Why We Die - and How to Deal with It

We are born. We grow up. We get stronger. We shrink. We get weaker. We die. That is pretty much the arc of life. 

In his new book Being Mortal, doctor and writer Atul Gawande heartbreakingly portrays humans who tend to pay a lot of attention to the first part of the arc, and pretend the second part only happens to other humans. It doesn’t of course. We are profoundly uncomfortable with "the idea of a permanent unconsciousness in which there is neither void nor vacuum — in which there is simply nothing,” as the late surgeon and writer Sherwin Nuland perfectly articulated in his 1993 book How We Die: Reflections on Life’s Final Chapter.

Take a look at our popular books on aging. Most of them don’t actually focus on aging, but rather on avoiding aging. Younger Next Year. Growing Younger Handbook. The Secret Method for Growing Younger. These are just some of the thousands of book titles you can order with a click from Amazon. Movies about older people most often portray them as spry, older versions of our young selves, ready to head off on an action adventure at the drop of a hat. If they happen to die in the movie, it is usually mere moments after they were alive and kicking. The slow, inevitable decline part of the life arc is skipped.

Yet, by refusing to believe we are growing old and will indeed die, we may actually hasten the endgame.

Why do we age? We don’t know the exact answer to that. Some scientists believe we are genetically engineered to age, that at some point in our lives, a gene switch goes off and the body begins to slowly shut itself down. There is some evidence for this. Geneticists have found genes in some worms, mice and other animals, that when “turned off,” have extended the lives of the creatures beyond their normal lifespan.

Then again, what is a normal lifespan for a human being? A couple hundred years ago, it was about 30 years. Even 50 years ago it was only around 65 years. Only with the advent of modern medicine, making lifespans of 80 years or more commonplace, have we staved off what would have been, and historically was, a much shorter existence. As the philosopher Montaigne put it in the 16th century, “To die of age is a rare, singular and extraordinary death, and so much less natural than others: it is the last and extremest kind of dying.”

The preponderance of evidence leans toward the probability that aging is not genetically programmed, but is simply our bodies slowly wearing away. Atul Gawande compares our bodies to machines, and explains how in a very simple machine, like a wind-up toy, one malfunction, like a broken spring, will render the entire machine inoperative. In more complex machines, however, backups are built in. If one component of the complex machine malfunctions, backups will keep the machine going. Often there are backups to the backups, and on the surface, the machine will continue running smoothly. Underneath, however, the complex machine is not in fine shape. Eventually the backups malfunction, and with no backups left, the machine will finally stop working.

So it is with the human body, one of the most complex machines in existence. We have backups all over the place: two lungs, two kidneys, two eyes, multiple teeth. We run smoothly over the years, but right around the age of 30, the parts begin showing their wear. We start running out of hair pigment cells, and our hair begins turning grey, skin cells become inefficient at getting rid of waste, gunk builds up, we develop age spots, our eyes become less elastic and we suddenly need reading glasses.

That’s all on the outside. On the inside, similar, less obvious changes are occurring. The bones begin thinning, the lungs, heart and arteries begin calcifying, and the brain begins shrinking. The parts of the brain that start shrinking first are the frontal lobes and the hippocampus. These are the parts that control our judgment, our organizational abilities and our memories. (Want to know why older people sometime seem confused, forget their keys, can’t seem to get their pill regimen straight? A literally shrinking brain is the answer.) All these processes go on and on, and despite the promises of our bestsellers on aging, they are not reversible. At some point, the backups to the backups are exhausted, the body breaks down, we deteriorate, grow frail and die. The end.

But what about the sometimes decades-long period when our bodies are failing but we are still very much alive? In another era, the unfortunate elders ended up in poorhouses, Dickensian horror shows that make today’s nursing homes seem idyllic in comparison. Fortunate older people were taken care of by their families. There were many more young people and far fewer older people. Anyone who lived to an old age was admired, a survivor with a font of knowledge to be passed down.

Sadly, that is no longer the case. The knowledge older people have is not valued in the same way as in the past. When most of us want knowledge, we do not have to ask our parents. We Google it. In today’s advanced technological world, our parents might not have the answer anyway. Fewer families take care of their aging relatives, who are expected to get by on their own, independently. If they cannot, we look to nursing homes and hospitals to fill the void.

Despite improvements, no one wants to end up in a nursing home. They are no longer the poorhouses of old; most are clean and staffed with competent people. Still, people fear them because nursing home residents are no longer in control of their lives. They are basically warehoused, regimented and catalogued. Studies have shown that indifferent care, even excellent indifferent care, results in indifference to life itself. As our bodies march inexorably toward oblivion, with our choices limited, it is perhaps understandable that we shut our eyes and pretend this won’t happen to us. It is either that or accept that the nursing home is our destiny. The eldercare industry is currently in flux. Numerous homes have flourished under new alternative care models, which operate under the assumption that the more control people have over their lives, the healthier, happier and longer-lived they will be. While these homes are still a distinct minority, it’s possible that in the future the elderly need not fear their fate.

Meanwhile, there is one thing in our control. We can accept that this will happen to us, we will not be young forever. That may seem like a simplistic idea, but it’s amazingly rare. And acknowledging it can have real-life consequences. If we know we will inevitably degrade, we can plan for that. If we are fortunate and have the resources, we can make sure we save enough money not to be a financial burden on our families. We can talk to our children, our partners and those close to us about what we want in the last part of life’s arc. We can make sure our wishes are known, and we can write them down. We can maintain contact with our family and friends, doing our best not to be alone if we can help it. Isolation is depressing, depression is a killer, and laughter is indeed the best medicine.

If we pretend we are still the young people we used to be, we set ourselves up for a rude awakening. By admitting to ourselves that we are in decline, we can literally protect ourselves. The greatest danger to all of us in our elder years is not disease. If we make it to 75 or 80, we have statistically already beaten the odds. An older person’s greatest enemy is actually falling down. Because our bodies are frailer, our balance more unsteady, we are in grave risk of falling and hurting ourselves. Our thinner bones break more easily. Our shrinking brains have more room to slosh around in our skulls and are more easily damaged by a blow to the head. When older people are hospitalized for these types of injuries, they are statistically apt never to fully recover from them. 

So, hold on to the stair rail. Ask a younger person to change the ceiling light bulb. Remove slippery rugs from your home. Equally important, find a geriatric physician, who is an expert in making sure we don’t take medicine that makes us dizzy (and likely to fall), who will examine our legs and feet to make sure our gait won’t cause us to stumble, that we’re wearing the right kind of shoes, and who can recognize the symptoms of depression.

You may not consider yourself old, but the truth is that your body began accessing backup systems from the time you were 30 years old. Plan for the adjustments that may save your life. Look at yourself objectively and be aware of the changes that are happening. While you are at it, look around you, too. There are many older people out there. It is important to realize that they are us.

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