Content Warning: The following post deals with super chill and breezy topics like aging, disability, and mortality. It may not be everyone’s cup of tea.

To the reader currently perusing this post while sitting on the toilet, I have a simple question: Do you ever think about your last bowel movement?

Not the one you had most recently. I mean the one you’ll have at the end of your life. Because that’s the funny thing about life: all creatures within that category consume nutrients and excrete waste. And at some point, unless you’re that immortal jellyfish, there will be a last time you do your business.

Now, some gentle readers may be horrified at this question. How could I so cavalierly discuss such a morbid and embarrassing topic? Well, it’s pretty simple. I read “Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life,” by Dr. Louise Aronson.

Dr. Aronson’s “Elderhood” features a collection of stories about her experience as a Geriatrician, a specialty that is often overlooked and undervalued. 

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“Elderhood” is an ambitious book. It heavily critiques the current American medical system, our society’s heavy dependence on unpaid and unappreciated care labor, and the general sense of ageism and ableism that permeates everyday life. The book also makes a convincing argument that although “old age” tends to be quantified as anyone over the age of 50, there’s a significant difference between being 55 and being 95. 

I read this book for two reasons: I have an interest in creating content directed toward older adults, and unlike Benjamin Button, I’m aging forward. If I’m lucky, one day, I’ll be in my 50s, and if I play my cards right, maybe even my 80s. 

Here’s a fun fact: Every person I have ever met will one day get older and shuffle off this mortal coil. And unless you or someone you know has successfully arranged for a portrait to age in their place, we have this in common. It’s an inevitability of life.

That’s why it’s so funny that our society has such an “Out-of-sight, out-of-mind approach” to aging and mortality. Realistically, most of us would benefit more from knowing a geriatrician than an anesthesiologist or plastic surgeon. Yet, I’ve never heard someone describe geriatrics as a particularly interesting field. It’s not like I would watch “The Nanny” and Fran Fine would work herself into a fit because a handsome, single, geriatrician was stopping by the Sheffield mansion.

The US population is aging, meaning that by 2020, 1 in 6 people was over 65. The number of people living in the US over the age of 65 by the year 2040 may even be 80 Million. That’s a lot of early-bird dinners to eat and a ton of 24/7 news to watch. 

In about 20 years, a significant number of people will become old. They’ll be entering a new phase of life, and for some individuals, that phase will require a lot of care.

“Elderhood” was a fascinating read because it brought up many salient points I think people are aware of yet prefer not to think about. Dr. Aronson told stories about older family members who were neglected by their relatives, unable to provide basic care for themselves (which includes bathing and going to the bathroom), and people who had lost almost all of the agency in their lives.

I mean, think of the oldest person you know. What is their life like, and what do you think it will be like in a decade? Are they financially independent? Do they have any issues with mobility? Do they have an active social life? How this person lives now is a clue to how it may be in a decade. If your grandpa is currently mobile but lives in a third-floor walk-up in another city, that might one day become a problem. If your grandma doesn’t know how to read a nutrition label and chugs orange juice despite her hyperglycemia, that may also become a problem. If your great-uncle loves to drive because it helps him to feel independent, there’s going to be a point where he can’t do that anymore, and unless he lives in a city with phenomenal public transportation, he’ll be trapped in his house.

Realistically, these problems will fall under the jurisdiction of your mom, your oldest sister, or another underpaid woman. (And yes, sometimes male relatives have to do the brunt of the care work, even if that is less often than their female relatives) 

If that sounds unfair, it’s because it is.

It is unfair that due to a natural part of life, a significant portion of the population will completely depend on their younger family members for basic care. It is unfair that many of these “younger” family members are in their 50s or older, and are putting their lives on hold to become caregivers. It is unfair to live independently for eight decades only to lose that independence unless you’re obscenely wealthy like that lady from “The Aristocats” and can hire fancy help. It’s unfair that there are so few resources to provide for what is essentially one-sixth of the population. And it’s unfair that our malfunctioning healthcare system unintentionally exacerbates the problem.

Victoria Sweet, MD, is the author of such books as “God’s Hotel” and “Slow Medicine.” I recommend reading her work if you’re interested in alternative medicines, particularly medicine that doesn’t treat the human body like a machine needing repairs. Dr. Sweet criticizes how the modern Healthcare System prioritizes efficiency over the well-being of its patients. This focus on efficiency has detrimental effects on the patients, healthcare providers (which, ironically, is a term Dr. Sweet does not like), families, and our society. 

One of the biggest problems with efficiency in medicine is that it is extremely dehumanizing. 

After reading “Being Mortal,” “Slow Medicine,” and “Elderhood,” I noticed a concerning trend. When a patient has a life-threatening illness or condition, our healthcare system is designed to respond with some method of treatment for that illness. That’s not always a bad thing. If I have a broken leg, I hope that by going to the hospital, the medical staff will help treat my injury instead of putting me down like an injured farm horse. The thing is, the human body isn’t designed to live in perpetuity, and sometimes things go wrong that don’t have a simple solution.

There are situations when a person may have an ailment that will not respond to treatment. The exact treatment prescribed may not only be futile but could even worsen that patient’s quality of life and make them sicker. I’ve seen this happen myself. 

In those situations, a palliative approach to a life-threatening condition may be more compassionate and help the patient live a better life in the time they have left. (For more information on this, I highly recommend Atul Gawande’s “Being Mortal,” which I’ve mentioned in another post.)

Focusing on comfort over treatment sometimes seems to be directly against what the field of medicine stands for. After all, aren’t doctors supposed to treat illnesses? Well, yeah, they should, but at a certain point, those treatments aren’t doing any good. 

The thing is, having a frank conversation with a patient about a life-threatening or terminal illness is extremely difficult. Would you want to have that job? No, of course not, unless you’re completely unfeeling. It feels a lot better to potentially offer someone a miracle cure, even if all that will do is give that person false hope. 

I appreciated that in “Elderhood,” Dr. Aronson acknowledges that mortality is a life certainty. Aging, and the eventual end of life, are certainties, and so even though it can be a bummer, we should be able to talk about it. We’ll probably be a lot happier if we could have more open conversations about these difficult topics. 

And if this sounds too intense, remember, Barbie consciously decided to leave Barbieland and live in the real world. Mortality, existential crises, aging, and cellulite are part of the package. 

If we actually want to make our world a better place, then we have to acknowledge that every person is going to age, and we’d be a lot better off if we planned for it. Also, we need to stop complaining about aging as if it’s the most awful thing that can happen to someone. Aging isn’t all bad or all good; it just is. It is better that we arm ourselves with knowledge to smooth out the process. 

So going back to the awful question I asked at the beginning of this post: what do you think is going to happen the last time you go to the bathroom? In the first few chapters of “Elderhood,” Dr. Aronson tells a pretty sad story about a frail older patient who is forced to soil himself due to a combination of unnecessary, uncomfortable medical treatments and an inability to get out of his hospital bed. This story horrified me and has been living in my mind “rent-free” for over a month. 

I’m going to go out on a limb and assume you don’t want to share the same fate as this person, nor do you want this to happen to any of your loved ones. So, use this as an opportunity to plan ahead. Maybe make a few lifestyle changes. Consider incorporating accessibility features in your home, even if you don’t technically need them yet. Someone will, and they’ll appreciate it. Call your grandma and see how she’s doing. Think about how you want to be treated by your doctors when you can’t get out of bed.

And if you really want to prepare yourself, check out “Elderhood” by Louise Aronson.