Saturnino P. Javier, MD, FPCP, FPCC, FACC
Dr. Saturnino P. Javier is an interventional cardiologist at Makati Medical Center and Asian Hospital and Medical Center. He is a past president of the Philippine Heart Association (PHA) and past editor of PHA’s Newsbriefs
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I do not demand that after nine decades of life, most nonagenarian patients should be more resignedly accepting of what the future holds. But it is probably fair and just to expect that at this age group, there is a more realistic, less disparate expectation of what life has yet to offer?
Even before the medical literature reported a few years ago that patients are living longer and getting older, there have been some previous anecdotal observations among medical practitioners that, indeed, the patient population has gotten older. Credit it to (or blame it on) better healthcare, more advanced technology, more effective medications, more competent healthcare professionals, greater access to healthcare, among others.
I have 90-year old patients who view a clinic visit as nothing more than an act of acquiescence to the children’s and grandchildren’s plea to seek medical follow-up and purely an unnecessary trip and expense when the reality of an expected and anticipated final departure date looms on the horizon. Eternally grateful and feeling abundantly blessed, they accept each day as an extended and overstaying privilege – and thus willingly accept the possibility that such extension may soon be curtailed and taken away. They oftentimes muse – “I have lived a full life, Dr. Javier, so I am ready to go anytime. I thank God for all the bonus years.”
I distinctly remember how a chain-smoking 87-year-old grandmother accompanied by her grandchildren once retorted to me when the issue of smoking cessation cropped up during a clinic visit – “Doctor, I am already 87. I do not intend to live forever. So just allow me to enjoy my last few days with my pack of cigarettes.”
Or take the case of this 89-year-old Chinese woman who is endlessly embarrassed to admit how old she is, claiming with all unfeigned shame and humility that all her (younger) friends and acquaintances have long gone ahead of her. As a result, her clinic visit becomes a constant session to keep reminding her that ‘going’ is not a choice for her to make.
A good number of these decidedly convinced and pragmatically minded patients have taken it upon themselves to remind me (and document it as well) that when the time comes, they wish none of those contraptions and extraordinary measures to keep them clinically alive – but essentially neurologically incapacitated, comatose or vegetative. “Please spare me those nose tubes, feeding tubes, stomach tubes, throat incisions, dialysis machines, ventilator equipment. “ And the ultimate heart-rending plea is quite commonplace – “Let me go when it is time to go.”
Indeed, for nonagenarians (and even octogenarians) who view their extended lives as God-given opportunities, death and dying are but the inevitable culmination of a fruitful journey.
But the opposite extreme is just as real. There are the extremely anxious, fidgety 90-year-olds who view any chest pain as impending heart attack or any headache as a looming stroke that takes them on a weekly visit to the nearest emergency room. These are the patients who go instantaneously into panic mode when the possibility of death occurs. Whether or not the reality of death has dawned at all – they wonder endlessly why they do not feel as strong and as active as before.
Countless times, I must have been tempted to say – “Nobody lives forever.” But such would be a mean and callous response from someone upon whom the care of this patient is entrusted. The eternal challenge for a medical professional is to assuage the fears of an extremely anxious family that has yet to accept that mortality is inevitability. How does one disallow anyone the perception that dying is NOT an option that we can all choose to decide on – when, where and how?
Nowadays, the narratives of death and dying continue to become manifest in social networks and chat groups. Daily chats usually commence with condolences for friends and colleagues whose parents have succumbed to old age or some terminal illnesses. Words of consolation and grief always drive home the inevitable conclusion that death hovers around quite constantly and menacingly for those in their pre-departure years.
Sept 2018 Health and Lifestyle