Normal isn’t healthy

An open-ended discussion of what a healthy centenarian looks like should begin with a look at what “normal” means. “Normal” is the average of all members of a population including the unhealthy. In our population, 120/80 is normal blood pressure. Normal fasting blood sugar, heart rate, percentage body fat all have their statistical norms. But what happens when we exclude all but the robustly healthy from the statistics? Is 120/80 still normal?

I’m assuming that a healthy adult should resemble an athletic 30-year-old, but is that reasonable for someone approaching 100? If we look at everyone over 90 and exclude all who have some medical problems, nobody’s left. We know what normal old people look like, but we don’t see many truly healthy old people.

There is real danger in entrusting your care to people who think you should grow old gracefully, meaning just go away and die somewhere out of sight. My VA physician told me that aging is normal and I should just accept it. Aging is normal, so I should give up this nonsense about adjusting hormones. But age is a condition which inflicts pain, disability and death on everyone who goes through it. Isn’t this the very definition of pathology?

The first death I personally witnessed while an intern at the University of Washington School of Medicine was a sweet old lady who was killed by her doctor, my attending. He felt that she had lived long enough and it was time for her to pass away peacefully. He instructed me to keep her comfortable and slowly increase the morphine as she entered the agonies of death. Then he left for the evening.

I did my own work-up on her and found her dehydrated and a little anemic. After I transfused some blood and gave her IV fluids, she came right around and felt much better. She didn’t want to die. I bet the senior resident that night that she would pull through.

I arrived in the morning to find that the attending had discontinued my orders and she was not to be given even food or water. That poor lady hung on for another three days in the hospital before dying of dehydration.

She had entrusted her care to a doctor who believed aging and dying is normal. He believed he was helping her through the inevitable.

To me, it felt more like murder.