Last updateFri, 06 Feb 2015 5pm

South of North: ‘What Matters in the End,’ title of a fine book, surprisingly mirrors what’s on many people’s minds

The United States Center of Disease Control and Prevention (CDC), which collects such data, reports that there were 40,000 known suicides in the U.S. in 2012.  That is the most recent year for which complete data are available.  And 40,600 suicide deaths make it the 10th leading cause of death for Americans. Someone in that country died by suicide every 12.9 minutes in 2012.  And a physician friend last November suggested that number had grown robustly since then, “continuing its account for more years of lives lost — after cancer and heart disease — than any other cause of death.”

Out of the ten leading causes for death, which stayed the same from 2011 to 2012, suicide was the only one that increased.  Cancer, chronic lower respiratory disease, stroke, diabetes, influenza and kidney disease all dropped.  Death rates from unintentional injuries remained the same.  Americans are getting better at managing health conditions, but “we’re not able to manage mental health as well, resulting in [these numbers]”, says Solveig Cunningham, an Emory University researcher.

But many people suffer from either incurable illnesses, or well-aged bodies that are becoming less and less able to perform the homely, daily tasks of life.  In the latter case, their increasingly aging and frail bodies force them to depend on others to get through the once-totally automatic tasks of taking efficient physical care of themselves.  This circumstance becomes more dismaying for those whose mental capabilities remain alert.  Unfortunately the more alert they are the more frustrated they become regarding the retreat of their physical capacities.  Often their physician will suggest this condition can be best dealt with in an “assisted living facility.”   A moment when patients – especially males – part company with their doctors.  

The resulting depression is not caused by a “dementia” or other brain diseases.  It is born of an individual’s anger at his/her own body’s inability to obey the brain’s directions and life-long useful commands.  To usefully comprehend this baffling circumstance, we luckily have the recently released text, “”Being Mortal: Medicine and What Matters in the End,” by a surgeon and staff writer for The New Yorker magazine.  It comes at an ideal time.  Because of cuts in what insurance pays them, doctors’ incomes have not kept pace with inflation.  This is especially true of recently graduated medical students, loaded down with gigantic educational debts. Thus there is a gravitation toward the highest earning specialties and away from lower-paid primary-care fields where doctors are in scant supply.  This is the terrain of Atul Gawande, and a relatively slim number of other docs. Gawande — and other boldly candid physicians — admit they’d be reluctant to speak frankly with mortally ill patients about their fears. So they tend to guide the conversation to one drug or procedure after another, dodging the reality that during a disease’s late stages many therapies are likely to increase suffering without lengthening life or restoring health. More than 40 percent of cancer clinicians admit to offering treatments they believe are unlikely to work.

On the patients’ side of this situation, some of those whose debilitation affects their bodies but not their minds side with 29-year-old Brittany Maynard who was diagnosed with a stage four malignant brain tumor and given six months to live.  She and her family moved to Oregon — one of the five states  in the United States that offer legal “permission” to terminally-ill patients who wish to end their suffering under a physician’s auspices.  

Several years ago, an American residing on the north shore of Lake Chapala faced a somewhat similar situation.  Faced with a leg amputation — during a time when medical advancement on both sides of the border was vastly less sophisticated, even in the area of prosthesis, than it is today — took the situation in his own hands.  A man proud of his physical prowess, he asked a friendly and common sense doctor (there were only a few physicians at Lakeside then) for a combination of medicines that would end his life painlessly and with dignity.  

Recently, a stranger whose sister is confined to an assisted living facility, and who himself is dealing with a tough physical situation, proudly told me that he will not be placed in “a home” when his illness confines him to a wheelchair.  Today, his implied solution was surprising: suicide. 

I mentioned the many fitting alternatives.  He nodded.  Then he said that the pain he was presently dealing with was increasing despite prescription pain killers, and he loathed the idea of being confined to a wheel chair.  His doctors told him, if he “suffered another  attack” he probably would lose the use of his limbs on one or the other side of his body.   He then would have to be more or less in the constant care of a nurse of some kind.

Though admittedly already suffering from an unspecified illness, he looked as if he had lived a robust outdoor life, and now stubbornly was not about to accept a life as an invalid.

Once you make up your mind to step away from a future of an “absurd, confined” life, he surprisingly confided, things became much simpler.  “The false importance of all the small stuff just falls away.  It’s like getting rid of a huge load of trivial junk.”   His amazing curb-side conversation left me speechless.  It was strikingly personal, concerning immensely private matters.  Why was he telling me these things?  He grinned and shook my hand.  “It’s not for everybody, but it really takes a load off.”  I gathered that he meant not only mentally, but emotionally, even physically.  I was going to ask where he lived, but he’d already unloaded a surprisingly huge amount of private material.  I was reluctant to seek more.  I wasn’t sure I wanted to know more.  His conversation seemed to be making me a participant in something that should remain personal, deeply secret.  I pulled back from any implied collusion in whatever plan – end-of-life? – he seemed to have in mind.

Yet it seemed to fit in the growing embrace of seeking a way to end one’s life in a chosen, individualistic – and for some – a seemingly appalling way.  It was dramatic, shocking and enlightening.  It made this small curb-side slice of the world seem be in the process of changing too fast.