Monday, May 9, 2016

Human Longevity

It's paradoxical that the idea of living a long life appeals to everyone,
but the idea of getting old doesn't appeal to anyone. 
– Andy Rooney

In a recent issue of his regular financial newsletter, John Mauldin wrote about the Gray Wave, an insightful essay on the coming retirement crisis. This stimulated my thinking on the subject of human longevity. (1)

Population History & Projections

Global population reached 1 billion around the year 1800; the second billion took only 130 years (1930), the third billion in 30 years (1960), the fourth billion in 15 years (1975), and the fifth billion in only 13 years (1987). During the 20th century alone, the population in the world has grown from 1.65 billion to 6 billion. In 2016 it is about 7.5 billion, and future guesstimates vary. (2)

Late-20th century acceleration in population growth was a result of modern vaccinations and medications. Other future technologies will have similar impacts. Unpredictable future events could have negative effects: wars, famines, epidemics and the like.

The highest population growth rates are in sub-Saharan Africa and parts of the Middle East. The lowest growth rates (even decline) are in Eastern Europe, Russia, China, and Japan.   Total growth masks the shrinking population in much of the developed world.

Population Dynamics

Globally, the combination of falling fertility and longer lifespan means that, in the next few years, the world will have more people over age 65 than it has children under 5. (3) This means that there will be fewer younger people supporting a larger number of older people. Recognizing that children also need care, the real problem will be shortages of young and middle-aged people to support children and the elderly.

For every 100 working age (20-64) people, there will be almost 80 children and retirees who will require support. Most children are going to be in Africa and Asia-Pacific, while most retirees will be in the developed world and China.

China’s one-child policy is creating an upside-down pyramid. Each worker in that generation in China will end up supporting two parents, four grandparents, and probably some of the worker’s own children, too. China does not have a Social Security program or the safety nets that have been created in the developed world.

If predicted fertility trends continue, within decades most of the world will be reproducing at below-replacement rate. Total population will have to peak at some point and then begin to fall.

Longer Lifespan

Medical advancements are adding many years to human lifespan. The rich live longer because new technologies are expensive and won’t be available to everyone. But they will spread fairly quickly. Cures for obesity, heart disease and cancer are all foreseeable within the next 10 years, with more advances over future decades.

The primary construct of most modern cultures is to prolong life. UN estimates that human life expectancy will exceed 100 years over the next century. The cover story of the February 23, 2015 issue of Time Magazine was, "This baby could live to be 142 years old". (4) The question arises: who would want to live that long?

The same question could have been asked in 1880, about living to 75, when life expectancy was only 40. And the same answers would be given: "Is that good?" and  "Why would anyone want to live that long?" 

Medical care will continue to advance steadily and life-extension technologies will continue to proliferate because it makes economic sense to keep people alive and productive as long as possible.

Retirement

For most of human history, people worked as long as they were physically able and died soon thereafter. In some parts of the world the period between no longer being able to work and dying was longer for people who had families to care for them. (5)

This began to change in the 19th century when industrialized agriculture started allowing farmers to feed their families and still have food to sell. Then support for older folks was shared between families and governments; programs like Social Security were created that guaranteed some income to the retired. Businesses did the same with pension plans. People who reached retirement age could stop working and depend on a combination of 3 things: (a) their own savings or pensions; (b) government; and (c) family (mainly their children).

While still in relatively good health, many older people do not retire. With life expectancy over 100 years, they continue to work and live comfortably on savings, pensions and Social Security. Older people are enjoying better health in their later years than their parents did. They work longer simply because they can and because they enjoy it and have little else to do. Many who are fortunate enough to own a home can use it as a retirement asset, either by selling and downsizing, or by getting a reverse mortgage.

Retirement problems are not just a US issue. Much of Europe and the developed world will be going through dramatic changes in their entitlement and retirement programs as budgets and debt escalate in the coming years.

Retirement Crisis

Retirement age is rising, but not as much as life expectancy advances. Retirees need more because (6) healthcare costs are high and rising. Low interest rates reduce what retirees can earn from savings, so they must make principal withdrawals.

In the US, the average net worth of somebody between 55 and 64 is $46,000 and many realize that they don’t have enough money to retire at 65. Because they expect to live a lot longer, they typically need more than they can afford. Many are dependent primarily on Social Security and have almost nothing to fall back on. This is quite scary for those who are approaching retirement age and haven’t saved enough.

Financial problems started when interest income became virtually nothing, pensions were reduced or eliminated, savings were lost in stock market declines and expected Social Security increases stopped. Older people started to work again, to boost their income – witness the Wal-Mart greeter. 

US Health Care Spending

Consider this: 5% of the US population generates 50% of overall health care spending. 65% of medical expenses are for the elderly. In the US, health care costs today amount to 17.5% of GDP compared to 9% in 1980. Projected increases exceed GDP growth and the total will increase to almost 20% over the next decade. Many think this is collusion between health insurance and pharmaceutical companies.

Complications arise when health problems occur. Some elderly people may have to pay hundreds of thousands of dollars just for medical treatments. At some point they are unable to work and must draw on their assets, or get family support. Without family assistance, many simply decline into poverty, or die.

Some families may feel obliged to take on the costs of medical treatment for uninsured elderly relatives, which could be a considerable amount. This may extends life for only a short time. One couple went deep into debt to save a parent who died soon after. One doctor remarked cynically: The cheapest patient is a dead patient.

Old Age Ailments

After the age of about 60 many diseases and infirmities come into play: Osteoporosis, hypertension, diabetes, arthritis, cardiovascular disease, cancer, Alzheimer's, Parkinson’s – the list goes on. The incidence of all of these diseases increases rapidly with aging.

In his new (2016) book: Old Age: A Beginner’s Guide, (7) Michael Kinsley writes about how he is handling his own early-onset Parkinson’s disease – he was diagnosed at age 42. He writes, “Sometimes, I feel like a scout from my generation, sent out ahead to experience in my fifties what even the healthiest Boomers are going to experience in their sixties, seventies, or eighties.”

End of Life

Aging and death are realities in every life. No insurance policy, gym membership, or super diets can fully protect anyone against a frightening, sad, depressing, or burdensome trajectory in the final days. These issues need to be considered before they eventually demand attention. (8)

Ezekiel J. Emanuel, an oncologist and bioethicist, wrote an article in The Atlantic, October 2014, with the title, Why I hope to die at 75.  Says Emanuel, when he reaches 75, he won’t actively end his life, but will stop seeking medical treatments to actively prolong it. The blunt, unsentimental humanity with which he presents his case is admirable. He was 57 when he wrote this; one wonders whether his views will change as he nears 75. (9) 

Let’s Engage

Recognizing the problems of old age and the inevitability of death, an important question remains: When would you prefer to die? (10)

Please answer the following questions for yourself. If you wish, you may share them via the blog. Or, send your responses to me, and I’ll publish on the blog.

  1. How long do you wish to live?  Or more bluntly, when will your life end?
  2. Would you like to know when (at what age) you will die? Or, would you prefer not to know in advance?
  3. Here’s an insightful exercise. If you prefer not to answer, why?
  4. You are informed that you will die within a week – Sunday, at noon. Please respond to the following questions:
a.     What will you do immediately? Will you keep it a secret? Why?
b.     Will you inform your loved ones? Anyone beyond immediate friends and family?
c.     Will you stay at home? Or travel to share the news with other?
d.     Do you think you’ll be able to sleep soundly? Why? Why not?
e.     Will you try to lead a normal life? Still go to work? Watch TV? Go to the movies?
f.      It is Saturday – you know you will die tomorrow. What will you do today?
g.     Sunday morning arrives. You know you will die at noon. Will you stay in bed to wait the inevitable? Or, will you go for a walk – on the beach perhaps, or a place you enjoy? Will you go alone? Or, with someone you love?  Will you return to bed to spend your last moments? How will you choose to make your exit?
  1. Did this exercise make you uncomfortable? Why?
References

  1. John Mauldin: Welcome to the Pale Gray Dot: http://goo.gl/gBAE2C
  2. US Census Bureau report, An Aging World 2015: https://goo.gl/1YWNBg
  3. People 65 and Older Will Outnumber Children Under 5: http://goo.gl/TTXYTN
  4. TIME: This Baby Could Live To Be 142 Years Old: http://goo.gl/hx4F8l
  5. Will Baby Boomers Change the Meaning of Retirement? http://goo.gl/MmN0ru
  6. Retirement Crisis Is Getting Worse for Average Americans: http://goo.gl/RjwPnA
  7. Old Age: A Beginner's Guide: http://goo.gl/zYdBS4
  8. JimPinto blog: Death Dynamics: http://goo.gl/Jk4i98
  9. Ezekiel J. Emanuel - Why I hope to die at 75: http://goo.gl/zWq7Mg
  10. Death Clock - Calculate when you’ll die: http://goo.gl/vqq7q6
..ooOOoo..

Jim Pinto
Carlsbad, CA.
USA 

17 comments:

  1. Always enjoy your blog. Here are my responses as this is a topic I often think about since my mother is ninety years old now.

    1. How long do you wish to live? Or more bluntly, when will your life end?

    80 or so - don't want to live very long if not healthy

    2. Would you like to know when (at what age) you will die?

    Not necessarily but yes if possible and enjoy every moment until that happens.

    3 & 4. Here’s an insightful exercise.
    You are informed that you will die within a week – Sunday, at noon.
    Please respond to the following questions:

    a. What will you do immediately?
    Get together with my loved ones

    Will you keep it a secret? Maybe

    Why? To spare their pain of knowing in advance and not being able to do anything about it

    b. Will you inform your loved ones?
    Maybe not - not sure.

    Anyone beyond immediate friends and family?
    Maybe.

    c. Will you stay at home?
    Stay around my home, go to my favorite places

    d. Do you think you’ll be able to sleep soundly?
    Probably, as I no longer fear death

    e. Will you try to lead a normal life?
    I would do whatever I wanted

    Still go to work? Definitely not

    Watch TV? Maybe a few favorite shows

    Go to the movies? Maybe if a good movie is playing

    f. It is Saturday – you know you will die tomorrow. What will you do today?

    Go to a yoga class, have lunch with my kids/close family/friends, go for a walk on the beach and enjoy the beauty and amazing energy it provides - one of my favorite things to do.

    Eat some delicious food, listen to my most favorite music, go to a museum, have an amazing dinner and not sleep that night, stay up and talk, play games, laugh and cry a little

    g. Sunday morning arrives. You know you will die at noon. Will you stay in bed to wait the inevitable?

    I'll get up and enjoy my delicious breakfast and talk some more and laugh some more

    Or, will you go for a walk – a place you enjoy? Maybe if my family wants to go.
    Will you go alone? Or, with someone you love? With my loved ones.
    I'll have all the time with myself where I am going... lol

    Will you return to bed to spend your last moments? Yes

    How will you choose to make your exit? On my bed, meditating and pondering on the magnificent life I have had.

    5. Did this exercise make you uncomfortable? Why? Not at all. Just made me think about what's important to me.

    With big hugs: Sandra

    ReplyDelete
    Replies
    1. Thank you, Sandra!

      I hope the insights helped you!

      Big hugs back for you!

      Jim

      Delete
  2. 1.How long do you wish to live? Or more bluntly, when will your life end? 85
    2.Would you like to know when (at what age) you will die? Or, would you prefer not to know in advance? It´s better to know the time to get off the party.
    3.Here’s an insightful exercise. If you prefer not to answer, why?
    You are informed that you will die within a week – Sunday, at noon. Please respond to the following questions:
    a. What will you do immediately? Will you keep it a secret? yes Why? a last joke ...
    b. Will you inform your loved ones? Anyone beyond immediate friends and family? no, that´s very intimate
    c. Will you stay at home? Or travel to share the news with other? It´s better to be alone, looking a nice landscape
    d. Do you think you’ll be able to sleep soundly? Why? Why not? Yes, I will sleep well, nothing more small things to disturb
    e. Will you try to lead a normal life? Still go to work? Watch TV? Go to the movies? Not work to survive, but normal life without so many conciliation
    f. It is Saturday – you know you will die tomorrow. What will you do today? To go fishing alone, certainly
    g. Sunday morning arrives. You know you will die at noon. Will you stay in bed to wait the inevitable? Or, will you go for a walk – on the beach perhaps, or a place you enjoy? Will you go alone? Or, with someone you love? Will you return to bed to spend your last moments? How will you choose to make your exit? As I said, enjoying a beautiful landscape, probably a little sad.
    5. Did this exercise make you uncomfortable? Why? Not uncomfortably but sad. To know that life ends is a too strong truth

    ReplyDelete
  3. 1. How long do you wish to live?

    I’d like to LIVE as long as possible — i.e., not just exist or survive. Or more bluntly, when will your life end? When my ‘life’ ends — not merely my existence.

    2. Would you like to know when (at what age) you will die?

    No, I like surprises! Or, would you prefer not to know in advance? Only if knowing in advance would help others in a meaningful way, but in general, probably not.

    3. Here’s an insightful exercise. If you prefer not to answer, why?

    I'd like to answer.

    4. You are informed that you will die within a week – Sunday, at noon. Please respond to the following questions:

    * What will you do immediately?
    Have as much sex as possible!

    * Will you keep it a secret?
    No, not necessarily, but only on a ‘need to know' basis.

    Why?
    Not something I’d want to share widely… why burden others with it until/unless there is no other choice.

    * Will you inform your loved ones?
    Depends on how I’m going to die: Quick & Painless vs. Long & Painful.

    Anyone beyond immediate friends and family? Probably not.

    * Will you stay at home? Or travel to share the news with other?
    Travel? Yes, if possible, but not to share the news with others — just to travel and see a bit more of life while I still can.

    * Do you think you’ll be able to sleep soundly? No
    Why? Why not?
    I think that would be very difficult to come to terms with that fast (w/o drugs).

    * Will you try to lead a normal life? Still go to work? Watch TV? Go to the movies? No, I would focus on doing what I consider to be important things; mainly time with friends & family.

    * It is Saturday – you know you will die tomorrow. What will you do today?
    Spend time with friends & family doing something fun; maybe a picnic with lots of food & music.

    * Sunday morning arrives. You know you will die at noon. Will you stay in bed to wait the inevitable? Or, will you go for a walk on the beach perhaps, or a place you enjoy?

    The beach would probably be my preference.

    * Will you go alone? No
    Or, with someone you love? Yes.

    * Will you return to bed to spend your last moments?
    Maybe, but not necessarily. How will you choose to make your exit? How ever it comes…

    * Did this exercise make you uncomfortable?
    Yes, of course!

    Why? Accepting one’s own mortality is something that most people are not very well prepared for since our society tends to ignore it and just sweep it under the rug most of the time — at least in America.

    People of faith probably do a little better with it, but not all — and not necessarily a lot better. I m very much aware of my own mortality, but that doesn’t mean it’s easy to accept. I lost my two best friends over the past 2 years at almost exactly the same age I am now. It made me think a lot about my own mortality and drove me to write down my last wishes just today — before I saw this blog. (Some coincidence, huh?)

    Those wishes are generally to be remembered in life rather than in death with absolutely no traditional funeral rituals. I just want to be cremated and my ashes spread in the ocean. No wake, no funeral, no flowers, no headstone, no nothing in that regard. (The last thing I want is for some funeral director to get richer as a result of my demise and/or for my friends and family to feel the need to spend a lot of money in honor of my memory!

    I’ve never been a cheapskate — quite the contrary — but this is something I’ve been adamant about since I was a teenager. I’ve always considered the ‘death industry’ to be a totally unnecessary evil that preys on people when they are at their most vulnerable.)

    ReplyDelete
  4. 1. How long do you wish to live? Or more bluntly, when will your life end?
    I don't really have a choice, but I'd much rather go soon if my health is failing.

    2. Would you like to know when (at what age) you will die?
    It would be good to know, for several reasons.

    4. You are informed that you will die within a week – Sunday, at noon.
    Please respond to the following questions:

    a. What will you do immediately?
    I'd tell several people

    b. Will you inform your loved ones?
    Yes

    c. Will you stay at home? Or travel to share the news with other?
    Probably stay home

    d. Do you think you’ll be able to sleep soundly? likely--who could?

    e. Will you try to lead a normal life?
    Yes

    f. It is Saturday – you know you will die tomorrow. What will you do today?
    Gather loved ones close, pray a lot

    g. Sunday morning arrives. You know you will die at noon.
    Will you stay in bed to wait the inevitable?

    I really don't know but I'll likely just lie there and wait.
    I actually don't fear death at all

    5. Did this exercise make you uncomfortable?
    No.

    ReplyDelete
  5. I do not wish to become sick and dependent. I've lived a good life up until now. Recent experiences have taught me that death is not the worst outcome and medicine doesn't have all the answers.

    I lost my Mom two years ago and then my entire Dad's side of the family last year.

    I had my parents living with me for a while. Their almost daily trips to the doctor, therapist, wound care clinies etc became almost a full time job for me. It was hard. While I enjoyed the emotional connection we shared, I was frustrated by the lack of the quality of life they had. I was also frustrated by the "industry" medicine has become. The doctor's act like they are the only ones in the picture and rarely review the entire list of medications that their patients are on, as a result each doctor is chasing the "lab results" with more and more medications.

    The doctors are all specialists now, concerned only with their narrow field of focus. Drug Interactions and potentiation don't seem to be fully considered.

    At one point my mother was depressed and almost non communicative. We sat down with a knowledgeable nurse-friend who reviewed all the medications and threw 60% of them away. My mom immediately started improving.

    Being with them at the end was very enlightening. Each made their own decisions about their final care and accepted the end when it was time. I can tell you that knowing the end is coming, sharing that knowledge with your loved ones and having those final conversations is very meaningful to the survivors. It meant a lot to me.

    My Uncle was being kept alive on a ventilator. He couldn't talk to me due to the tube down his throat, but wanted to. When it became obvious that he would no longer recover, the tube was taken out. It was explained to him that he wouldn't live for very long after being extubated. During his last hours, we had many interesting and surprising conversations. His humor was true to the end. At one point, he urgently motioned for me to come close. (just like in the movies, for that final declaration) When I was near, he whispered to me "just wanted to let you know... there is no bright white light." We had a good laugh. He died soon after. I thought it was a good way to go. I felt peace, not anguish. We were able to say goodbye, share some laughs, and enjoy our connection.

    So to your survey, I'd respond that I would want to let my family and close friends know that it was my final days, and let them spend time with me. In the end, if life isn't about sharing our emotions and love for one another, then what's the point in living. Its the quality of the time we have to spend not the length of time.

    ReplyDelete
    Replies
    1. What a moving response! Thank you!

      The story of your sharing his final moments with your Uncle is beautiful and moving. Thank you for sharing it!

      Delete
  6. 1. How long do you wish to live?
    Only as long as I have something to enjoy.

    Or, more bluntly, when will your life end?
    Who knows? I don’t.

    2. Would you like to know when (at what age) you will die?
    Yes, and that info may be available as our technology develops.

    3. Here’s an insightful exercise.
    4. You are informed that you will die within a week –Sunday, at noon.
    Please respond to the following questions:

    a. What will you do immediately?
    Make sure my will is up to date and affairs in order.

    Will you keep it a secret?
    No. Why? I did not keep my birth a secret.

    b. Will you inform your loved ones?
    Anyone beyond immediate friends and family?
    It matters not.

    c. Will you stay at home? Or travel to share the news with others?
    I hope to sail off into a sunset.

    d. Do you think you’ll be able to sleep soundly?
    Sure. Why? I take Paroxetine. Why worry? Why not?

    e. Will you try to lead a normal life?
    No. I’ll sip some fine wines.

    Still go to work?
    What work?

    Watch TV?
    Not likely.

    Go to the movies?
    Probably not.

    f. It is Saturday – you know you will die tomorrow. What will you do today?
    Spend quality time with family, friends, and wines.

    g. Sunday morning arrives. You know you will die at noon.

    Will you stay in bed to wait the inevitable?
    No. Too much work to do on the boat.

    Or, will you go for a walk – a place you enjoy?
    Maybe a swim.

    Will you go alone?
    Alone, for sure.

    Will you return to bed to spend your last moments?
    Not if I have any choice.

    How will you choose to make your exit?
    I’ll let it happen.

    5. Did this exercise make you uncomfortable?
    No. Why? Death may not mean the end of life.

    ReplyDelete
  7. 1. How long do you wish to live?
    I want to live as long as I can be productive.

    2. Would you like to know when (at what age) you will die?
    I prefer to know.

    3. Here s an insightful exercise.
    4. You are informed that you will die within a week Sunday, at noon.
    Please respond to the following questions:

    a. What will you do immediately?
    Tell everyone and develop a plan.

    b. Will you inform your loved ones?
    I'll tell everyone.

    c. Will you stay at home? Or travel to share the news with others?
    Stay home.

    d. Do you think you ll be able to sleep soundly? Why? Why not?
    I'll take amphetamines to stay awake for the entire week.

    e. Will you try to lead a normal life? Still go to work? Watch TV?
    Go to the movies?
    None of the above. I'd prepare instructions for loved ones.

    f. It is Saturday you know you will die tomorrow. What will you
    do today?
    Spend the time with my daughter.

    g. Sunday morning arrives. You know you will die at noon.
    How will you choose to make your exit?
    Listen to my daughter tell me her dreams.

    5. Did this exercise make you uncomfortable? Why?
    No. We all die.
    Death makes me uncomfortable because it sucks
    and I'll miss my daughter.

    ReplyDelete
  8. How long do you wish to live? Or more bluntly, when will your life end? I'll be ready to die when I can no longer be productive, or have accomplished all that I have set out to accomplish.
    2.Would you like to know when (at what age) you will die? Or, would you prefer not to know in advance? Prefer to not know.
    3.Here’s an insightful exercise. If you prefer not to answer, why?
    4.You are informed that you will die within a week – Sunday, at noon. Please respond to the following questions:
    a. What will you do immediately? Will you keep it a secret? Why? It really depends on the situation. If I'm not ill, or suffering, and can continue trying to make the world a better place, then the first thing I would do is begin figuring out how to delay my death for as long as possible. If I'm suffering, I'd probably asked to be put in hospice and get it over quickly.
    b. Will you inform your loved ones? Anyone beyond immediate friends and family? Depends. See a. If I'm suffering, they probably already know. In any case, I probably wouldn't advertise it unless doing so would ease my suffering, or restore my health, but I also would not hide it.
    c. Will you stay at home? Or travel to share the news with other? Again, it depends on whether I'm ill and suffering or not. If ill, I would stay at home. If able, I would either not have time to do anything but focus on avoiding death, or would acquiesce and do something enjoyable.
    d. Do you think you’ll be able to sleep soundly? Why? Why not? If suffering, I would want drugs to make sure I slept soundly. If trying to get well, I probably would not sleep soundly. In any other case, it would depend on what my death would mean to my family: are my children prepared to fend for them selves in the world? If not, then I most definitely would not sleep soundly.

    e. Will you try to lead a normal life? Still go to work? Watch TV? Go to the movies? Similar response to previous questions. Depends on health condition. If I could still function, but the end is inevitable, I would do whatever I thought would be the most enjoyable at the moment.
    f. It is Saturday – you know you will die tomorrow. What will you do today? Same as e.
    g. Sunday morning arrives. You know you will die at noon. Will you stay in bed to wait the inevitable? Or, will you go for a walk – on the beach perhaps, or a place you enjoy? Will you go alone? Or, with someone you love? Will you return to bed to spend your last moments? How will you choose to make your exit? I would choose to make my exit at the top of a snow covered mountain with my skis on.
    5.Did this exercise make you uncomfortable? Why? No. I'm not afraid to die, and having dealt with health problems over the past several years that have put me close to death's door, I've come to terms with it. Nonetheless, I abhor an unfinished life. While the thought of death itself doesn't cause me great anxiety, the thought of leaving before I have finished all that I wish to achieve does cause me anxiety - especially where my children are concerned.

    ReplyDelete
  9. 1.How long do you wish to live? Or more bluntly, when will your life end?
    Any day …Life is so un-sure
    2.Would you like to know when (at what age) you will die? Or, would you prefer not to know in advance?
    Will be handy if known otherwise one return backs to unknown where he/she comes from.
    Here’s an insightful exercise. If you prefer not to answer, why?
    You are informed that you will die within a week – Sunday, at noon. Please respond to the following questions:
    a.What will you do immediately? Will you keep it a secret? Why?
    No won’t keep it a secret. Will rather enjoy remaining time here before starting NEW journey to new destination, if any.
    b.Will you inform your loved ones? Anyone beyond immediate friends and family?
    Will inform to all whom I know.
    c.Will you stay at home? Or travel to share the news with other?
    Will live normal day nothing special or nothing ordinary.
    d.Do you think you’ll be able to sleep soundly? Why? Why not?
    Yup will sleep sound and will turn of the alarm as there is no rush to get-up tomorrow!
    e.Will you try to lead a normal life? Still go to work? Watch TV? Go to the movies?
    Just another day though it is last.
    f.It is Saturday – you know you will die tomorrow. What will you do today?
    Same thing that I have been doing on Saturdays.
    g.Sunday morning arrives. You know you will die at noon. Will you stay in bed to wait the inevitable? Or, will you go for a walk – on the beach perhaps, or a place you enjoy? Will you go alone? Or, with someone you love? Will you return to bed to spend your last moments? How will you choose to make your exit?
    As entry was not known and was celebrated by few, same goes with the exit.
    Did this exercise make you uncomfortable? Why?
    Not all all… I take this as another leg of journey. You arrive you go…

    ReplyDelete
  10. 1. How long do you wish to live?

    As long as I can. No exact age or range. At this time, I'm ok with living in lots of pain. Mind you, I say this having been blessed with minimal pain so far. In other words, I'm honest answering the question today but I reserve the right to change my mind in the future as many times as the future me wishes. My intent is to be able to experience as much as I can with this body in this life. Though in the moments that count, I may choose otherwise. I'm ok being a wimp (definition provided by Google) though I hope to live fully.

    2. Would you like to know when you'll die?

    No, I wouldn't care to know though I'll accept knowing if circumstances make it possible (accident, terminal illness, death threat, etc).

    3. I've answered it. See below. It was never about whether I'd like to answer it but, more excited about what my answer would look like. :)

    4. The fictional setting: today is Monday, 9PM, sitting at home in front of the computer. My wife in the living room and daughter doing her homework.

    I've just been told I'll die Sunday, May 22 at about 12pm PDT. Deep down, I know the news is true but totally unexpected. My heart rate has gone up, blood rushed to my face, my hands sorta went numb and are getting sweaty. My mind has gone blank. My body has gone weak but I'm sitting down. Seconds later, a sensation of crying, helplessness and fear is overtaking me. I really don't know what to do. I could use help; I need my wife to help me but I don't want to tell her. Oh God, this is crazy, I'm losing it, I don't want to make a scene, I'm very afraid. I wish I can go to bed; I don't want to think about this. Maybe this is not happening or maybe tomorrow I'll know what to do. Oh my God, I feel completely helpless. I need my wife's support and comfort but I don't want our daughter to even suspect what's going on. What do I tell my wife? how can she help me? how will she react? it'll get worse. I must compose myself and find strength to comfort her. It's ok to cry and feel helpless at times; I've told my daughter this many times before. This is a time to do that but this time we must do so together. It's ok to cry, it's ok to be fearful and helpless. It's ok to feel it's unfair; it's ok to not understand what's happening. It's ok to not want to let this happen. My daughter will want to fix it; "there must be a way to fix it!", she'll say with a determination. "Let's call the hospital, let's call the police, let's go to the emergency room.; c'mon daddy, don't give up, we gotta do something!", her voice is shaky and her eyes are watery now. It's not going to happen. I know deep inside this is the end, I know my body, my eyes, my being conveys it and she knows it too; it hurts and feel knots in my chest for how she wants to fight what is and all the suffering and confusion this is causing her. This is all in my head before I even decide to tell her. What do I do, God? why is this happening?; a few minutes ago I was just sending an email to my friend, thinking about my software code and planning to check the sports news. I bury my face in my hands for a moment, I get up go to the mirror; I don't want to look at myself. I wish to get to the point to brush my teeth. My fingers feel heavy and awkward; I have difficulty holding the toothbrush then steadying the tube and squeezing the paste. The automated exercise of brushing my teeth has helped get a hold of myself a bit. However, two conflicting actions are in my head: tell both, my wife and daughter, right away or say goodnight quickly and go to bed, plan to tell my wife tomorrow after our daughter has gone to school.

    Response continued below

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  11. Continued from response above

    I must admit that this exercise is quite strenuous. , I've diverted from the questions but I choose to leave the above soliloquy in my response because it's helped me make the exercise that bit more real. So I'll continue with brief but thoughtful responses to the questions.

    a. My decision is to tell my wife and daughter right away. I must make an effort to bring down my mask and cry with them; work through the feelings/thoughts/emotions together.

    b. Who else to tell? - my first sense is that I've told the people that must know. Everyone else can wait and a decision that's much more important for those that stay behind to make. In other words, I'll try to be ok with their decision to share with whoever they want to share it with. Their decision can lead to more crying and suffering the three of us and with others; I'll want to choose to be ok doing this. I know it will help bring family and friends together to help comfort my wife and daughter once I'm gone.

    c. Travel? - no need to travel to see anyone. Anyone that wants to see me, they're welcome to. The exercise of "seeing" me appears pointless to me. I just hope I can spend time with my wife and daughter.

    d. Sleeping? - I foresee sleeping little at first. Mostly immersed in worry about the ones I'm leaving behind. I'm hopeful a peace with what is will soon develop so the three of us can feel a good energy. Then, I hope sleeping is just a thing that's done when needed.

    e. What will Tuesday, Wednesday, Thursday and Friday be like? - I feel like money, social responsibilities, the answer to what will happen when I'm gone will initially take secondary place. No more work though I will call for time off and decide to inform my boss about the news as late as I can (say Friday PM). I think it inconsiderate but given the circumstances I feel justified. Thursday or Friday, I'd like to go over our finances, insurance, burial plans, our will.

    f. Saturday - time with family. Cry, laugh, talk, listen; just be together.

    g. Sunday morning - Be with my family. Be anxious, be afraid, be sad, be loved but be together. If we've been able to accept what is, I imagine us being very happy, immense joy, blessed, grateful. Thankful for being and the moments. I hope we'll feel connected always.

    h. The moment of death - how? - it depends, I would like for my wife and daughter to be with me when I die but only if they're ok to be there with me as well. I feel like I'll be ok, at peace, with whatever is to happen. I will stop worrying about them, let go, just be in those moments. Hopefully this energy will convey so they feel it and comfort them. As far as whether in bed or elsewhere? - preferred at home but it's not relevant to me.

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    Replies
    1. Jorge:

      Thank you for your heartfelt comments. I'm sure everyone who reads this blog will appreciate your openness and sincerity. I am happy and grateful that you chose to go through the exercise and shared your thoughts. Your spontaneity and the clarity of your thinking certainly help me with my own views of life and death.

      Thank you, Jorge - from me and many readers of this blog!

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  12. 1. How long do you wish to live? Or more bluntly, when will your life end?

    A sign of wisdom and maturity tells me that I must die when I finished my responsibilities such as to see my children well settled in life. And of course, I must leave my wife well protected and supported by my children as she was my mistress when I was young, companion in my middle age, and nurse when I became old. But I must say, ‘I as a human being will never feel accomplished or having finished my jobs’. We are always ambitious, desire to reach for the stars.

    I cannot predict when my life will end. As far as my physician and I know, I am not suffering from any chronic illness to die shortly. But one may die of a bad fall which is very common in old age. Sir William Osler in his “The Principles and Practice of Medicine: says “Pneumonia may well be called the friend of the aged. Sometimes an older person's "heart just stops in his sleep. Bible clearly says “Death comes like a thief”, which often makes us ponder over this aspect of death.

    2. Would you like to know when (at what age) you will die? Or, would you prefer not to know in advance?

    I would not like to know when and how I would or should die though I hear about death every day on the news, I see it regularly in our surroundings.

    3. Here’s an insightful exercise. If you prefer not to answer, why?

    I think nobody wants to know when he would die.

    Death is a very difficult thing that we don't want happening to us. We delay even writing our own will because it is only acknowledging our own inevitable demise. It is said, in the Victorian era in London, death was openly debated as the standard of life was much lower and the average life expectancy was around 48. Now we are obsessed with prolonging life – eating healthier, exercising harder, or doing anything to put off death. This is also in one way, a human desire for survival and it is the only thing that pulls us out of the despair. Spiritually, I strongly believe, hope is the gift of God. We can’t get up each morning without it. Jesus said to the blind man of Jericho, “Receive your sight; your faith has healed you.”

    4. You are informed that you will die within a week – Sunday, at noon. Please respond to the following questions:

    a. What will you do immediately? Will you keep it a secret? Why?

    1. First of all I would not trust my doctor and try to see a better doctor. If I believed the doctor and if I was mentally conscious at the time, I will pray to Jesus intensely, seek pardon for all the sins I committed and would beg him to take care of my wife and sons. I will ask for a priest to have my confession and receive communion, then start consoling my wife, telling her not to worry and will try to gain all my strength to give the best advise to my sons how to give her the needed support.

    b. Will you inform your loved ones? Anyone beyond immediate friends and family?

    I will inform if possible only to my eldest son and not even to my wife.

    c. Will you stay at home? Or travel to share the news with other?

    I will stay at home. But I will not share this ugly information with my wife or friends.

    Do you think you’ll be able to sleep soundly? Why? Why not?

    I won’t be able to sleep as anxiety would overtake me.

    e. Will you try to lead a normal life? Still go to work? Watch TV? Go to the movies?

    No. I may go to work but avoid watching TV or going for a movie.

    f. It is Saturday – you know you will die tomorrow. What will you do today?

    As I said earlier I will be hoping against hope to live longer holding my rosary. I would lie in bed and panic—sometimes cry—thinking about how to leave without my family. Once in a while I’d find myself repeating over and over into thin air, “Lord have mercy on me, and please take care of them. Please take care of them.”

    Continued ...

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  13. Continued ...

    g. Sunday morning arrives. You know you will die at noon. Will you stay in bed to wait the inevitable? Or, will you go for a walk – a place you enjoy? Will you go alone? Or, with someone you love? Will you return to bed to spend your last moments? How will you choose to make your exit?

    All these depend upon my mental and physical status. If I remain sound in body and mind, I will be praying and living in hope. ’I will think about my own death, too in a compulsive hysterical way. What would my family do without me? What would happen to me? It would be a terrific time. I will ask my sons and wife to hold me, and I tell them that I loved them so much. It would be a crying moment for us all.

    5. Did this exercise make you uncomfortable? Why?

    Definitely uncomfortable. Because as Francis Bacon said “Men fear death, as children fear to go in the dark; and as that natural fear in children is increased with tales, so is the other”. This exercise also made think about the purpose of our lives. We always try to have comfortable lives without answering certain existential questions and ponder what legacy we want to leave for our children and our community.

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  14. 1. How long do you wish to live? Or more bluntly, when will your life end?

    My life will end when I am no longer able to care for myself – when I have to depend on others to assist me on a permanent basis with the “Activities of Daily Living” ( toileting, bathing, eating, transferring from a bed to a chair etc.) This could be the result of an illness or simply aging. There are no trade-offs for these items for me.

    2. Would you like to know when (at what age) you will die?

    Yes. I would. It would enable me to know how to spend my time and how to budget for the time I have left.

    3. Or, would you prefer not to know in advance?

    Given a choice I would definitely want to know.

    4. Here’s an insightful exercise. If you prefer not to answer, why? You are informed that you will die within a week – Sunday, at noon. Please respond to the following questions:

    a. What will you do immediately? Will you keep it a secret? Why?

    I will contact the people closest to me – Family and Friends, and invite them to a get-together. I will want to have the opportunity to be with them one more time. We’ll have a WAKE, with me still present.

    b. Will you inform your loved ones? Anyone beyond immediate friends and family?

    My family and those friends that have become family will know. They are the ones I will want to spend time with.

    c. Will you stay at home? Or travel to share the news with other?

    I will stay at home. It’s my castle. My safe spot while I am alive.

    d. Do you think you’ll be able to sleep soundly? Why? Why not?

    I will likely be writing until I am tired enough to go to sleep. Death is a part of life – staying awake will not delay the inevitable. I might be fortunate enough to die in my sleep.

    e. Will you try to lead a normal life? Still go to work? Watch TV? Go to the movies? f. It is Saturday – you know you will die tomorrow. What will you do today?

    Yes – my life will be normal. I don’t work for pay any more so my “work” is what I choose to do. I will be with my family and friends and – time permitting – will write.

    f. Sunday morning arrives. You know you will die at noon. Will you stay in bed to wait the inevitable? Or, will you go for a walk – a place you enjoy? Will you go alone? Or, with someone you love? Will you return to bed to spend your last moments? How will you choose to make your exit?

    I will follow whatever usual routine I have followed – walk with my husband and our dog to the park, have breakfast, read the paper. When noon approaches, I will go to bed for my final nap.

    5. Did this exercise make you uncomfortable? Why?

    It did not. I am not scared of death. I have thought about this for many years. California recently (finally) allowed terminally ill people some level of control but I have had a copy of “Final Exit” on one of our bookshelves for many years. All the appropriate places are highlighted and I hope that I will have the mental capacity to read and implement the steps when it is time.

    I found the book “Being Mortal” by Atul Gawande very, very helpful. The key questions he identifies which deserve to be answered by each person facing death are:

    · What are your biggest fears and concerns?
    · What goals are most important to you?
    · What trade-offs are you willing to make, and which ones not?

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