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How and When Will I Die, Doctor?

That’s what I asked my new primary care doctor—a gerontologist. “What do you think I’m likely to die from, and how long from now?” He blurted, “Wow! Nobody ever asks me that!”

But it seemed a reasonable question. I knew that prior to this initial appointment with him, he had diligently studied all my medical records for the last twenty-five years or so—all the hospitalizations, scans, images, prescriptions, all the remanufacturing of my body with bovine aortic valves, bladder cancer ablations, joint surgeries, vascular treatments, even the inch-long stent improbably jiggered into a teensy internal iliac artery buried inaccessibly within the cage of my pelvic bones.

And then he had just spent an hour politely interrogating me about my own perspective on every notable element of my health, past and present, seeking to add color and dynamism to the hyper-factual clinical accounts he found in files and computers. At that moment, he seemingly knew more about my body and prospects than anyone else on earth, and so why not ask the question we all wonder about (don’t we?)

It's a question that I first encountered point-blank when as a seminary student sixty years ago I was training for hospital chaplaincy. Assigned to the oncology ward at UCSF hospital in San Francisco, I found myself deeply engaged with a patient named Kent who was within days of death—a death both he and I knew to be imminent. Our conversation had gone extensively into a host of remarkable similarities of our two lives, including his being exactly my age (26) and his being a newly ordained Catholic priest.

Kent broke the chain of coincidences by saying, “I guess the primary difference between us is that I know exactly when I am going to die, and you don’t.”

Kent has been dead for sixty years. And during my own subsequent sixty years of being alive I occasionally wondered when my life might end. But apparently for many decades, I subconsciously thought I knew. During my 60th birthday party, I felt an unexpected and inexplicable burst of exhilaration. I wasn’t high on champagne or anything else. So I took a time-out to ask myself what might account for such a strong surge of emotion. The answer came instantly: my father (and Patti’s father also) died at age 59, and I suddenly realized that I had been living with the expectation that I too would die at 59. Now here I was, 60! I get to keep living!

But keeping on living isn’t always a blessing. My mother was a force of nature who worked full-time into her early 80s as Director of the Victim and Witness Assistance Agency of San Francisco, and spent all her other waking hours as a Democratic political organizer, campaign strategist, and guru. Then she got blasted by a hard stroke one day and soon we got the call that she was in her last hours. My three brothers and I gathered at her hospital bedside to say goodbye. We watched as her breathing gradually slowed, and then were fascinated to hear her say aloud to whoever was greeting her from the other side, “Take me gently, now.” At that, we quietly slipped away, as did she.

Early the next morning I went to collect her personal effects from her hospital room. Mom was sitting up at the edge of the bed, eating her breakfast from the tray and reading The S. F. Chronicle. Seems she had gone into the tunnel of white light, had seen the beckoning image beyond, asked to be taken gently, and then decided to decline the invitation. Some other time, perhaps.

Mom didn’t make a lot of mistakes, but that was a big one and a sad one, as she soon realized and often commented during the next year when she died in unpleasant installments.

So I asked the doctor my question: what is likely to be the cause of my demise, and when do you imagine that might occur? The conversation that ensued was something to treasure. Of course he offered all the requisite I’m-not-a-crystal-ball disclaimers and mentioned a few popular causes of death for the elderly, like pneumonia. He told me I was getting pretty used up--especially my heart--and that I was not going make it to 100. But he surmised that I probably had another five or possibly even ten years to go. I think the ten was a sop to take the edge off the no-100-for-you, Eliot.

But he then went to explain in wonderfully down-to-earth language how my heart is most likely to take me down via a massive heart attack. The best part was his real-life description of the scenario when I do hit the deck: people will come rushing to save me, attacking me with CPR, defibrillators, intubation, injections, whatever…

Big mistake, in his opinion. Given my age and the destruction a heart attack will cause at my advanced age, he set exceptionally dim odds for my coming out of such an cataclysmic event in any condition I’d care to live in. How dim? Like (his number) maybe 1 chance in a 100.

I told him that Patti and I (and our kids) are very clear about DNR. We do not want any extraordinary efforts that would prevent our release from life when it is apparent that continuation would be significantly compromised. Patti and I have long-since executed “Living Will” instructions in writing for each other, the family, our physicians, and the local hospital as well. We are very insistent about DNR when it’s clearly time for us to go.

But NJ where we live has now produced a very specific form to guide out-of-hospital clinicians like EMR teams whose vehicles are now the equivalent of rolling Emergency Rooms and would presumably be the first to confront my floundering carcass. My doctor gave me a copy of the NJ DNR form and recommended my executing it to preclude possibly counterproductive interventions. But when I subsequently asked my cardiologist about it, he thinks its overkill (yeah, bad pun; sorry about that), owing to potential unintended consequences he named. So there’s work to be done on that issue yet, but we’ll definitely get it sorted out because the bottom line is clear: I do not want to overstay my welcome as a functioning person.

Thing is, I delight in every single day of my life, and I delight right this minute thinking about what I’ll be doing tomorrow and the day after that and especially the day after that. Because, that's when we'll be headed for our farm in Maine, where I'll be gamboling into four months of joyous family time and boating and golfing and gobbling oysters and reading and writing and watching the birds flit about our apple orchard.

Or not. And if “or not”, that’s okay. I love life, and I love my life. But I am not greedy for life. I have been blessed beyond measure in every conceivable way during my time in this realm of being. And I am more than a little bit curious about what the next realm could present. I really do suspect there may be more going on when my spirit is finished with my body.

But for now, I find myself recalling a summer evening sixty-odd years ago sitting around with our cherished circle of friends, when we got to musing about what we might want to have on our grave stones. When it came my turn, I imagined it might read:

No one who has ever lived

is sorrier to be dead than

Eliot Alexander Daley

Still works for me.

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