How you live is how you die

Yes, selfies and shark attacks can kill. But what we really fear is old age
Suzanne Moore


As we seek to prolong our lives, we shut old people away, only happy to see them if they are healthy and happy

Are we afraid of old people? Photograph: Alamy

Every day I read about something that will help me stay alive for longer. Usually, it’s something dietary: a bean, a berry, some kind of vegetable that we use to feed cattle. Then there is a message about moderation. Somehow, I soak this information up, regurgitate it to my friends over too many units as we nod in agreement that we should do something about ourselves. Information is power, but sometimes it feels more powerful to ignore it. Am I slowly killing myself ? Clearly. Will I live to regret it? No idea.

But there are always new things to worry about. One survey shows that more people died last year taking selfies and falling off things than in shark attacks. This isn’t funny really, but it seems to me I was always far more likely to die in the pursuit of some narcissistic exercise than anything that involves swimming. Is this stupid way to die any worse than some sensible way to die? Because the sensible way to die involves getting really old, which is terrifying.

The cool thing is not to be afraid of death, but of the actual dying bit – and when I was younger, I am sure I said that. Now I am afraid of all of it: cancer, Alzheimer’s, having every day overcast with cloudy, arthritic joints. Then I strip my fears to the bone and they are about being dependent. And losing my sense of self. And needing other people. And I wonder: is this a fear of dying of old age – or actually a fear of old people?

This may be a vile thing to say but it’s there, isn’t it? We constantly talk of an ageing population in an abstract way. This is the subtext to why we may benefit from taking in refugees. They will care for us in the end. We constantly express our disgust at the way old people are treated but we don’t want to see them unless they are healthy, happy and hiding their diseases. Jackie Collins was amazing to do as she did, but most of us couldn’t, or wouldn’t, keep up appearances like that.

The reality is that many of the illnesses of old age will hit if we get to 80, and most of us are befuddled by what to do. We must keep alive and be kept alive while actually being given minimal care and regarded as an embarrassment. It is as if the time-bomb of this unproductive, decrepit layer of society is a theoretical discussion that is solved by bolting down green juice and behaving like immortals.

Doctors who deal with mortality, day in and day out, can be good to bad to brilliant. The best I have seen have been paediatricians – possibly because there is something so unnatural about children dying that it cannot be ignored. When one of my children was in an intensive care ward, two of the eight children there died on the same day. Everyone was openly devastated: the parents, the nurses and the doctors. They got us together and talked about how they felt and how they would work for our children.

On cancer wards, though, I have seen curtains pulled round a bed while a corpse is removed, with not a word said to the other patients. But what some of the best thinkers who happen to be doctors (Henry Marsh and Atul Gawande, for instance) are now talking about is both ageing and death, and how to have the best possible end, knowing that it is going to end. There is a consistent line coming from medics worried about the suffering caused by overtreatment. This means thinking about what to prioritise – especially with the elderly. It is to talk about quality of life and a return to personhood. What does this individual need? And the answer may not be medicine.

Gawande took his father’s remains to Varanasi, sprinkling his ashes in the Ganges water. He knows, as a good Hindu, that this rite is sacred. But as a doctor, he also knows that to sip the holy polluted water is dangerous, so he premedicates himself. However, he still ends up with giardia. But what comes from his experience is his father’s vitality, his work and connections remaining vivid till the end.

This is in sharp contrast to what we know is actually one of the biggest diseases of old age: loneliness. It may well be a cliche to contrast Gawande’s extended family to the atomised existence of the west, but the figures speak for themselves: a million people over 75 say that they don’t know their neighbours and haven’t spoken to anyone for a month. Their company is a TV set.

So when physicians talk of the myriad problems of treating the elderly, when we talk about palliative care and assisted suicide, we must be honest. The reality is a set of policies that have slashed social care, underpinned by the idea that caring is itself a low-status, feminised activity. The corollary is that what it means to be cared for is to be the lowest of the low. Old. Alone. Helpless. So we shut old people away as we seek to prolong our own lives. Indeed, a privilege of the west is we now fear not dying, but ageing, as much as we fear death itself. We literally cannot face our own futures.

This piece from The Guardian sums up so much of what I feel, and don't talk about, around the subject of ageing and death. Bill and I watched his parents fade over time, each in their own style (Dad fighting and cantankerous, Mum wryly humorous and grateful for everything she had). If we live so long, we don't know what our end-style of living will be, or how our dying will unfold.

I often say - probably too damn often, it's one of those things I've started saying - that the way you live is the way you die. Gangsters are shot down in cold blood. Drunk drivers drive drunk and die (often taking others with them). The grumpy die most reluctantly, wanting to win just one more battle and failing. The grateful, like Mum, go out as gently as a tide.

Talking about and looking at old age is deeply taboo in a culture that still worships youth, or at least only accepts old people who act unnaturally young. Think about it. When was the last time you saw a news item about an "oldster"? They're always reaching some incredible milestone like being 114 years old, or getting married at over 90, or running a marathon. No glimpse of adult diapers, of speech contorted by strokes, of infirmity. And certainly, no loneliness.

I'm over 60 now, though I still can't quite believe it, and Bill is nearly 70. I don't say this to him, but when he dies I will be very tempted to go with him. I'd like to. I don't want to outlive my mate. He's my mate, for God's sake, my life partner. I would never be one of these widows who boo-hoos into a kleenex for 5 minutes, then takes off on a cruise. There would be no new boy friend to scandalize the family.  My life would be over. No, really, it would. I don't care how correct or incorrect that is, and I don't care if "most women adjust just fine" and "only grieve for a year" (apparently having an "on/off" switch somewhere in their soul).

I can face looking after him for years, being infirm, institutionalized, anything. We did say "in sickness and in health", and we also said, "'til death do us part". But they didn't tell us how to do it.

I'm not much good at this life thing, and in many ways I really think it would be better if I wound it up in the next couple of years. Suicide is hard on the family however, and the memory of it never quite goes away. It would be cowardly, because the apocalypse is coming in the next ten years, and maybe I need to be here, and maybe not. Depends on who else is left.

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Pie are square (whoops, round!)

I'm not much when I first wake up in the morning, but I had to be up today. My daughter-in-law was stopping by this morning to pick up a newspaper flyer so she can buy one-o'-dem-dar hot water machines (the Keurig type, which we were recently given and couldn't figure out, except that now we're addicted to it, to that little sucking sound as coffee instantly, effortlessly fills your cup).

When I started noodling around this morning trying to find news sites, I hit on the New York Times. I follow Dick Cavett's blog, always backward-looking and dropping names with audible clunks, but somehow as compulsive as celebrity-watching itself.

But on the same page, I saw the link to the food section: "Pies to Die For".

I wonder if anyone else gets the irony.

We hear, constantly, about how unhealthy it is to be obese, about how it strains the health care system almost beyond the breaking point, and about how it's still escalating. It has oozed into the lives of innocent children, kids raised on McDonald's and almost complete inactivity until their arteries are plaqued-up as severely as a 75-year-old's.

Cheek-by-jowl (pun intended) with these alarms are blaring ads for family restaurants serving ever more grotesque portions of really-bad-for-you food. Fast food chains keep upping the ante, with KFC serving up these horrible things made of two deep-fried chicken patties instead of bread (and who knows what the filling is. A pound of deep-fried peanut butter?)

Blecccchhhh! But people are buying it. People are eating it.

Fat is the new thin.

I can't remember a time when the culture wasn't obsessed with thinness. Models and actresses have that translucent look, as if they'd disappear if they turned sideways. Their pictures are splashed all over the women's magazines, their bony chests sticking out like a chicken's, often with weird globular bolted-on breasts that clearly display the join. These space-alien versions of womanhood appear cheek-by-quivering-jowl with recipes for mouthwatering, saliva-gushing, quintuple-chocolate indulgence cake (the recipe always containing at least a cup of butter) and other scrumptious heart-attacks-waiting-to-happen.

Maybe that pie really is to die for.

Oh, I'm a great one to lecture. I've been a shape shifter all my life. Recently, after a major weight loss, I've begun to creep upward again. I'm just hungry all the time. There are certain intractible family stresses that take a constant toll. Or so I tell myself.

The thing is, all that scrumptiousness won't particularly appeal to a naturally thin person. They will take one taste and go, "mmmmmmmmmm!" - meaning, "bleccccccchhhhhhh". It's kind of like a non-drinker trying to get through a cocktail, finally leaving 2/3 of it sitting on top of the piano. (Sick, eh?) So how come so many people have seemingly had their "blecccccchhhhh" mechanism disabled?

It's NOT heredity, folks. You don't "inherit" fat in a couple of decades. Heredity doesn't suddenly jump out at you like a jack-in-the-box, no matter how convenient it is as an excuse.

It's not just the ready availability of four-patty cheeseburgers (Faster! Higher! Greasier! There's a recession on, and we need those obese people's bucks!). Who actually does anything any more? Who walks? Men drop their wives off at the door of the mall, thinking they are doing them a favor so they don't have to walk the one minute or so from the car.

I walk all the time, and quite frankly, I'm a freak. People stare at me strangely, constantly offer me rides because they assume I'm too impoverished or too weird to drive (maybe so!), or offer false congratulations. "Good for you! I should be doing the same thing" (but I'm not, because I don't want to be stared at and considered weird).

When my daughter-in-law, a keen observer of social trends, was looking through her Home Outfitters flyer, she saw an ad for an egg cracker. "So we don't even crack our own eggs any more?" What next, I wonder - some sort of device you attach to the toilet paper roll?

I have tried to swear off those super-hyper-morbidly-obese shows on TLC, because it's hard to look at anyone whose body has become that grotesquely misshapen. They hardly look like a human bodies any more. Like the gargantuan Mr. Creosote of Monty Python, these patients (usually in for bariatric surgery) look like they're on the verge of exploding. They usually say they don't eat very much, and have "feeders" (often wives, though husbands will do) bringing food to them all the time. What kind of food, and how much, we can only imagine, but like a stash of porn, it's kept secret.

For a while, there was a ludicrous series about an obesity clinic in the States which allowed its patients to order in pizza which was delivered right to their rooms.

There's a certain strange term that has cropped up on these shows, and it sounds like the evil scientist in some low-budget 1950s horror flick: panniculus. What happens is, when a person exceeds, say, 500 pounds and keeps gaining, the fat gets confused and doesn't know where to go. Everything is maxed out, so to speak. So, instead of exploding, the body provides a sanctuary for the excess fat: a sort of circular blob, often attached to the abdomen or inner thigh. It lives there, expanding 'til it's full-up and another one pops out somewhere. Dr. Panniculus, the evil wizard of fat, has taken over the body completely.

People in this situation sometimes do lose weight, but they end up looking like deflated balloons, the stretched skin flopping around and making life miserable. It's usually removed, but we often hear that over 90% of people with major weight loss gain it back again, and more.

What would happen then? Would you become a sort of living Mr. Creosote? How much can skin stretch, anyway?

More to the point: where did this plague come from? When I was growing up, we had a neighbor who weighed, maybe, 280 pounds. She was socially shunned and had very few friends, so my mother took her on as a project. (She had caseloads, not friends.) Though it reeked of pity, this at least got her out a little. Otherwise she would have stayed in the house, hidden from sight.

Dick Cavett posted a blog about obesity, and wondered if the circus fat lady of his youth might be considered relatively thin now, or at least unremarkable, not even large enough to qualify for something like gastric bypass.

Will this just keep on going? Where does it stop? I think obesity is affecting about a third of the population now. If something becomes that prevalent, it gradually becomes more acceptable. Or maybe we just don't see it any more.

I recently tried on some clothes, just cheap little tops, grabbing for a Size Large because my ass is so big right now (and the store so tacky). They nearly fell off me. But the Medium slid all over me too. Finally I resorted to a Small, and it was still pretty generous. I wasn't in the Women's(i.e., "plus") section either, just the average range.

I'm not huge, but no way am I small either. I just have a big butt. It has always been a fitting problem. Until now.

Is this size manipulation just an adjustment to the burgeoning bodies of consumers, or a way to make women feel better about themselves? Or just buy more? Is all this a sort of weird rebellion against the imperative to be thin, thinner, thinnest? (If so, the boomerang is about to smack us all on the back of the head.)

Years ago, it used to be considered bizarre and daring for women to wear pants. In the early '60s, long hair meant that you were a pansy. When I was a kid, nobody but sailors wore tattoos, and women never did unless they were in the circus.

We get used to things. They become normal, or at least standard and unremarkable.

Type II diabetes is so common now, people almost expect it. You manage it, but don't try to cure it. Just take your meds, and go on eating.

Food as a cheap, ready drug? Escalating stress levels? Environmental chaos, pessimism and doom? Economic recession? Nature's way of tipping the board and sending us the way of the dinosaurs, as yet another experiment that either failed or just ran its disastrous course?