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Every day in the emergency department I see the aged. They come through the front door with the assorted infirmities that come with advanced years. They come through the ambulance bay when those afflictions become much worse, or suddenly change, or when they have no other way to come to us.

Some days, the ambulance entrance resembles nothing so much as a train station to eternity, with stretcher after stretcher lined up, bearing a frail, gray haired person who is struggling to breath, clutching her chest, crying in fear, screaming in confusion. It is these days, as healthcare slowly unravels, that we often ask ourselves whether so much that we do is too much. After all, we work so hard to maintain the physical form of those who have lost most or all of their mental clarity over years of decline.

Too often, family members want ‘everything done’ for individuals whose lives consist of lying on one side, unable to speak any but confused, mumbled words, dependent wholly on those caring for them in nursing facilities. It sometimes seems a cruel exercise in maintaining the living shell of a long lost memory. It sometimes seems a cost we cannot afford as a society.

And those assertions are not untrue. We spend great treasure on futility in American healthcare. Not only in the aged, of course, but mostly in that group. Many times physician and nurse conversations turn quickly to hospice, to ‘Do Not Resuscitate’ orders. Perhaps in our exhaustion we feel that death is the easiest, and the least expensive, alternative to the problems we face. This is a dark thing, but an increasingly popular idea as medically assisted suicide grows in popularity around the world. In fact, roughly three percent of all deaths in Canada today are the result of medically assisted suicide. That number is shocking, but not surprising, as Western culture celebrates the vitality of youth (ironically a group fraught with depression and anxiety) and tries to brush away and hide the inevitability of decline.

However, I have come to some conclusions as I have watched the trains of the sick and dying roll past. The first of those being the remarkable fact that I do, in fact, see those old, sick persons while they are alive.

Every day I see a very old man or woman with a disease that would have quickly killed them years before. They are in their 70s, 80s or 90s and have congestive heart failure; and have for years. (When I was in medical school that diagnosis meant you had about one year to live.)

These men and women have had colon cancer or breast cancer. They have had coronary artery bypass surgery or multiple coronary stents. They have had arrhythmia and cardiac arrest. They have had strokes and have been rehabilitated. They have survived sepsis, pneumonia and broken hips. Car crashes and falls have broken them, and they have pressed on back to life. My own father-in-law, beset with Covid-19 and two weeks on the ventilator at age 83 (with underlying Black Lung) is 86 and playing golf.

What this means is that several generations of men and women have served as the beneficiaries and victims of our clinical experimentation, of our attempts to reach past the boundaries of what we thought humans could survive. We have done remarkable things. It will be argued by some that this came at great cost. And there is no question.

However, physicians down the ages looked at dead and dying young men on battlefields and constantly thought ‘we can do better.’ Their efforts, which were doubtless viewed as futile and expensive by some, gave us modern combat medicine which saves untold lives. (And those lessons, of course, moved over into the civilian world which in some cities resembles a battlefield.)

What we are doing, as we care for our oldest and most vulnerable citizens, is pushing the envelope of illness, recovery and function. Already people who would have been bed-ridden for life have their lives given back to them with proper cardiac and stroke care. If we give them five good years, or ten, or twenty, is it worth the effort?

It may be too easy for the young to dismiss that and say, ‘well I don’t want to live that long anyway.’ Easy to say when one is on the low side of fifty. But after 50 those numbers don’t seem so old as they did before. And as love grows, so does the desire to share that love as long as possible with friends and family.

But another reality comes to mind. That is the little spoken reality that the world is depopulating more rapidly than anyone expected. Many nations are now below replacement rate. That may seem like a victory to those who have been taught to fear the population bomb. But what it really means is fewer people to do, well, almost everything.

That means fewer people to grow food, fewer people to manufacture goods, fly airplanes, drive trucks, give medical care, serve in restaurants, put in septic lines, run factories and everything else. It also means, and this is no small thing, growing old very, very alone. And while the idea of a depopulated paradise might seem delightful, it would probably be miserable and if depopulated sufficently, become unsurvivable, as specialized and interdependent as we have become.

Furthermore, skills are being lost at a shocking rate. That old man with the chest pain may be one of the few people who could still dismantle a locomotive engine and put it back together. The demented woman clutching the baby doll? In her locked away, inaccessible thoughts are decades of wisdom, and love, born of raising children and grandchildren. The man with the stroke who can’t speak? He has forgotten more mathematics and nuclear physics than most will ever know and could still run a nuclear power plant if he weren’t so afflicted. It is likely the equations still run through his mind.

And that doesn’t count the infirm welders we haven’t replaced, the broken line-men, the aged nurses too arthritic to work, the many times wounded soldier who can’t walk but still understand battle.. There is so much brilliance and skill lying untapped in those we overlook. They become just another troubling, annoying patient to put on hospice and be done with at last, so that we can move on to the ones who count. The young ones who know…less and less. The young ones who have not learned the lessons of their ancestors or the skills needed to survive.

Maybe the best thing we could do for the future is take our knowledge and direct it at trying harder to give longer, more functional lives to those who come to us late in life. They hold wisdom, knowledge and skills that we still need, and will need more if the news is any predictor.

All of this makes me see those people on the stretchers differently. I mean, we frantically try to conserve resources and recycle material goods but we are all too ready to toss human beings out just because the their years are too many and it might be hard to give them more.

I suspect that we may soon discover, through hard times, that they are a resource we can not longer afford to devalue. Maybe then we’ll actually try harder to prolong not only their lives but their utility. And in the process, their ability to lead joyful, useful lives untethered to our medical science and too heartless attitudes toward them.





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