Preferred Exit

Warning: Lugubrious Subject

Public health authorities are troubled because so many Americans worry more about less probable causes of death that about those which are both more prevalent and more preventable. At the same time, these authorities have trouble discussing the problem because—well, let’s face it, death is depressing, and what could be more depressing than an article, or a TV show, or a call-in show, about different ways of shuffling off this mortal coil. We have an incredible variety of euphemisms for it, and we will do almost anything to avoid looking it in the face.

We Americans, when we think about kicking the bucket at all, have very decided preferences. There’s accidentally falling into one’s bank vault and drowning in money, for instance. Or everybody’s favorite, getting shot by a jealous husband (wife? Significant other?) at age 95. That one has a particular resonance for me, because my maternal grandmother really did have a hostile run-in, at age 78 or so, with her 54-year-old boyfriend’s wife. It did not culminate in gunfire. Which is actually kind of a shame. When she finally did depart to the Great Beyond, 7 years later, she had been totally disabled by a series of strokes. If anybody had bothered to consult her, she would undoubtedly have preferred the Frankie-and-Johny scenario.

But, aside from these modes of departure most often encountered in fantasy, most of us prefer to go to the happy hunting ground by some means which is quick, more or less painless, and not preceded by any long period of physical or mental disability. We have pretty clear ideas about which methods meet these specifications, too. Heart attack is the biggie—one brief moment of chest-clutching pain, and then—wham! exit, comfortably. This attitude may be colored by the universally-admitted fact that, ultimately, everybody dies of “cardiac arrest.” For younger people, the car crash is seen pretty much the same way—a cloud of dust, a squeal of brakes, a crunch of impact, and the rest is silence. Some people—mostly men—still see maternal death in childbirth as “natural” and not especially agonizing. Most suicides are planned with the same requirements in mind—something as close as possible to a quick “natural” exit. For men, this is frequently a gun; for women and less macho men, an overdose of some kind of depressant drug will do the job.

At the other end of the spectrum is cancer, which most of us connect with protracted and insuperable pain, and stroke, which we see linked with physical paralysis and mental disintegration. We see the degenerative nerve diseases in the same light, except that they’re a lot less common.

Our preventive health behavior pretty much mirrors these perceptions. We will go to enormous lengths to avoid any chance of getting cancer—except, of course, for smokers, about whom more later. But we worry a lot less, and therefore behave a lot less carefully, about heart attacks and car crashes.

Ultimately, of course, everybody dies of something, and the immediate cause of everybody’s death really is cardiac arrest. But our perceptions about car crashes and heart attacks are dangerously inaccurate (docs here, correct me if I’m wrong.) These days, the first heart attack—the one that really does operate on the wham-bam-thank you ma’am model—is unlikely to be the last. And the ones in between tend to result in progressive physical and mental disability—as well as, sometimes, in strokes, with all their attendant drawbacks. Likewise, car crashes don’t always kill everybody involved, or not instantly, anyway. They may, instead, cause head or spinal injuries which leave the victim paralyzed and possibly vegetative for years. So can gunshot wounds, even self-inflicted ones. (Death in childbirth, by the way, is likely to be preceded by several hours or even days of intense pain. And, yes, it does still happen in this day and age in the world’s richest country, though rarely in its better neighborhoods.)

Furthermore, those people who figure once you’ve gone off into the never-never land of a coma, your own problems are over and you have become somebody else’s problem, may be mistaken. I have it on pretty good authority from people who have spent time on life support in a comatose state and then recovered, that, even if you are not visibly responding to pain and other stimuli, you may very well be feeling them, and that the grossest concomitants of “life support” –having one tube run down your throat and another run up your urinary tract—hurt just about as much as if you were “awake” for them, which is a lot.

Then there’s smoking. Most smokers get introduced to the weed in their teens, and rely on the fundamentally inaccurate belief that the time smoking takes off of your lifespan comes off the end you look forward to least anyway, the last few years in a nursing home. In fact, most people spend only about 6 months in nursing homes or other custodial facilities, and the time lost to smoking generally comes out of the time before being totally disabled at the end, so that you die earlier mainly because you become disabled earlier.

In short, if you really want to croak painlessly and expeditiously, your best bet is to stay on good terms with a paramour whose significant other is a good shot—and in the meantime, to quit smoking, eat sensibly, and drive carefully.

Jane Grey

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