there waiting for me and she’s going to bawl the hell out of me: ‘How could you have done that? How could you have let them kill me?’

“Have I ever told you my private theory of aging?” he asked.

“No, but maybe we’d better have another drink,” I said.

“Here’s my theory: You start getting a certain number of physical infirmities; you become cranky,” he said. “A certain amount of cynicism sets in. All that crankiness, all that cynicism, all those aches and pains conspire to make it easier for you to leave this earth. If you’ve just plain had it, if the news sounds like the same old news and people are acting like the same old jerks, you’re not going to miss reading the next newspaper. You’re not going to miss listening to the next song, which probably sounds like all the others, only sillier. Boredom is nature’s way of saying it’s time to go.

“But my mother is a very stubborn woman, and it feels like she is just hanging on out of that stubbornness. I say this because as I read what’s happening to her, it seems like agony to me.

“On a conscious level, I knew that the possibility of this situation existed, but subjectively nothing prepared me for it. I think it has been personally hard for me because, in my heart, I’ve always been the sort of person who believes he can figure out any problem if he puts his mind to it.

“I have a hard time accepting destiny. It’s one of the failures I have in common with the rest of American society. We have a hard time accepting the reality of the inevitable. And yet, here it is: I cannot save my mother from this.

“I’ve tried to take comfort from what I know about the way children die. They really do see it as a transition, as going from one state to another. I’m not religious in any sense of the word, but I do try to take comfort from the experience of those children. Yet that wars with another side of my nature, which is pragmatic and practical.

“I’d like to believe that at every stage, even when you’re loosing your life, you have a choice. But there does come a moment when you have no choice. That is a very hard thing for many people to absorb--and I’ve discovered I’m one of them.

“Our culture is not good at resignation--especially when it comes to issues like this. We place a very high premium on life, perhaps because death--visible death, at least--is not a commonplace event in our society.

“I’ve tried to imagine myself in the same position my mother is in. I’ve actually stood over her bed and tried to project myself into her body, and I can’t. I simply can’t imagine what’s going on inside that mind. The mind is really the seat of being for me, and I don’t have the slightest idea what may be happening in hers. Are there dreams, thoughts, reveries, feelings? I don’t know. I have no idea.

“But I’ve also thought that life in any form is important. It’s so easy to say, particularly of another person, ‘Well, they’re not having much of a life, so what’s the point of letting it go on?’ But what’s happening to her is so ignoble. People don’t die well, you know--at least not like this.”

A waiter appeared. “Are you Dr. Berkowitz?”

“Yes.”

“There’s a call for you.”

Five minutes later, Marty made his way back through the gathering crowd.

“My mother has died,” he sighed.