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Authors: Atul Gawande
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Stoughton, a few miles away, and I asked if I could come along. He had a ten-year-old gold Toyota Camry with automatic transmission and 39,000 miles on the odometer. It was pristine, inside and out. He backed out of a narrow parking space and zipped out of the garage. His hands did not shake. Taking the streets of Canton at dusk on a new-moon night, he brought the car to an even stop at the red lights, signaled when he was supposed to, took turns without a hitch.
I was, I admit, braced for disaster. The risk of a fatal car crash with a driver who’s eighty-five or older is more than three times higher than it is with a teenage driver. The very old are the highest-risk drivers on the road. I thought of Alice’s wreck and considered how lucky she was that no child had been in her neighbor’s yard. A few months earlier, in Los Angeles, George Weller was convicted of manslaughter after he confused the accelerator with the brake pedal and plowed his Buick into a crowd of shoppers at the Santa Monica Farmers Market. Ten people were killed, and more than sixty were injured. He was eighty-six.
But Felix showed no difficulties. At one point during our drive, poorly marked road construction at an intersection channeled our line of cars almost directly into oncoming traffic. Felix corrected course swiftly, pulling over into the proper lane. There was no saying how much longer he would be able to count on his driving ability. Someday, the hour would come when he would have to give up his keys.
At that moment, though, he wasn’t concerned; he was glad simply to be on the road. The evening traffic was thin as he turned onto Route 138. He brought the Camry to a tick over the 45-mile-per-hour speed limit. He had his window rolled down and his elbow on the sash. The air was clear and cool, and we listened to the sound of the wheels on the pavement.
“The night is lovely, isn’t it?” he said.
3 • Dependence
It is not death that the very old tell me they fear. It is what happens short of death—losing their hearing, their memory, their best friends, their way of life. As Felix put it to me, “Old age is a continuous series of losses.” Philip Roth put it more bitterly in his novel Everyman : “Old age is not a battle. Old age is a massacre.”
With luck and fastidiousness—eating well, exercising, keeping our blood pressure under control, getting medical help when we need it—people can often live and manage a very long time. But eventually the losses accumulate to the point where life’s daily requirements become more than we can physically or mentally manage on our own. As fewer of us are struck dead out of the blue, most of us will spend significant periods of our lives too reduced and debilitated to live independently.
We do not like to think about this eventuality. As a result, most of us are unprepared for it. We rarely pay more than glancing attention to how we will live when we need help until it’s too late to do much about it.
When Felix came to this crossroads, the orthopedic shoe to drop wasn’t his. It was Bella’s. Year by year, I witnessed the progression in her difficulties. Felix remained in astonishingly good health right into his nineties. He had no medical crises and maintained his weekly exercise regimen. He continued to teach chaplaincy students about geriatrics and to serve on Orchard Cove’s health committee. He didn’t even have to stop driving. But Bella was fading. She lost her vision completely. Her hearing became poor. Her memory became markedly impaired. When we had dinner, she had to be reminded more than once that I was sitting across from her.
She and Felix felt the sorrows of their losses but also the pleasures of what they still had. Although she might not have been able to remember me or others she didn’t know too well, she enjoyed company and conversation and sought both out. Moreover, she and Felix still had their own, private, decades-long conversation that had
I was, I admit, braced for disaster. The risk of a fatal car crash with a driver who’s eighty-five or older is more than three times higher than it is with a teenage driver. The very old are the highest-risk drivers on the road. I thought of Alice’s wreck and considered how lucky she was that no child had been in her neighbor’s yard. A few months earlier, in Los Angeles, George Weller was convicted of manslaughter after he confused the accelerator with the brake pedal and plowed his Buick into a crowd of shoppers at the Santa Monica Farmers Market. Ten people were killed, and more than sixty were injured. He was eighty-six.
But Felix showed no difficulties. At one point during our drive, poorly marked road construction at an intersection channeled our line of cars almost directly into oncoming traffic. Felix corrected course swiftly, pulling over into the proper lane. There was no saying how much longer he would be able to count on his driving ability. Someday, the hour would come when he would have to give up his keys.
At that moment, though, he wasn’t concerned; he was glad simply to be on the road. The evening traffic was thin as he turned onto Route 138. He brought the Camry to a tick over the 45-mile-per-hour speed limit. He had his window rolled down and his elbow on the sash. The air was clear and cool, and we listened to the sound of the wheels on the pavement.
“The night is lovely, isn’t it?” he said.
3 • Dependence
It is not death that the very old tell me they fear. It is what happens short of death—losing their hearing, their memory, their best friends, their way of life. As Felix put it to me, “Old age is a continuous series of losses.” Philip Roth put it more bitterly in his novel Everyman : “Old age is not a battle. Old age is a massacre.”
With luck and fastidiousness—eating well, exercising, keeping our blood pressure under control, getting medical help when we need it—people can often live and manage a very long time. But eventually the losses accumulate to the point where life’s daily requirements become more than we can physically or mentally manage on our own. As fewer of us are struck dead out of the blue, most of us will spend significant periods of our lives too reduced and debilitated to live independently.
We do not like to think about this eventuality. As a result, most of us are unprepared for it. We rarely pay more than glancing attention to how we will live when we need help until it’s too late to do much about it.
When Felix came to this crossroads, the orthopedic shoe to drop wasn’t his. It was Bella’s. Year by year, I witnessed the progression in her difficulties. Felix remained in astonishingly good health right into his nineties. He had no medical crises and maintained his weekly exercise regimen. He continued to teach chaplaincy students about geriatrics and to serve on Orchard Cove’s health committee. He didn’t even have to stop driving. But Bella was fading. She lost her vision completely. Her hearing became poor. Her memory became markedly impaired. When we had dinner, she had to be reminded more than once that I was sitting across from her.
She and Felix felt the sorrows of their losses but also the pleasures of what they still had. Although she might not have been able to remember me or others she didn’t know too well, she enjoyed company and conversation and sought both out. Moreover, she and Felix still had their own, private, decades-long conversation that had
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