I have had over a decade to think about Dr. Ezekiel Emanuel's 2014 essay in the Atlantic where he talked about his plans for medical treatment after age 75. Of course he was talking about averages and coming at it as a medical professional; and I'm sure he plans to be a statistical outlier. Afterall, in his line of work (oncologist) you have to be an optimist. We'll know in about 5-6 years.

Dr. Emanuel's plan was at age 75 to:

• Stop all routine screenings, including colonoscopies and other cancer tests.
• Refuse cardiac stress tests, pacemaker implants, heart valve replacements, and bypass surgeries.
• Eliminate all routine interventions. This includes forgoing flu shots, vaccinations, and antibiotics.
• Reject all intensive treatment- chemotherapy, ventilators, surgery, and dialysis.
• Still accept palliative care, such as pain medication, and treatment for acute injuries like a broken hip to maintain his quality of life until natural death occurs.

Unless he was still contributing to society and active. The good Doctor seems to thinks that there is some magic cut off date. That you throw every medical intervention at your life until your old and done. I see it differently. I think many over consume medical care and do not end up with a better life. I have instead focused on a healthy lifestyle. I am slowly turning away from medical interventions. 

 
I gave up the first two items on Dr. Emanuel's list in my 50's. After watching family members go through years of cancer treatments never being well again and turning their family's life into a cancer battle, I quietly stopped getting screened in my 50's. As my nearest and dearest tested positive for the BRCA mutation, I declined and went about my life. At 70- so far so good. It won't last, this is that perfect moment when everything is fine for both my husband and myself. We are both happy and well. These moments end and should be cherished.

 
Covid happened in my mid 60's and I stopped (or maybe I never started) Cardiac stress tests et al. I never plan to even look at let alone replace my heat valve. Bypasses and pacemakers are also out of the question. I think a heart condition would be a fast and kind death. Certainly, I would reject all intensive treatments at this time in my life and have prepared my will, medical directive and the holder of my medical power of attorney accordingly. 

On the other hand, I had an infected toe (do not ask about the pedicure disaster that caused that) and I got antibiotics to fix that when the ointment failed. I do not want to return to the dark ages. Yes, I got a shingles vaccine, a Covid vaccine during the pandemic years and flu vaccine. I am a firm believer in hospice

I am an engineer not a doctor. I try not to get sick. I fully understand that my approach will practically guarantee that I die a little too soon. That is preferable than a little too late. I love my life    I love the work I am doing advocating for sustainable water, and the environmental groups I volunteer with.  I live in the countryside where it is an hour's drive to my doctor and have basically avoided going there until she makes me show up to renew my blood pressure medication every couple of years. She lets me slide on all the cancer screening, but does her series of tests and screens and then sends me off for another few years.

To just show you how inconsistent my philosophy is, for some strange reason I love having my teeth cleaned and regularly go to the eye doctor. As I mentioned previously, I had cataract surgery and am happy with the results. 

Taking the first bus is about making mindful decisions about medical treatment and quality of life. For example, though I eat a healthy, organic, homemade diet, exercise daily, maintain a healthy weight and monitor my blood pressure. I don’t get mammograms anymore. I have dense breasts and have had 6 call backs and one biopsy over the years. Apparently, no one actually sees anything useful in my mammograms, and I no longer care. I have no plans of ever being a cancer patient.

On the other hand, I had cataract surgery and diligently put drops one eye for glaucoma. I value my eyesight and the wonder of the world that reading brings to me; and the beauty of nature and art. These are some of the things that make life worthwhile. 

During the coronavirus pandemic I am diligently practicing hand washing, mask and glove wearing and practicing social distancing and staying home except for my forays out to various stores in search of supplies. Last week I got up at 4 am twice to line up before the 6 am “senior hours” in search of toilet paper and other groceries. I failed on both attempts to score toilet paper. The irony of senior hours at stores that cause us to line up in the cold predawn in hopes of finding toilet paper is not lost on me. I am amused rather than afraid.

I was fortunate enough to have a niece find the giant toilet paper 30 packs at Costco and managed to buy one and get her husband to go in and buy one for me. She is a sweet and thoughtful woman. I suppose like all the young she is trying to protect her old relatives. I accept that I am old and in the vulnerable category. In good shape, but nonetheless 65 is old. We now have adequate supplies and I am happy at home. I am not alone. I am with my husband and constant companion of more than 40 years as well as our two cats who have chosen this moment to suddenly get along. I am content and not afraid (and kind of overjoyed about the cats).

This time spent talking with my husband about the latest updates on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)- what we've all been calling covid-19 has given us the opportunity to discuss something that has happened during our lifetime. The idea that everything can be fixed or cured has come to be commonly believed. It is not true, and never has been. There are things out there that kill people. I had a friend in High School who died of the flu and every year people continue to die of the flu. Now, there is covid-19 with a higher death rate, no vaccine as yet, and limited treatments. It will be a challenge to develop an effective vaccine for a coronavirus. This covid-19 will be with us for some time. We will have to go about our lives, with this disease in the background. 

The year I was born Albert Einstein died on April 18, at age 76 at the University Medical Center at Princeton University. Professor Einstein’s abdominal aortic aneurysm burst, creating internal bleeding and severe pain. Though he went to the hospital he refused further medical treatment. saying, “I want to go when I want. It is tasteless to prolong life artificially; I have done my share, it is time to go. I will do it elegantly.”

Slight variations of his refusal of emergency medical attention have been reported, but they all agree that he refused and knowingly chose to die at that time. It is Professor Einstein’s example that I will follow with my life. Of course my life is not nearly as valuable as Professor Einstein’s. I am 65 and hail and healthy, but I know I cannot remain that way forever. So, I choose to take the first bus, to heaven. This means that in all likelihood I will someday make a decision where I feel a bit of regret that I do not have more time.