Tag: aging

America Collection/General interest
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Running for Life — or a Lifeline

by Fran Johns

REFLECTING ON 90 YEARS OF FLEET FEET

Contemplating the Pacific before Marathon Day 2006 (Author photo)

In the untroubled days of my long-ago, think 1940s, central Virginia childhood I was not what you’d call a stand-out athlete.

Back before Little League transformed playtime into organized sports, a kid needed to be agile at kick-the-can and ferocious at dodge ball. I was neither. Oh, I wasn’t the last one chosen, but I also wasn’t often captain.

Intricate heirarchies were built around who could climb highest in what tree; I would get to about the three-quarter mark and start thinking about broken bones, of which I had my share. In short, the time and place called for a degree of bravado I desperately wished for and basically lacked.

But I could run.

Early on I learned that running could win friends and influence social standing. So I was a clutz at catching (or hitting) softballs? Get me on base, somehow, and I could fly. Pinch runner was my best position.

Fleet feet were my secret weapon, largely because I, along with most of the other kids in town, went barefoot beginning on the first balmy day of springtime.

I was really good at going barefoot.

The farm kids, traditionally strongest of us all (child labor laws did not apply to family farms) had to wear boots because of what they were stepping in all day. But except for classes or formal occasions I spent roughly half the year barefoot. As a result, my feet were like leather on the bottom by April. Cinder tracks for Field Day relay races? No problem. Don’t believe those depictions of Hermes in sandals; bare feet can be a superpower.

Photo by Irina Kalinina on Unsplash

When I got around to raising my own children, shoes were definitely in, and running was not yet. Well into the 1960s, if you’d been seen running around the neighborhood, by now I was in another small town near Atlanta, everyone would assume you had just robbed a bank. Or forgotten to turn the stove burner off. I kept up a passable tennis game, and team-sport skills served me well when the parents played the soccer kids. (The kids still always won.) I biked to freelance jobs; that was no fun.

Suddenly, beginning in the 1970s, running became A Thing. Hallelujah!

By now my children were looking at colleges, I was juggling several careers, my marriage was unraveling and life seemed to be coming at me with three questions for every answer. The search for answers began when, no longer barefoot, I laced up my sneakers and took off running. 

In those early days of the running craze, it was possible to find a 5k or 10k neighborhood run every weekend, everywhere, rain or shine. There were fundraisers for nonprofits, celebrations of obscure holidays or just get-together excuses. We ran for T-shirts or free pizzas or occasional awards. It took a while for women and girls to turn out; I was in my early 40s when I took home an engraved plaque declaring me Oldest Female Finisher.

And again, running was my salvation.

The problems that seemed hopeless at 3 AM could dissolve into possible solutions while jogging around leafy streets at dawn. We formed running groups of friends who turned into supporters. I wrote my best articles in my head, ready to type on return.

I did not turn into a great winner (other than the Oldest Female Finisher and a few red ribbons) but running helped me win other battles. Several of them coalesced into my first Bay to Breakers race. In 1992, having won, or at least survived, a few of the dark-days problems cited above, I began a new life in a new marriage in a new city, San Francisco.

How about all those people behind #33911? Even if they’re mostly walking (Author photo)

Before leaving I had contracted to write a magazine article comparing the Peachtree Road Race, then featuring a lot of crazies, to the Bay to Breakers, featuring certified crazies by the dozens. Feeling duty bound to complete the race although I had not trained a single day, I pulled on a pair of worn, comfy sneakers and set out to walk it.

It could not be done.

At every other corner were singers and dancers, cheering (drinking) people, jazz bands and throbbing music. It was impossible not to dance — and run. After starting at the back of the mostly-walker crowd I broke out running whenever the route was not straight uphill. My knees were in revolt for the next three weeks, but I got the story in on time. 

Speaking of hills. San Francisco quickly reduced me to a walker. Partly because my new home city was too beautiful to learn at a running pace and partly because very few consecutive blocks don’t involve mini-mountains, my running career ground to a stop. It stayed dormant while I traveled the globe with the excellent Final Husband, while I went back to school for an MFA and generally lived a blissfully happy life.

Suddenly I had passed my 70th birthday.

One day I woke up thinking everybody should run a marathon before turning 75, and I had never run a marathon. So I filled out the forms for the Nike Women’s with its Tiffany gold necklace prize, talked my daughters into joining me and began training (the three of us plus one young friend all in different states.)

I rediscovered the sheer joy of fast-paced movement and quickly remembered the benefit all those endorphins brought. Even doing the hills — I trained on segments of the planned route — brought back the old exhilaration. Clear head, clear thoughts, or sometimes no thoughts at all.

Four months into my marathon training a lump in my breast brought plans to a screeching halt. Instead of going on a training run I was being wheeled into surgery. It was mid-February.

Photo by Olga Kononenko on Unsplash

That was the bad news. The good news was that no cancer cells were found in my lymph nodes, so I skipped radiation and the bad chemo, and went straight to the mild and manageable Tamoxifen.

By mid-March, my racing partners were reaching their projected times. I was feeling like a slug.

Until one morning when my husband said, casually, “I wonder if being lopsided would affect your running gait.” Which started me thinking about the gold necklace again, and the fact that the race was still more than two months off.

I traded a few messages with the race people, who assured me it would not be called cheating, under the circumstances, if I wimped back to a half-marathon. And more importantly, I could still have the necklace. Besides, it was paid for, and I am basically cheap.

I went back to training. There were always others doing the same thing. I got more than a few strange glances, the little old lady loping up and down the hills? Mostly I got thumbs-up signs.

Perseverance pays. By the time we four members of Team Gran assembled for dinner the night before the race we were equally pumped, if unequally prepared. Plus, the matching T-shirts had arrived on time.

#3911 nearing the finish line ahead of a clearly unhappy #3855 (Author photo)

The race, my first and last marathon, began on a chilly morning that quickly turned into a brilliant San Francisco day. I ran for some of the route, jogged other sections and walked a few uphills. People passed me — a lot of people passed me — often shouting words of encouragement, sometimes asking how old I was. My husband, who knew this town like the back of his hand, would pop up at unexpected places holding “Go, Team Gran” signs for us. (The team ran the first few yards together and then split into our respective time-slots.)

This is the best possible way to end a race: When I got to the half-marathon exit I felt like I could’ve gone on for miles. I still had sense enough to know I wouldn’t have made it to the end. The word ‘cancer’ had never crossed my mind.

At the pre-arranged meeting spot we four eventually picked up our formal certificates, the swag bag and the coveted Tiffany gold.

That necklace, the Oldest Female Finisher plaque and a few dozen ribbons, certificates and T-shirts have slowly disappeared.

I walk the city hills now, two or three miles of them on most days, but no longer break into a run for fear of breaking something else. But the pure delight, the thrill of spotting unexpected beauty, the clarity that fresh air brings, the joy of motion . . .

Priceless.

General interest/Optimism Collection
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The Wild Witch Speaks

by Fran Johns

OR – How I want to be remembered

I come from several generations of mostly women — who may or may not be witches.

The youngest of four sisters, I grew up among aunts and great-aunts who were occasional role models and always sources of entertainment. My sisters and I welcomed ten more daughters into the next generation, although my father — one of five brothers himself — did eventually acquire two grandsons (including my own firstborn.)

By the time of my recent exhaustively celebrated 90th birthday, things had evened out a little: two nieces had had five sons (and no daughters) between them. The rest of that generation is a mixed bunch. Thirty-some of us gathered in Georgia not long ago to celebrate my own longevity and the life of my last remaining sister Helen, who died earlier this year at 95.

The night had cooled and frivolities settled down somewhat when my giant birthday cake was brought out. Son-in-law Paul, whose passions include all things culinary, creates these ten-pound wonders. I hope I was saying some thing profound for the moment, but in truth do not remember.

Profound or not, the moment was captured by my nephew Chris. A writer/poet/English teacher, Chris later found it reminded him of a piece by noted American poet Lucille Clifton. Photo and poem were thus framed and sent to me. Clifton (1936–2010) was a poet/writer/educator herself, and two-time Pulitzer finalist. I am proud to be in the same frame with her.

daughters by Lucille Clifton

woman who shines at the head

of my grandmother’s bed,

brilliant woman, i like to think

you whispered into her ear

instructions. i like to think

you are the oddness in us,

you are the arrow

that pierced our plain skin

and made us fancy women;

my wild witch gran, my magic mama,

and even these gaudy girls.

i like to think you gave us

extraordinary power and to

protect us, you became the name

we were cautioned to forget.

it is enough,

you must have murmured,

to remember that i was

and that you are. woman, i am

lucille, which stands for light,

daughter of thelma, daughter 

of georgia, daughter of

dazzling you. 

 

General interest/Optimism Collection
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Old Age Needn’t Be the Pits

by Fran Johns

ONE 90-YEAR-OLD’S ARGUMENT FOR KINDNESS, GRATITUDE AND A DOSE OF ACTIVISM

Photo by Daphné Richard on Unsplash

Turning 90 — which I am now happily doing — is a mixed bag.

Things I’m happy to have skipped: Internet dating. Raves. Tik Tok. ChatGPT. Crowdsourcing. Being referred to as a Content Provider 😡.

Things I’m happy to have enjoyed: Big bands. The hula-hoop. TV before cable. The jitterbug. Trash-free cities and waterways. Patriotism before it got a bad name, and civil discourse before it was eliminated from our democracy.

I’ve recently read pearls of wisdom shared by folks turning 30 — or 50, or 20, or even 70. I was brought up to believe that age brought wisdom.

Nahhh. Age brings wrinkles.

At least my wrinkly brain still functions, as do my wrinkly feet. One can hardly ask for more. My advice to the under-90 set is that if you keep using your brains and your feet you’ll probably be fine. It is wise to appreciate them anew every day.

Things that make it worthwhile to be very old:

Kindness. Kindness should be #1 for any age, but mean old people are just the pits. Which brings up:

Attitude: Optimism works for me. Old people have a lot to be grumpy about (I do not.) But grumpy old people are the pits and then some.

Activism. When you’re emailing congressmen, out working for a cause, joining marches or writing postcards to voters you don’t notice arthritis.

Curiosity. Try to be at least as curious as you were 86 years ago.

Friends. Nobody doesn’t want to be friends with an unthreatening old person. (See above.) It is wise to have been collecting friends all along, but young friends are important because the others keep dying off.

Gratitude. On the worst day there’s something to be grateful for. By the time you get this old, just waking up is one.

Finitude. Specifically: I’m likely to die soon. (Hopefully not tomorrow; another few years on the planet would be okay.) But dying is not the worst thing that happens to anybody. It is wise to consider this reality and take appropriate action.

Faith. In god by whatever name, in Mother Nature, the celestial universe, doesn’t matter. It is not wise to think we humans are the be-all and end-all, an idea too depressing for any age. It is wise to consider the stars and clouds and oceans, and the fact that if we don’t take better care of our little planet whoever’s in charge is likely to give up on us.

That’s about all the nonagenarian wisdom I can come up with.

I’m grateful to you for reading.

End-of-Life/General interest
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The Glory of Modern Dentistry

by Fran Johns

Or – How in the world am I going to pay for all this gadgetry?

Photo by Quang Tri NGUYEN on Unsplash

Dentists, my oral surgeon told me almost as an aside — he’s sticking needles in my jaws, and I’m supposed to feel sympathy? — have the highest suicide rate of any profession. I reflected on this, having nothing better to do at the moment.

After Googling around when I got home I learned that MDs are at greatest risk, but the DDS folks are close behind. This is not research, it’s only Googling, but here we are.

Back to my oral surgeon. I am spending a lot of time with oral surgeons, and oral everything elses, having reached the advanced age at which all that expensive stuff — crowns, implants, you name it — done 25 years ago wants to be redone. Regardless of how loudly I argue that I don’t need another 25 years — could they patch me up for five or six, maybe? — I find myself captive to the stratospheric talents (and costs) of today’s dentistry.

Rather pricey view from (one of) my dentist’s offices (Author photo)

Please do not get me wrong. I am immensely grateful to the entire profession, and the way they have kept me smiling through the years without looking like a toothless goofball. Eating is nice, too. So dentists and I are longtime besties.

But now I’m worried about their depression levels.

I do not want to get into the suicide business, which is a sad and serious issue never to be written about lightly. So I am only worrying about what might make them so sad.

Money? How can that be? Admittedly all that fancy equipment must cost a fortune — and many of my dentists are in an historic, heavily gilded downtown building on which I feel I pay upkeep. But as they all have other patients besides yours truly, and what I’m spending on this averages out to the choice between two weeks in Paris or fix that tooth — well, nobody’s talking minimum wage here.

It must be staring down throats all day. Have you considered how repulsive the view into your throat really is? I thought not. Or it could be the fear that, at any moment, an enraged patient might chomp down and amputate your gloved finger? That would definitely increase workplace anxiety.

Self portrait with (happily only temporarily) purple jaws (Author photo)

In the end, however, I have decided to quit worrying about my dentists’ health and wellbeing. They, after all, are not the ones with purple jaws and occasionally absent teeth. Plus, I’m assuming they can afford therapy, given the bills I am paying.

Now, about that bank I’m planning to rob . . .

America Collection/General interest
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Should You Still Be Driving?

by Fran Johns

A CLOSE LOOK AT THE UNIVERSAL QUESTION

Photo by Jan Baborák on Unsplash

I am slowly talking myself into giving up my car.

Though still, I honestly believe, a very good driver, I cannot escape a tiny, nagging question: Could I live with myself if I were involved in an accident in which someone is injured or killed? Even if it were clearly not my fault, could I avoid suspecting some failure of eyesight or reflexive response or yet unknown factor had played a part in an accident that might not have happened if I weren’t driving?

So I have begun this conversation with myself.

It starts with the memory of former conversations, one in particular. For years my three sisters and I discussed who would get our widowed father from behind the wheel of his car (none of us wanted to volunteer.) “Never had an accident in fifty years!” our father would declare. None of us wanted to point out the chaos in his wake. We were saved by a family friend who undertook to explain to our father how much money he could save on gas, insurance, repairs, etc.; he threw in a list of small town neighbors happy to be on-call chauffeurs. My father died 12 years later, at 90, never having injured a fellow creature.

This background conversation relates to the personal relationship I have with my 2001 Volvo S40 The Bud. Less intimate than my relationship with its predecessor LilyPad, a forest green 2000 Volvo S40 that was demolished by a 14-wheeler in 2020. The LilyPad and I were turning right from the right-turn lane; the 14-wheeler was turning right from the center lane blithely unaware of the legal maneuvers of that little car below. I consider it a testament to good reflexes that I was able to get out of his way after he demolished the front of the LilyPad and before he demolished the rear; the driver’s side and I survived unscathed.

But two more years have ensued. The conversation continues:

How certain are you that your reflexes are really as good as safety requires? Suppose someone’s beloved dog darts into the street and you don’t hit the brakes quickly enough. Could you live with that loss — knowing that a better driver might have avoided it?

And how about eyesight? I have, like much of the over-70 population, macular degeneration. Cataract surgery several years ago greatly helped my vision, but still. I have AMD and my eyesight is only going to get worse. At what point do I decide it’s worsened enough?

I think there is no magic moment when one can say, Today I should quit driving. Occasionally a driver receives a signal. My sister Helen, for example, was in her early 70s when she went to get the family car from its parking space in a Boston street lot. Instead of backing up a few feet as she had done countless times before she went forward, rolling to a stop against a sidewalk sign.

Everyone said, “Oh, that’s a common error. Your foot slipped.” “Nope,” said Helen, as she handed the keys to an attendant. “Someone could’ve been on that sidewalk. I put my foot on the wrong pedal. I am never driving again.” She never did.

There are, of course, good drivers in their 80s — I continue to consider myself among them — or perhaps older. There are plenty of bad drivers in their 20s or 30s. But those of us in the older category should be peculiarly attuned to the questions about when we turn from good to bad. It’s unlikely to be one lightbulb moment.

So we might all do well to have the conversation. What are the pluses? All that money I’ll save on no more insurance, gas, repairs (you might figure from the age of my vehicles that car payments are not an issue.) Parking meters. Garage fees. Fastrak fees and miscellaneous tolls. And even as little as I drive it, The Bud is not helping the environment; its namesake worked hard for the planet.

The minus? It comes in handy. There’s the convenience of being able to zip off to the park or the grocery — almost the only places to which I frequently drive. Freedom? A lot of drivers cite their car as a symbol of freedom; actually, I feel most free when walking a few miles, carrying stuff in my backpack.

I live in a city where public transportation is quite good for the most part; taxis and ride shares are everywhere. For what I’d save on the costs outlined above I could take an awful lot of cabs. My father’s small town had no public transportation — but neighbors beat light rail any day.

You can see the direction this conversation is going. Before my next birthday — still nine months off — when it’ll be time for driver’s license renewal and close to time for new smog check, registration etc, I think I will have taken the leap, gotten the airport-effective Real ID, sold The Bud and adjusted to a new life of being chauffeured when necessary.

I believe the car-free life will be just fine.

End-of-Life/General interest/geriatrics/Health/Lifestyle/seniors/Women
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Aging, Guilt & When to Complain

by Fran Johns

One of an occasional series on the advancing years

It’s more than a little ominous: 85. I mean, look at all those good people who missed this mark in just the past few months or so: Oliver Sacks, 84 – just barely. Dead Poets Society founder Walter Skold, 57. Peter Mayle, 78. David Cassidy, 67. Stephen Hawking for heaven’s sake, 76. Approaching 85 is its own little why should I still be around anyway? season of guilt.

Guilt - Lachlan Hardy
(Lachlan Hardy)

So perhaps it’s only right that the impending milestone might involve a teeny negative or two. Guilt will do it every time. For me, it’s a nagging suspicion that this party is about to be crashed. On March 15th of my last turn at being 84, for example, I woke up at 5 AM, even before the alarm rang, to catch a flight beginning an overseas adventure. Everything went right. Bags properly packed. Good breakfast. All devices and power cords cross-checked. Problem-free trip to the airport. Zip through security. Thirty minutes before boarding time, when I heard my name being summoned to Gate 11 it was not even a surprise. Probably left my wallet at home, I figured, or someone just called to say the conference had been cancelled. It was so unexpected, this call, that by the time I reached the gate I was fully reconciled to having had too much good fortune for any one day. They wanted to offer me $500 on a future flight if I’d trade my Business Class upgrade. Such is the emotional hazard of approaching 85.

Then there is the limitations business. Pre-80, who worried about acknowledging limits?  Certainly not I. At 72 I signed up to run my first marathon, just because I figured everyone should try to run a marathon before hitting 75.Runner A bout with breast cancer intervened to mess up my training, but I got back on track at least enough to finish the half, feeling absolutely confident I could’ve kept right on going. (Although probably not for another 11 or 12 miles.) And then. One day in Paris, having inched past 80 with no further temptations into distance running, the ominous stairs challenge sneaked up on me. I had only recently moved, at the time, out of a 4-story house in which I was constantly zipping from laundry (ground level) to studio (4th floor) with nary a care. Thinking it would be fun to trip up the circular staircase to the top of Notre Dame right before closing time, I got about 30 steps and decided to let the rest of the group go ahead. More slowly, I climbed another 20 or 30 steps before my little heart said, “I don’t think so.” This would’ve been less embarrassing were not the Notre Dame lookout designed as one way Up, straight across, and one way Down the other side. Luckily for me the concessionaires were just closing up shop and let me follow them down the Up staircase, which is why I did not have to spend the night locked inside the cold stone walls of Notre Dame.Nob_hill_view

Ever since, I have begun to notice limitations on previously-negotiable San Francisco hills. If the heart doesn’t send out alerts, the lungs huff and puff their indignation. This happens a few times to my intense consternation, and I make an appointment with my doctor. I complain a lot. She orders tests that proclaim everything is just fine and dandy. She speaks briefly of the really sick people under her care, mentioning a few of their ages and afflictions. “You’re 84 years old,” she observes; get over it.”

How am I going to complain when I hit 85?

 

 

End-of-Life/General interest/Health/Healthcare/Medicine/physicians
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Surviving to live another day

by Fran Johns

It started innocently enough: I was complaining about being short of breath at a dinner party. Several physicians were at the table; one suggested that it might be possible to increase lung capacity by doing exercises with a spirometer. “I’m not a pulmonologist,” he said, “so I don’t know; it’s just a thought.”

Incentive_spirometer

The thought was planted. I fired off an email to my primary care physician (we love Kaiser Permanente) asking if she knew of such a thing, and/or might refer me to someone to give it a try. She replied with a request that I come into the office so she could evaluate me. Well, grump, grump; all I wanted was a quick fix, but anyway. It takes all of about 10 minutes to get to the Kaiser Medical Center. I arrived for an 11 AM appointment.

The good Dr. Tang patiently explained that she did not prescribe via email. And because it had been 2 or 3 years since we last examined the heart/lung situation she would like to do another work-up, to see about this shortness of breath business. She went very lightly on the issue of my being 83 years old for heavens sakes, although she did mention she had 60-ish patients in worse shape than I. (This is a compliment, coming from one’s physician whom one reminds of her mother, although I was still looking for some magic way to walk uphill without having to stop and catch my breath.)

She then ordered a zillion blood tests, an EKG and a chest X-ray. Still grumping a little, I set out for all these, vowing that if even the smallest of lines appeared I would just come do it all another day. It took me roughly 3 minutes to get in for the EKG, less for the X-ray, and when I got down one more floor to the lab and pulled ticket #372 the automated voice was already saying “Now serving #372 at Station #4.” After dutifully following all these instructions, I went home to take a nap.

Within an hour, a voice mail message arrived from my doctor. “Your tests are fine, I don’t want to alarm you. But I’d like for you to come back in right away. Just tell the front desk you’re here.” Alarmed, I set out for the Medical Center once again. Lung cancer. Definitely. A spot on the lung showed up on the X-ray, and I will definitely die of lunch cancer in the immediate future. fear

Fortunately, the 10-minute drive didn’t allow too much time to contemplate my impending demise. “No, your X-ray is fine!,” she said. “Your lungs are fine! It’s just this one test that came back pretty high. It’s a screening test for possible blood clot. These tests are set very high because we don’t want to miss anything. Still, I want to be sure there’s no clot there that could indicate a pulmonary embolism causing your shortness of breath.” OK, I prefer not to have clots floating around in my bloodstream.

So does Dr. Tang. Whereupon she ordered a CT scan – which meant walking uphill a block to the hospital where they have those fancy machines (and radiologists to read what the machines report.) “Once you’re done,” she said, “come back to the office and as soon as we have the results we can talk about them.” I set out on the brief uphill walk. Pulmonary embolism. Definitely. Isn’t that what did in my mother at age 70? Embolism, aneurism, something blood-clotty. I’ll probably die of pulmonary embolism before I get back down this hill.Grim reaper

It is now close enough to closing time that most Kaiser people are closing up. But the CT scan people wait for me, hook me up to the dye thing and run me back and forth through the machine. I walk back downhill, mildly optimistic because nobody gasped while I was getting dressed in the cubicle several feet from the scan people. With nobody now at the receptionist desk, I walk into the nursing/examining room area and tell a smiling nurse that I’ll be outside if Dr. Tang needs me. And sure enough, in another 5 minutes – not enough time to consider calling the crematorium – she comes bursting through the door saying she’s so glad I waited.

“As I said, these screens are set very high so that we don’t miss anything,” she begins. “In your case, there was nothing to miss. It was just a false positive.” I exhale. We talk briefly about how I might increase my exercise regimen if possible – which might even address the shortness of breath issue; I concede that I am, indeed, 83.

On the way home, no longer planning to die in the immediate future, I count the cost: six hours, several hundred dollars co-pay. And I give thanks for our Kaiser membership, modern medical technology and my good doctor.

happiness

 

 

compassion and choices/Death and Dying/End-of-Life/geriatrics/Health/Medicine/seniors
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Death, Dying & the Grey Zone

by Fran Johns

clouds

Death-and-dying usually goes with I-don’t-want-to-talk about-it.

Katy Butler wants us to talk about it. She worries, though, about the culture of death-denial, and about the lack of language when we do try to talk. How, for instance, do you say “I don’t want any more surgeries,” without its sounding like “I’m giving up”? Or how do you say “She doesn’t want that treatment” without its seeming you don’t want to keep Mom around? Especially when you know what Mom wants, but the doctors don’t?

Butler, author of the acclaimed 2013 memoir of her parents’ dying years Knocking on Heaven’s Door, spoke at a recent meeting of the San Francisco Bay Area Network for End-of-Life Care. Network members – physicians, teachers, counselors and individuals associated with a wide variety of end-of-life organizations – were clearly in tune with the message: death comes, but few acknowledge or prepare for it. It’s that vast majority, those who don’t want to talk about it, who concern Butler and her audience, including this writer.

Knocking on Heaven’s Door details, in graceful prose, how Butler’s highly educated, physically active, devoted parents managed to get caught up in the brutal reality of dying in the U.S. Her father, a decorated veteran of World War II, suffered years of gradual descent, including having a pacemaker put in when that was mainly a cruel prolongation of suffering; her mother suffered in parallel but very different ways as his caregiver. It is all, Butler fervently believes, unnecessary suffering. She quotes her father as he declined:

“I don’t know who I am any more.” Another year or so later: “I’m not going to get better.” And still later, “I’m living too long.”

Butler speaks of this in terms of “the Grey Zone.” Whereas most of us want simple, black-and-white answers – “This pill will fix everything;” “you can expect to live another four to six months” – in truth, the time before dying is the Grey Zone. And whereas the Grey Zone used to be short and swift, today – thanks to modern medicine and technology – it is forever expanding.

ER

Everyone will enter the Grey Zone sooner or later. You, reader of these words, and I, writer. You may ski into a tree, or get hit by a truck tomorrow, causing your Grey Zone to be little more than a blur; I could have a major stroke or aneurism and be at the crematorium tomorrow. But in all probability, our Grey Zones will come in bits and pieces, and will extend for many months or years. They are likely to include a few hospital stays for broken bones or debilitating illnesses, chemotherapy for cancer, possible time on a ventilator, multiple medications with occasional unpleasant side effects, outpatient and inpatient experiences with doctors we have never seen before and encounters with medical technology yet to come.

Butler advocates shifting our Grey Zones away from the relentless need to prolong life at all costs to the consideration of what really makes life worth living. We would do well, she says, to be aware of when “that space between active living and dying” should shift from Cure to Care: to easing our way from good life into good death.

Butler’s understanding of these issues come from witnessing her father’s long, anguished journey through a Grey Zone of many years and her mother’s steadfast refusal to allow a similar prolonged struggle to mark the end of her own life.

Quite apart from the expanding battles to legalize medically hastened dying, the need to acknowledge the Grey Zone is equally urgent. Most of us would opt to shorten that space between active living and dying, or at the very least to move gracefully from good life into good death.

It can happen, but not without paying attention. Reading Butler’s book, with an eye to how you would like to knock on heaven’s door yourself, is a good way to start.

Because looking realistically ahead makes infinitely more sense than zoning out.

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