Sunday, August 12, 2007
I was talking about death with a brilliant young doctor at a party last night. He said the old should just go home and sit down as 'everything is designed to fail at the same time', so fixing one failing system, most commonly the heart, was a very temporary expedient as another was bound to fail soon afterwards. This gave a peculiar poignancy to the nearby spectacle of the late middle-aged groovers who were, as usual, the only occupants of the dance floor, the young having better things to do. Meanwhile, following our conversation, Nick Cohen writes this morning (while kindly plugging my book) about the newly discovered disparities between the life expectancies of the rich and the poor. In rich parts of the borough of Westminster, for example, a wealthy 65-year-old woman can expect to live to 96 and a poor one to 77. The usual suspects - smoking, bad food, lack of exercise - are blamed, but I think, as does Cohen after talking to me, the most important factor is access to the best health care. In Britain we may have thought that the NHS democratised health care and that may once have been true. But now the rich know how to play the system. They master the variety and complexity of what is available so they can demand more from the NHS and, when that fails, they can go private. As a result, parts of Britain are rapidly becoming like Martha's Vineyard or Palm Beach, enclaves of the rich, old and healthy. This division is going to grow ever more extreme as it is now clear that, in a number of areas, medical science is making significant progress after a long period of stasis. These will produce expensive treatments that the rich will demand and pay for. The brilliant young doctor, therefore, may soon find the rich old are not, with good reason, going to sit down and wait for the next system to fail.
The trouble is, of course, we don't really know what to do with them when they stubbornly persist in Staying Alive - one of the songs that, inevitably and poignantly, always causes the most enthusiastic bopping among middle-aged groovers. Today, once again, we hear of shabby treatment of the old in care homes. The truth is that the young (meaning anybody under 50), however well-meaning, are impatient of or disgusted by the old. And they are confirmed in their prejudice by the unfortunate fact that even the most expensive modern medicine, though it may keep you alive, does not, as yet, rejuvenate. Once you're old, you stay old. Most damagingly, cognitive ability declines and nothing more effectively encourages impatience in the young than elderly forgetfulness or mental incompetence. They might as well, runs the unspoken thought, be dead. This, I suspect, is one reason why the rich old cluster in their enclaves. They are seeking relief from the familiar, withering judgments of their condition, from the dance floor surrounded by the wincing and giggling young.
Posted by Bryan Appleyard at 6:11 am