I was heartbroken when I heard about Robin Williams’ suicide last August. He’d overcome so much, and in the process it seemed he’d grown wise.
But I also felt betrayed. Had his unhinged joyfulness been just an act? Or had he forgotten his own lessons?
My questions vanished the other day when his widow shared the terrible truth: When he died, Robin Williams was battling dementia — and he was losing. Framed in that context, his suicide seemed understandable to me. I’m not sure I would want to stick around, either, if I could look forward only to a steadily declining quality of life.
“Quality of life” is a phrase we hear often, but it’s a concept we seldom discuss when it really means “end of life.” I’ve been thinking about this lately because of my friend Sal.
Three months after we moved Sal into his assisted-living apartment, he finally seemed settled and content. But then, in September, he fell and broke his hip. Sal would need surgery and a year of physical therapy (“PT”) before he could walk again.
The surgery went well, but Sal was discouraged when I went to visit him in the nursing home last month. “Don’t give up on your PT,” I chirped. “Why? What’s the point?” he snapped back. And he did have a point: Even if he could get back on his feet, he was unlikely to regain enough strength or confidence to move back into his apartment.
His cousin wrote last week to tell me Sal had decided to quit PT and stay in the nursing home. Sal’s bed was empty, though, when I went to visit last Friday. “He moved to our permanent ward,” said the nurse, guiding me down a quiet hallway.
One floor up, the elevator doors opened to a vision of hell. Dinner had just concluded and several elders skittered aimlessly in their wheelchairs, their feet slipping on the sludge of half-chewed, half-dropped food that coated the floor. A few slumped like inert sacks of grain, while several others wailed and waved their spindly arms, as if they were drowning in their chairs. “Help me! Help me! Please help me!” The cacophony was overwhelming.
I spotted Sal at the last table, willing his trembling hand toward his mouth. As I approached him the payload of macaroni and beef tumbled onto his lap, and he bit down on the empty fork. He was unshaven and his clothes were filthy.
To his left was a woman whose bare, scarred scalp suggested recent brain surgery. She alternated between animated small talk and demented, tearful delusions (“Don’t tell Daddy I have it. I don’t have it, Daddy. No, I don’t have it!”).
Sal ignored her, even when she tugged at his shirt. Then she started yanking on his left arm. I looked around for help, but saw none of the staff. “Gently, Jacqueline,” I interceded, “remember that Sal is 94.” She stared at me for a moment, expressionless, and then returned to her soft crying.
“How are you doing, Sal?” I asked, leaning in to hear him above his neighbors. I didn’t know whether he’d rant about the noise, ask about his belongings, or complain about the food. “The fact is,” he said, measuring each word, “I’ve come to the end of my life.”
I’ve felt unsettled since then, because I know he’s right. I know he’s given up, he’s stopped finding joy in things he once loved, and — like so many of the elders with whom he’s warehoused — he’s just waiting for his body to give out.
When I heard the news about Robin Williams the other day, it struck me that he and Sal represent two (extreme) sides of the same coin: What happens when we avoid the tough questions.
We’re terrified of talking about death in the States, as if silence will somehow keep it at bay. But the fact is we’ll all face it eventually. So doesn’t it make sense that — just as we discuss “quality of life” with our doctors and families — we should be able to talk about “quality of death”?