Slippery slope...

A few weeks ago, our youngest son Dónal traveled with friends to Wisconsin, in large part to slip and slide the various water parks that make Wisconsin’s Dells “the Dells.”

I long ago, back around the time I last climbed aboard a roller coaster at Hershey Park in Pennsylvania — and we’re talking some 25 years ago, when Karen and my youngest brother Patrick last convinced me to ignore common sense — started resisting any spur-of-the-moment impulse that might give gravity even more leverage to sooner end my life. Since then, I have reasonably reasoned that the older I get, the more opportunities there are to die without, on my own volition, having to add to the list of possibilities. So, for all my youngest son’s entreaties to the contrary — “oh, c’mon, Dad, it’s fun…can’t wait to do it…it’s only a 50- (or was it 80-) foot vertical drop” — I proverbially begged to differ. After all, he’s sixteen, what does he know about what life can do to him, to me, to his mother, to all those who love him, in that, that one instant of unknowing.

The thing is, that at this, my age of 57, there are not only more — and more frequent — opportunities to die (yes, Karen, I’m showing my Irishness again), but it is truly all too easy to gain admittance into that somewhat less than amusing amusement park that beckons at middle age and broadens beyond. Ignore your high blood pressure, and you’re screwed. Step into the minefield of diabetes, and, guess what, you’re screwed. Crank up on the burgers and fries, and, you know what, you’re screwed. Wait a few more years, and, for whatever good luck you might have had before, the time bomb of genetics goes off, leaving you at the mercy of glaucoma, cancer, stroke, you name it.

It’s a crap shoot…life, that is.

In my former position as a family physician in a small and rural town in Iowa, I would, every Tuesday, every other week, visit a local nursing home. Most of those Tuesdays, I’d see six or eight or ten nursing home residents in the course of a couple of hours. Most were routine visits, mandated, mostly, by Medicare. But some were the kind of encounters, which, I knew, could all too easily lead to that slippery slope, that water slide, which is, young or old, the realm of the possible for all of us, and hardly fun.

If you’re young, let’s face it, time is decidedly on your side.

But get yourself into a nursing home, and all it takes is one infection, one new onset, as those of us of the medical persuasion shorthand it, of A. fib, of an otherwise ordinary UTI, of ARF, and you are, in the vernacular, a get-out-of-my-emergency-room “gomer,” if not an outright goner. And if that shorthand gives you the short end of the stick, consider this: giving you the benefit of a doubt, stretching your diagnosis to atrial fibrillation, to a urinary tract infection, to acute renal failure, changes nothing. It all depends on those immediately around you and how quickly they respond to your more or less pressing problem.

Dare I share a secret?

Every time I entered that nursing home, I smelled death.

I would slip, in an instant, from the car into Iowa sunshine, walk toward the shade of the building, pull open the front door, step into the vestibule beyond, reach for the next door, the shadows beyond, give that last door a yank, and then…

Sometimes it was the smell of the newly dead.

Mostly, however, it was the smell of those about to die.

The infection festered; the heart failure neglected beyond the usual swelling those of us in the know chalk up to everyday lower extremity edema; the pneumonia, treated, too often half-heartedly, and now gone amuck; the emphysema, COPD to those of us in the trade, that makes comfortable company until it decides that today, today, this day is the day you die.

All of us die.

But none of us, not one of us, need be sped off life’s stage.

It is, this doctor is going to say, too easy to die in a nursing home.

You — or your mother, father, sister, brother, does it really matter — are, let’s face it, a bed. Nothing more, not much less. A bed that ups the occupancy rate, ensures reimbursement from this insurance or that, or, if age allows, from Medicare, and, in the end, keeps the nursing home in the black. If you — or your mom or dad or those luckless siblings — die, oh, well. The tail end of the greatest generation and the front end of the baby boom bunch pretty much ensure plenty of replacements. Why get hung up on good-hearted Bob, after all he’d already had 101 good years, or ill-fated Ruth, who, until she started paying rent at the home and then started packing on pounds of water weight, had been in pretty good shape; or luckless Helen, bride, all those decades ago, of Bob and now his widow, whose heel wound, somehow, without anyone noticing, became the feeding ground of maggots; or, for good measure, poor, poor Thelma — ah, c’mon, she’s already 97, who cares if she makes it to 98, and so what if she has a son who himself cares. I mean, she’s 97, what, what at this point is left to enjoy of anything that resembles life?

Let’s say, though, it was me. Or, maybe, you.

Are you ready to be admitted to the home, welcomed, more or less patronizingly, encouraged to mix with those who, knowingly or not, signed on before you, survived so far, and who are, like it or not, your new neighbors and roommates? Are you willing to give up those extra years, whether in your 80s, 90s or beyond, to the unintentioned ignorance or ill-intentioned malfeasance of those hired to care for you? Are you, at 97, ready to hear, in action even more than words, why bother imagining a future when your life, your precious life, is all about the past?

If you’re lucky, you’ll fit in, stay healthy, avoid the ever-swirling infections, the stumble in the hallway, the all-at-once illness that means a trip to the emergency room and, perhaps, a longer stay in the hospital, and the risk, simply by the company you’re keeping, that you’ll buy the infection that will buy you the farm. If you’re even luckier, you’ll look forward to bingo, enough so that, even when called out for your every-other-month checkup, you won’t, as did my patient Jean, who threatened me with a “kick in the pants,” mind the intrusion. Luckier still, and lunch — which, like breakfast and dinner in a nursing home, is but a stepping-stone in the slow, ineluctable journey that marks life’s end, and which, on any day, guarantees a traffic jam of wheelchairs and walkers at the chalk line of the cafeteria — will be nothing more than a speed bump in your day, and you’ll soon be in and beyond to the momentary nirvana of gelled this and gravied that. Another meal, another day, in lives all too achingly short of days.

And if you’re not as lucky, if death sniffs around and decides you are the one, that today is your day, that no number of prayers, no amount of hope can stiff-arm its approach?

Oh, well.

Life, if not for you, goes on. Your bed is serendipitously open. There is, like it or not, insurance money to be had. Those left behind — spouse, siblings, children — will get over it, won’t they?

© 2008 by Dónal Kevin Gordon