Being Mortal

There is great wisdom expressed by the novelist Kurt Vonnegut about The Brothers Karamozov by Fyodor Dostoyevsky: “There is one other book, that can teach you everything you need to know about life… but that’s not enough anymore.”

In search of what might be missing, I followed his advice and read Democracy in America by Alexis de Tocqueville. While that book might in fact be the book that best demonstrates the strengths and vulnerabilities inherent in our form of government, a lot has changed since its publication in 1831, thirty-eight years before professional baseball became America’s sports obsession.

Clearly, more written guidelines are needed to help steer the course of one’s life. For me, the next literary breakthrough came from Neil Postman’s 1985 Amusing Ourselves to Death: Public Discourse in the Age of Show Business. Long before the internet or Trump, Postman saw television’s entertainment value as a present-day “soma,” the fictitious pleasure drug in Aldous Huxley’s Brave New World, by means of which the citizens’ rights are exchanged for consumers’ entertainment.

Last week, I was given a copy of Being Mortal: Medicine and What Matters in the End by Atul Gawande, the surgeon-author whose resume makes everybody else seem like slackers. The 2014 book begins with an acknowledgement of what we all know is an inevitability—death—and then explores the multitude of ways we are given to approach it. While we might be accepting of death, how we die is the question most fraught with fear.

“I don’t mind dying,” an old friend used to quip, “I just don’t want any pain.”

Gawande spends a good part of the book examining those places where most of us will spend at least part of our final year. Hospitals, retirement homes, nursing facilities, and assisted living communities are among the choices. Hospice, of course, can take place in a dedicated facility or at home. Given the choice, most of us would probably opt for home, surrounded by family.

Both of my sets of grandparents and my parents skirted the out-of-hospital experiences. My grandfathers died before there was such a thing a dedicated care and housing for the elderly. One died at work, the other at home after a short battle with colon cancer. By today’s standards, they were young.

My maternal grandmother, Ruth, died at 95 in the hospital in her western Nebraska town. She was active in her community, active to the point of pretty much running things. If she happened to miss a city council meeting and learned about an ordinance that she didn’t like had passed, she talked to however it was to facilitate its reversal.

When the DMV wouldn’t renew her driving license, she bought a golf cart. She spent at least three afternoons a week reading to “the old folks” at the town’s nursing home. She was decidedly older than many of the residents.

My paternal grandmother never drove a car. She spent her entire adult life in Cicero, an early settlement of Bohemian and Czech immigrants on the western edge of Chicago. Her last apartment was a two-story walk-up above a bakery on Cermack Road that she shared with a parakeet. Though she couldn’t read English, she subscribed to The Sun-Times for the obvious reasons.

Gawande wrote a single chapter about a young doctor who was hired to be medical director of a nursing home. Many of his ideas were to break rules that he systematically gained exceptions for to advance his views on how to best live one’s final weeks, months or years. A two-story building, he had one dog and two cats per floor. He also had 100 birds—birds that were caged in every residence. He wanted the facility to be as homelike as possible.

My father had a similar view about helping the elderly better enjoy old age. It was coming up on his mother’s birthday, a day in November when the entire family would gather to honor her. Dad went to a pet shop and bought a very expensive parakeet that was even banded to show its pedigree. Later, the bird somehow got out of the cage and flew into the picture window in our front room.

The bird died.

It was time to leave for babička’s party and the pet shop was closed for the day. Dad went to E.J. Corvette, kind of a poor man’s Walmart, and bought a parakeet for pennies on the dollar. He removed the band from the dead bird’s leg and put in on the cheap replacement. Who would know? Who would care?

My babi accepted the caged birth with nothing short of disdain. As the weeks went by, I’d go to visit babi. I noticed the bird squawked a lot. Turns out she had taught it to swear in Bohemian. The bird outlived my grandmother.

I spent nine weeks in a skilled nursing facility in Denver. After sixteen days in a coma and several weeks in ICU, I had lost the ability to walk, dress or feed myself. While the stay wasn’t altogether unpleasant, I missed my family, and I was deeply depressed about being there. I shunned all of the little concerts and activities (bingo, crafts, etc.) that were offered. Like my maternal grandmother, I thought those things were for old people.

The highlight of each week was when volunteers would bring their dogs to visit the patients. Each was a big dog, full of friendly tail wags and wet kisses. In a place that reeked of death, the canine visits were little reminders of home, which, of course, was the point. Most of us will want to face being mortal as comfortably as possible. And there is no place more comfortable than our own homes.

Photo illustration by Courtney A. Liska