The Thing About Life is That One Day You'll Be Dead (14 page)

Boys vs. Girls (iv)

Between the ages of 55 and 64, men are twice as likely as women to die in car accidents and four times as likely to commit suicide. Losing a job, separating from my mother, battling manic depression, my father would sometimes threaten that he was going to drive to the Golden Gate Bridge and jump off, but the threat never seemed real: he's a survival machine.

Between ages 35 and 54, the ratio of men to women is even, then it increasingly favors women. In 1990, less than half of people in their 30s were female, but 80 percent of centenarians were women. Now, 90 percent of centenarians are women. Will my dad become a centenarian? He dearly wants to (see above; see below).

Men have much higher testosterone levels than women, which makes them more susceptible to cardiovascular disease—the main reason they don't live as long. Testosterone also suppresses the immune system and makes it more difficult for males to resist infection. Premenopausal women have 20 percent less blood in their bodies than men and a correspondingly lower iron load. Iron ions are a source for the formation of “free radicals,” molecules formed during food metabolism that can harm the body; a lower iron load leads to a lower rate of aging, cardiovascular disease, and other age-related diseases in which free radicals play a role. Testosterone is the cause of the spike in the sex-mortality ratio at puberty (the trigger for boys' destructive and self-destructive acts) and then increases blood levels of LDL (“bad” cholesterol) and decreases levels of HDL (“good” cholesterol), putting men at greater risk for heart disease and stroke. Estrogen has exactly the opposite effect, in addition to acting as an antioxidant, which neutralizes radicals.

Throughout the animal kingdom, species show the same sex difference in life span: females nearly always live longer than males, with a few exceptions (for instance, hamsters, guinea pigs, and wolves). Female longevity is more essential, from an evolutionary perspective, than the prolonged survival of males. In a mammal, the male's contribution to child raising is often much less than the female's (my father's role wasn't to be a caretaker but to be cared for); without her, the child will probably die. Female sperm whales' life span is 30 years longer than male sperm whales'. For orcas, there's a 20-year difference. If a male calf survives to its first birthday, it can expect an average life span of 30 years, while a female can expect an average life span of 50. The maximum estimated life span for female orcas in the wild is 70 to 80; for males, 50 to 60.

A species' life span is correlated with the length of time its young remain dependent on adults. The necessity for female longevity in the human reproductive cycle has determined the length of the human span. The longer a woman lives and the more slowly she ages, the more offspring she can produce and rear to adulthood. For men, on the other hand, reproductive capacity is mostly limited by their restricted access to women. Men are stronger, taller, faster, and less likely to be overweight than women—older men have 20 percent higher maximum oxygen capacity than older women do—but women, as a group, live longer than men. In the United States, newborn girls have a life expectancy of 7.7 more years than newborn boys. At 65, it's 4.4 years' difference in life expectancy; at 75, 2.9; at 85, 1.4. The more vulnerable males are eliminated from the aging population faster than females are. Who else but my dad would have survived the third rail?

In Latin America and the Caribbean, life expectancy for women is 72; for men, 65. In Europe, life expectancy for women is 76; for men, 67. In the Middle East, the figures are 71 and 67; in Africa, 52 and 50; in Asia, 66 and 63. Male life expectancy continues to exceed female life expectancy only in such countries as Bangladesh, India, and Pakistan, where female infanticide and bride-burning are common practices.

Women have more chronic nonfatal conditions (arthritis, osteoporosis, and autoimmune disorders), but men have more fatal conditions such as heart disease and cancer. At all ages, women detect odors better than men (when a friend asked many of her women friends what they remembered most when they thought of their mothers, nearly all of them associated Mom with a smell); the ability to identify odors declines earlier and more rapidly in men than in women. Epilepsy attacks males and females in approximately equal numbers, but the death rate from it is 30 percent higher in males. Females suffering from the same infectious diseases as males die at a much lower rate. Among women and men who smoke equally large numbers of cigarettes, women are more resistant than males to lung cancer and heart disease. Men's higher metabolic rate, compared to that of women, reduces their longevity (according to his doctor, my father has the heart of a 70-year-old man). Women have a higher ratio of brain weight to body weight than men do; women's higher brain weight to body weight increases their longevity. British geneticist Steve Jones believes that the male of the species—given his shorter life span, declining sperm counts, and the decrepit nature of the Y chromosome—may be doomed to oblivion in 10 million years. Jones's theory isn't widely held, but still, as Jack Nicholson has said, “They're smarter than us, they're stronger than us, and they don't play fair.”

Women have lived longer than men since at least the 1500s. Between 1751 and 1790, in Sweden, the average life expectancy at birth was 36 for women and 33 for men. However, only in the last 100 years has it become clear that women's life expectancy exceeds that of men; until then, so many women died in childbirth that their life expectancy, as a group, was nearly the same as that of men. In West Africa, more women still die in pregnancy than from all violent causes. In the developing world, the lifetime risk of dying from pregnancy is 1 in 32; in the developed world, the risk is 1 in 7,000. Every year, more than half a million women die during pregnancy or childbirth; 10 million suffer injuries, infection, or disability. Since 1900, life expectancy for women worldwide has increased 71 percent (compared to 66 percent for men), but mortality from lung cancer has tripled in women in the past two decades. Because more women now smoke, drink, and work outside the home, there's been a striking deceleration in the extension of female life expectancy. In America, life expectancy for women is now 80 years, for men it's 75 years, and the gap is steadily closing. As women behave more like men, they live less long.

Chronicle of Death Foretold

When you're dying, your blood often becomes extremely acidic, causing muscles to spasm. The protoplasm is too compromised to sustain life any longer. You may emit a short series of heaving gasps; sometimes your larynx muscles tighten, causing you to bark. Your chest and shoulders may heave once or twice in a brief convulsion. Your eyeballs flatten out because their round plumpness depends on the blood that's no longer there. When you die, you don't—contrary to legend—lose 21 grams in weight; if human beings have a soul, it doesn't weigh anything.

In extreme cases such as severe trauma, exactly when someone is pronounced dead depends on where he or she dies. In the United States, some states say that brain activity is the only criterion; in other states, it's respiratory and cardiac activity. In France, the brain has to be silent for 48 hours. In the former Soviet Union, patients needed to flatline for five minutes. According to Dr. Henry Beecher, “Whatever level of electrical brain activity we choose, it's an arbitrary decision.” Doctors have more personal anxieties about dying than people in any other profession.

For people in the 50-to-59 age group, the death rate is 56 percent less than it is for the general population; 50-to-59-year-olds are just too busy to die.

In a study of 1,000 Major League Baseball players who played between 1876 and 1973, the players had a death rate 25 percent lower than that of men overall. A 1986 study of 17,000 Harvard graduates, ages 34 to 74, found that death rates declined as energy expenditures increased, up to 3,500 calories a week; above that, and death rates increased slightly. (Swimming vigorously for an hour burns approximately 500 calories.)

Cardiovascular disease kills 40 to 50 percent of people in developed countries. Cancer kills 30 to 40 percent; car accidents kill 2 percent; other kinds of accidents kill another 2 percent. When my father and mother separated and he was mixing antidepressants with alcohol, he drove smack into a garbage truck (accidentally? intentionally? never really explained), totaling his car but leaving him without a scratch—the Energizer bunny. In the United States, heart disease kills 1 in 40 65-to-69-year-olds, 1 in 27 70-to-74-year-olds, 1 in 11 80-to-84-year-olds, and 1 in 7 people 85 years old and over. In 1949, 50 percent of American deaths occurred in the hospital; in 1958, 61 percent; in 1977, 70 percent; now, 80 percent. Septic shock (extremely low blood pressure due to extensive infection in a vital organ) is the leading cause of death in intensive care units in the U.S.: 100,000 to 200,000 deaths a year. Only 36 percent of Americans have living wills. In the U.S., elderly white men commit suicide at a rate five times the national average. One in five doctors receives a request for physician-assisted suicide, and 10 percent of those respond by agreeing to assist.

In the Paleolithic age, half of all babies died before reaching their first birthday; mothers often died giving birth. For most of the last 130,000 years, life expectancy for human beings was 20 years or less. The huge majority of people ever born died early in life from an infectious or parasitic disease. In the second century a.d., the average life span was 25; at least one-third of babies died before reaching their first birthday. Two hundred years ago, the average life span for an American woman was 35; a hundred years ago, it was 48; it's now 80—the largest, most rapid rise ever.

In 1900, 75 percent of people in the United States died before they reached age 65; now, 70 percent of people die after age 65. From 1900 to 1960, life expectancy for a 65-year-old American increased by 2.4 years; from 1960 to 1990, it increased 3 years. In England in 1815, life expectancy at birth was 39 years. In Europe during the Middle Ages, life expectancy at birth was 33 years, which is approximately the life expectancy now for people in the least developed countries.

Very old age in antiquity would still be very old age now. In the sixth century
B.C.
, Pythagoras lived to be 91. Heraclitus of Ephesus died at 96. The Athenian orator Isocrates died at 98. The average life span has increased since the industrial revolution, but primarily because of declining rates of childhood mortality. In Sweden during the 1860s, the oldest age at death was usually around 106. In the 1990s, it was around 108.

In developed countries, 1 in 10,000 people lives beyond the age of 100. In the U.S., there were 37,000 centenarians in 1990; there are now around 70,000. The majority of American centenarians are female, white, widowed, and institutionalized, were born in the U.S. of Western European ancestry, and have less than a ninth-grade education. Ninety percent of current American centenarians have an annual income of less than $5,000 (excluding food stamps, federal payments to nursing homes, and support from family and friends); they often say they were never able to afford to indulge in bad habits. In many ways, this is true of my father: he grew up relatively poor, our family was always barely making ends meet, and he now lives a spartan life on a fixed income.

On his 100th birthday—five days after which he died—Eubie Blake said, “These docs, they always ask you how you live so long. I tell 'em, ‘If I'd known I was gonna live this long, I'd have taken better care of myself.'”

“Who wants to be a hundred?” asked Henry Miller, who died at 89. (That's my dad waving wildly in the third row.) “What's the point of it? A short life and a merry one is far better than a long one sustained by fear, caution, and perpetual medical surveillance.”

Woody Allen, on the other hand, has said, “I don't want to achieve immortality through my work. I want to achieve immortality through not dying. I don't want to live on in the hearts of my countrymen. I would rather live on in my apartment.”

Another joke courtesy of Dr. Herring:

A priest, a minister, and a rabbi are discussing what they'd like people to say after they die and their bodies are on display in open caskets.

The priest says, “I'd like someone to say, ‘He was righteous, honest, and generous.'”

The minister says, “I'd like someone to say, ‘He was kind and fair, and he was good to his parishioners.'”

The rabbi says, “I'd want someone to say, ‘Look, he's moving.'”

Eighty-eight percent of Americans say that religion is important to them; 82 percent of Americans believe that prayer can heal. Ninety-six percent of Americans say they believe in God or some form of universal consciousness; 72 percent believe in angels; 65 percent believe in the devil. In one study of 3,000 American men and women over age 65, people who attended church were half as likely to have strokes as those who never or almost never attended services. In another study, of nearly a thousand American men and women admitted to a coronary care unit, those who received remote, intercessory prayer fared better than those who did not. Those on the receiving end of prayers were less likely to require antibiotics. In a survey of 92,000 American men and women, people who attended church more than once a week were far less likely to get certain diseases than those who attended infrequently. Over a five-year period, the death rate from heart disease was twice as high among those who didn't go to church very often as it was for those who frequently attended. During a three-year period, infrequent attendees were twice as likely to die of emphysema and four times as likely to die of cirrhosis of the liver as were frequent attendees. In a study of 230 older American men and women who had just had cardiac surgery, people who said they received strength and comfort from practicing their faith were three times more likely to survive than those who didn't.

When my father was a boy, he studied the Four Kashas—the Four Questions—in Hebrew School and so had no problem reading the Hebrew text and translating it when his father called on him, during Passover Seder, to recite the Four Questions: Why is this night different from all other nights of the year? On all other nights we eat leavened bread or unleavened bread; why on this night do we eat only unleavened bread? On all other nights, we eat bitter herbs and other bitter food; why on this night do we eat only bitter herbs? On all other nights we eat either reclining or straight up in our chairs; why on this night do we eat only reclining? My father, the youngest of four brothers, was the most adept at Hebrew and, as he says, “basked in the sun of my father's approbation. I, the kosher ham, squeezed every ounce of personal satisfaction out of it.” He had a Bar Mitzvah at the Pennsylvania Avenue Synagogue, where he delivered a brief sermon, expressing gratitude on reaching religious adulthood, but his mother had recently died, at age 49, leaving his father and six children, so the ceremony was more somber than festive. (At her funeral, her casket was pulled through the street on a horse-drawn cart, and my father remembers being deeply embarrassed by his father's open display of grief—weeping and pounding the casket.)

My father's father introduced him to Socialism a couple of years later; my father lost God and has been, as he would say, a “devout atheist” the rest of his life. Of late, though, he prefers to call himself an agnostic—“It's all very mysterious, Dave.” He also can't say, “When I die…” Instead, he says, “If and when the time might come…” After that, it's all mumbled, euphemistic evasion.

         

Cormac McCarthy: “Death is the major issue in the world. For you, for me, for all of us. It just is. To not be able to talk about it is very odd.”

Charles de Gaulle said, “The cemeteries of the world are full of indispensable men”—one of my father's very favorite quotations, and mine as well. It's consolation, of a sort: everybody tries, no one wins, everybody dies.

Propertius said, “Among the dead are thousands of beautiful women.”

Juvenal: “Weigh the dust of Alexander the Great and the village drunkard, and they'll weigh the same.”

Schopenhauer: “We are all lambs led to slaughter.”

At 51, Tchaikovsky said, “I am aging fast, I am tired of life, I thirst for quietness and a rest from all these vanities, emotions, disappointments, etc. etc. It is natural for an old man to think of a prospective dirty hole called a grave.”

Freud said, “What lives, wants to die again. Originating in dust, it wants to be dust again. Not only the life-drive is in them, but the death-drive as well.”

In 44
B.C.
, Cicero said, “No one is so old that he does not think he could live another year” he died in 43
B.C.
On his deathbed, William Saroyan said, “Everybody has got to die, but I always believed an exception would be made in my case.” Edward Young wrote, “All men think all men mortal but themselves.” The ancient Indian epic
Maha-bha-rata
asks, “Of all the world's wonders, which is the most wonderful? That no man, though he sees others dying all around him, believes that he himself will die.”

         

My father's column for the condo tennis club newsletter about his heart attack, at 86:

I was doing what I had done on Memorial Day since memory runneth not to the contrary: playing tennis. It was a picture-postcard perfect day. The temperature was a comfortable 75, with a light breeze. I felt like a tiger. Just another lousy day in paradise.

My partner, George Tripodes, and I were playing a match against old friends and rivals Jim Black and Harry Langdon. We won the first set—barely squeaked through at 10–8 and were leading in the second set, 4–3. It was my turn to serve. I quickly jumped into a 40–love lead. I walked from the deuce court to the add court, where I hoped to make it 5–3, when I suddenly felt like an elephant had placed a huge foot on my chest (a standard description, I know, but that's exactly how it felt to me). I paused for a few seconds, saying to myself, “Now what was
that
?” It was like nothing I had experienced in my 86 years on planet Earth. It was, as I was about to learn about an hour later, a heart attack—a relatively mild one, true, but still a full-fledged heart attack.

I wasn't going to let a little old heart attack prevent me from winning my serve or finishing the set. George walked over to me as I was getting ready to serve and asked if I felt okay. “You look a little pale, Milt,” he said.

“No problem,” I assured him, adding that I wanted him to cover the right hand alley because I was planning—heart attack notwithstanding—to serve the ball into the extreme right corner of my opponent's court.

And that's exactly what I did, drawing a feeble response in return, and sending us into a 5–3 lead, one game away from winning the set and match. Our opponents made it 5–4 and now it was George's serve. We had a tough time winning the sixth and final game; we finally managed it after a couple of long rallies. I wasn't much help to my partner in that final game but never let on for a moment that I was feeling “a little strange.”

When the set ended, I didn't bother to shake hands with Jim and Harry. I grabbed my tennis bag and windbreaker and walked back to my building, about 100 yards from the courts. I walked back slowly but somehow managed to make it to my apartment, throwing some cold water on my face, then knocking on the door of my neighbor, Mary Steiner, a retired registered nurse. Mary took my pulse, checked my heartbeat, and immediately called 911.