»  The Straggler, No. 30

April 11, 2005

  Last Call


The college I attended had a large teaching hospital attached, so I spent many hours of my youth socializing with medical students. They were an amiable crowd on the whole, though my reverence for the medical profession never quite recovered from the spectacle of half a dozen of Britain's future neurosurgeons and cardiologists at the Wheatsheaf pub around closing time attempting to belch "God Save the Queen!" in chorus.

Well, I recall a conversation with a medical student who had just completed his final exams and was contemplating further study in some specialized area of medical practice. He was very knowledgeable about all the specialties, about the intra-professional prestige of each, their various remunerations and opportunities. He was personally attracted towards dermatology — a thing I found surprising, as the prospect of a lifetime spent inspecting other people's pimples and rashes did not seem to me to be very appealing at all. Ah, he replied with unanswerable logic when I mentioned this, but the dermatologist gets very few night calls.

What, I asked this fellow, was the least popular specialty among his classmates, when they discussed these issues among themselves? He replied without any pause for thought at all: geriatrics.

It is not hard to see why this should be so. The conscientious medical doctor wants to help people stay in the world, not to ease their passage out of it. The ailments characteristic of old age are in any case mostly incorrigible, so that the general atmosphere of terminal gloom that fills the doctor's workday is made darker yet by the knowledge that not much of what he does will have any effect. Pity the poor geriatrician.

Pity even more his patients. Old age is too often a cruel and degrading business, and there does not seem to be any prospect that this will soon change. Death is of course the great leveler; but for those of us who reach old age, the leveling process may begin years before the end. We have all known vigorous and intelligent people reduced to shuffling incoherence by the aging process, at one with those lame and dimwitted folk past whom they sped so breezily in former days. "Now she is like the others," said Charles de Gaulle at the graveside of his Down-syndrome child. Visit an old folks' home, as I did recently, and gaze upon the socialist ideal of human equality at the other end of life.

The 20th century's great poet of death, Philip Larkin, wrote a poem titled "The Old Fools"; not easy to read, even if you are accustomed to Larkin's unsparing approach.

 … do they fancy there's really been no change,
And they've always behaved as if they were crippled or tight,
Or sat through days of thin continuous dreaming
Watching light move? If they don't (and they can't), it's strange:
Why aren't they screaming?

This is not a universal condition, of course. If senescence can level the proud and the meek, old age can also sometimes be just as unfair as the rest of life. We see this person decrepit and muddled at 60, that one agile and alert at 90. Some of us will thrive in good health until felled instantly, like Dr. Johnson's friend Robert Levet: "Then with no fiery throbbing pain, / No cold gradations of decay, / Death broke at once the vital chain, / And freed his soul the nearest way." There is a health cult — my wife has some dealings with them — promoting the slogan: "Live long, die fast." Yet we all know from our own acquaintance that the horrors of Alzheimer's, arthritis, or a paralyzing stroke can happen to anyone, athlete or couch potato. Not many of us will be lucky enough to be transported instantaneously to the next world from a ski slope or a bed of lust. A sensible lifestyle can shift the odds a little, but the odds are still not good.

All this is worth bearing in mind as the nation debates Social Security reform. Our present system is untenable, as Ramesh Ponnuru has demonstrated in these pages. Some sensible reform is needed. It is, however, hard to see how socialism can be squeezed out of the picture. Provide for ourselves? Decent nursing-home care is very expensive; and when you have run through all your life's savings, you will be in the same boat as other oldsters who made no provision at all. Trying, not very successfully, to manage my own parents' last years, I heard again and again, from professionals and commoners alike, that, as one seasoned and respectable geriatrician told me, "Saving money for your old age is a mug's game."

It is a cliché among prison reformers that the way a society treats convicted criminals is a good index of its level of civilization. I don't know about that; but the way we treat the helpless old would seem to me to be at least as good a measure. The state that Larkin called "hideous inverted childhood" presents a moral challenge not many cultures have risen to. Fables about the reverence for the old that pertained in past times or distant places evaporate quickly when you look closely at the evidence. In 19th-century Akenfield, the English village about which Ronald Blythe wrote a classic study, old folk were often put in outbuildings to endure cold and hunger until they ceased to inconvenience their descendants. Do not the Chinese manage these things better? Not all of them, to judge from the treatment of Tung Chi-ping's grandmother in his book The Thought Revolution: "The men … would give nothing to my maternal grandmother. Mother was pregnant, but she had to share her meager portion with the old lady … Grandmother was treated in this way simply because she was in no position to object to it."

In Japan, furry or childlike robots are being marketed as companions for lonely old people. "The [$5,600] robot has the conversation ability of a five-year-old," says the news story I am looking at, "considered just enough for small talk to keep the elderly from going senile." Is that what it comes to at last, all this lusting and striving and praying? To curl up in bed with an infantile robot? ("Equipped with six sensors and an IC chip which keep track of the owner's sleeping time.") As Larkin wrote in that relentless way he had: We shall find out.