From the Editor

“And yet, and yet, would we old be young if we could?” So asks the British novelist and scholar Janet Todd in one of many disarmingly forthright reflections on age and illness in her new memoir, Radiation Diaries: Cancer, Memory and Fragments of a Life in Words. The question comes near the end of her account of a seven-week radiation treatment for pelvic cancer, an experience that coincided with her 100-year-old father’s struggles with a similar medical ordeal. Todd offers an answer:

Take away aches and pains and approaching death, and the answer may be, just may be, No. In old age you can see a life, really see it—well more of it. Before this [treatment], I think I liked being old. All passionspent? Maybe not quite, but obsessions much reduced. Contemplating, at the very best moments, a dignified, accepting farewell. 

The “evening of life,” as Soren Kierkegaard dubbed life’s closing chapter (and which we take as the title of this issue’s theme), is not a stage that we Americans are particularly well disposed to handle. In a culture that celebrates youth and vitality as the summum bonum, old age and its accompanying frailties seem more like shameful system failures than inevitable realities from which we might learn. It need not be this way. As studies of other times and cultures amply demonstrate, old age has more often been understood as the crowning culmination of the well-lived life, and the elderly as depositories of cultural wisdom. Why, then, asks sociologist Joseph E. Davis, in the opening essay “No Country for Old Age,” does contemporary American society understand and frame the evening of life “in ways that lead inevitably to its devaluation”? Examining the messages purveyed through the commercial media and the dominant medical discourse, among other sources, Davis directs us to consider how our culture’s relentless emphasis on self-optimization and autonomy has led us to see “aging and death as realities to hide,” making it particularly hard for us denizens of modernity to cope with inevitable decline or even “maintain our sense of self in the face of dependency, disability, and an aging body.”

Denying the reality of old age, we too often fail to profit from its invaluable lessons. Two personal essays in our thematic section resist this impoverishing trend. Essayist and novelist James VanOosting, writing from “inside” a progressive and incurable disease in “Off-Label Scripts,” explores the importance of the narrative constructed between physician and patient: “Too many medical stories degenerate into melodramas—overgeneralized, interchangeable, and, hence, forgettable. Nuanced narrative, on the other hand, can animate experience, rendering it individual, distinct, and memorable.” 

In his contribution, “Being There,” historian Wilfred M. McClay reminds us that “in writers from Homer to Sophocles to Milton, blindness leads to the profounder form of vision. Loss is gain, diminution is increase, woundedness produces strength, disability opens the door to extraordinary ability, wisdom is shown as foolishness and foolishness as wisdom.” McClay drives home the point with a loving portrait of his mother during her last years following a debilitating stroke.

Old age thrusts many of us into the care of the medical system, where we hope to find at least some relief from the worst effects of physical decline. In “Neglected in the House of Medicine,” physician Justin Mutter, a gerontologist and professor at the University of Virginia School of Medicine, finds that system wanting. Indeed, he charges that our health care regime too often fails the elderly by insisting (under the strictures of the Medicare benefits scheme) so exclusively on the diagnosis of specific diseases rather than attending to the condition of the whole person. “The result,” Mutter writes, “is an object lesson in futility: an American health care system that, despite its remarkable technological capacities, achieves poor outcomes for older adults.”

The shortcomings of that system emerge with disturbing specificity in author and translator Sarah Ruden’s “Body on the Altar,” an unflinching account of her father’s stubbornly heroic (and sometimes just maddeningly stubborn) refusal to enter the house of medicine except for the most urgent—and then only limited—treatment. With the stoicism and self-reliance of a Depression-era child, this fiercely independent thinker and provider was, as Ruden shows, one of those “who resist the system at all costs, with their loved ones and the community in mind, even if that means hiding a fatal illness for months or years and dying relatively young to avoid a high-pressure diagnosis and high-tech treatment.”

Whether the health care system supports or betrays us, the end comes for all. But how we see that end depends on our understanding of the meaning of human existence and its place in the larger scheme of things. In his essay, “The Lost Art of Dying,” literary historian Thomas Pfau notes how so many great works of modern fiction reveal something “frightfully stunted and inept” about the responses to death and dying, evinced in characters “conspicuously lacking forms of practical wisdom and metaphysical hope that once must have been built into the very framework of everyday life and practice.” Asking what an “alternative framework that viewed death as the decisive threshold within an eschatological narrative [would] look like,” Pfau excavates the elaborate metaphysical structure of belief articulated in works of religious reflection written during a relatively brief moment in late medieval Europe, at a time marked by plague and widespread wars.

The larger point driven home directly by Pfau, and more indirectly by our other contributors, is that the evening of life can be the time that truly redeems all that precedes our inevitable worldly end. Alternatively, if “the life we use up as we approach death is used to flee death,” in sociologist Georg Simmel’s words, we face being overwhelmed by despair and what Pfau calls “a meaninglessness that such a demise casts back on the entire trajectory of one’s life.” The value of a human life may appear no clearer than it does in its twilight hours.