At the Penn-Brown football game last fall, I found myself seated next to a lovely if inscrutable woman whom I will call “Jane.” As I attempted to converse with her, Jane’s responses seemed just a trifle off. She said she had moved to Philadelphia recently but couldn’t recall her previous home. She said she had a teenage son who was enrolled in a wonderful school, but she couldn’t recall its name or location. She added that she hadn’t seen her son in a few weeks and wasn’t sure where he was.
At one point in this disjointed conversation— conducted, you understand, between plays of a football game— Jane remarked, seemingly a propos of nothing, “I have a terminal illness.” When I asked about her prognosis, Jane replied, “About ten years.”
I subsequently learned that Jane suffers from early-onset Alzheimer’s disease, and that she had moved to Philadelphia to enroll in the University of Pennsylvania’s highly regarded memory enhancement program. The injustice of our relative situations has plagued me ever since: I’m 81 and I’m fine; Jane is 55 and she’s dying. Worse: She’s dying of a disease that, barring some medical breakthrough, will rob her of the ability to recognize even her closest relatives and friends or retain any awareness of events in her life, past or present. People with Alzheimer’s— that is, one out of three Americans over 85— lose their human connections and memories even as the disease intensifies their desire for companionship.
How on Earth could someone of good will cheer up such a person? It could be the ultimate challenge.
Lessons from Hooters
Sandra Day O’Connor confronted such a test in 2005, when she retired from the Supreme Court to care for her husband, who had suffered from dementia for 15 years. But within a year, John O’Connor’s dementia degenerated into Alzheimer’s, requiring his wife to place him in a facility. There, he fell in love with another resident at his facility— a common pattern among Alzheimer’s patients. Sandra Day O’Connor was required to visit a husband who no longer recognized her; instead, her visits consisted of watching John and his new partner sitting on a bench together, clearly smitten with each other. As the O’Connors’ son Scott recalled, “Mom was thrilled that Dad was relaxed and happy and comfortable living there,” even though he no longer recognized his own wife.
My friend Burnell Yow!, a Philadelphia artist, encountered a similar challenge when his father-in-law was diagnosed with Alzheimer’s. Burnell resolved to find some way to inject some sunshine into the man’s final years — no easy task for a patient who could barely identify his own relatives. Burnell’s ingenious solution: He took his father-in-law to lunch at the flagrantly sexist Hooters restaurant in Maple Shade, N.J. There, for an hour or so each week, this demented man experienced the pleasure of being fawned and fluttered over by busty young waitresses wearing tight T-shirts, and Burnell discovered his own previously hidden talent as an emotional problem solver.
Not long ago I attended a talk by a hospice nurse about her long career spent serving people in the final stages of life. In one case, this angel of mercy recounted, she cared for an Alzheimer’s patient whose first words, upon seeing her, were: “I thought they’d send a younger woman.” Talk about ingratitude! And yet, think about it: This patient lacks any sense of who he is or what’s going on. He’s likely to die within a few days or weeks, regardless of the care he receives. If he’s typical of Alzheimer’s patients, his highest priority is personal companionship. Who would best serve such a patient: a nurse, or one of those waitresses from Hooters?
What about Grandma Moses?
Which brings me to audacious proposal made ten years ago by the oncologist and medical ethicist Ezekiel Emanuel. In an article for The Atlantic, Emanuel argued that we’d all be better off if everybody checked out at age 75.
“The fact is that by 75, creativity, originality, and productivity are pretty much gone for the vast, vast majority of us,” wrote Dr. Emanuel, who was 57 at the time.
“Doubtless, death is a loss,” Emanuel acknowledged. “But...living too long is also a loss.” Prolonged life, he insisted, “negatively transforms how people relate to us and remember us: We are no longer remembered as vibrant and energetic but as feeble, ineffectual, even pathetic.”
It’s bad enough that many seniors today voluntarily segregate themselves in over-55 retirement villages, thus depriving younger generations of their institutional memory. Emanuel wants these elders to voluntarily check out altogether.
Forget for the moment the implications of Dr. Emanuel’s age 75 advice for exceptional folks like Verdi (who composed Falstaff at 80), Michelangelo (who designed the St. Peter’s basilica in his 80s), Churchill (who completed his four-volume History of the English-Speaking Peoples at 81) , Luis Buñuel (who directed That Obscure Object of Desire at 77), or Grandma Moses (who didn't start painting seriously until she was 78 and was still producing masterpieces after she turned 100.). What of all those elders who suffer from Alzheimer’s and dementia and consequently lack any functioning memory to speak of?
Emanuel’s thesis echoed a comment occasionally uttered by my late father, Herman Rottenberg, during the five declining years that preceded his death in 2013 at 97: “Everyone would be better off if I were removed from the scene.” Like Dr. Emanuel, Dad presumed that totally dependent people serve no useful function. That presumption fails to consider that every challenge in life can offer a valuable learning experience — that even so-called “useless” people are useful.
In many respects, my own father’s declining 90s presented me with an unexpected gift. After gallivanting around the globe for 50 years as an international folk-dance impresario, this lifelong type-A personality suddenly found time for his family, a willingness to accept help from others, and an eagerness to express feelings like “I love you” that had previously rarely crossed his lips. Those last years of caring for Dad were surely difficult, yet the experience was priceless. Would Dr. Emanuel deny me or my relatives the benefits of those final years of caring for my Dad?
Henry Gibson’s solution
So, what keeps me going, at age 81? Communicating with friends and family through this column, for one thing. Books I have yet to write, for another. My curiosity as to how everything will turn out, for a third. The challenge to outlive, say, Vladimir Putin, Donald Trump, Ali Khamenei, and Mitch McConnell, not to mention Ezekiel Emanuel (when he turns 75, I’ll be 90).
Jane, my seatmate at the Penn-Brown game last fall, did not quietly accept her Alzheimer’s diagnosis. She moved to Philadelphia to seek specialized help at the Penn Memory Center that wasn’t available elsewhere. My Dad, in his 90s, revealed a gratifying side of himself that we hadn’t encountered before. Burnell Yow!, my artist friend, discovered that even a male chauvinist dive like Hooters may serve some useful purpose. Last year the Food & Drug Administration approved lecanemab (brand name: Leqembi), the first drug found to successfully slow mental decline. Within ten years, scientists say, Alzheimer’s may be handled in your doctor’s office much the same way diabetes and heart disease are treated now: with a combination of drugs and lifestyle strategies.
Strange, the new and effective remedies you discover, if you just hang around long enough.
So, whose counsel should I follow? The esteemed medical ethicist Ezekiel Emanuel, who wants everyone to die at 75? Or the country-Western songsters Henry Gibson and Richard Baskin, who offered this advice in Robert Altman’s 1975 film, Nashville:
If the doctor says you’re through, keep a-goin’.
He’s a human just like you: Keep a-goin’.
Ain’t no law says you must die;
Wipe them tears from off your eye;
Give old life another try. Keep a-goin’.
To ask the question is to answer it.
Enjoy Dan Rottenberg’s new memoir, The Education of a Journalist: My Seventy Years on the Frontiers of Free Speech. You can also visit his website at www.danrottenberg.com
From reader Len Lear:
I am 84 and still work full-time and work out every day.
But my brother, Albert, who lived in Center City Philadelphia, was diagnosed with Alzheimer’s at age 81 (although he was an obsessive jogger every day for decades and never smoked or drank alcohol) and lived for almost two more years. He did not know who we were in the last several months. I look forward to the day when Alzheimer’s can be treated in the doctor’s office.
From reader Bob Gardner:
I think it was George Burns who, when asked what his doctors think about him smoking cigars, replied: "All my doctors are dead."