Raul Zimmerman, MD
This past May 13th, I read the death notice of Susannah Mushatt Jones. Ms. Jones was the oldest person in the world (not just the oldest person in the U.S.) when she died in New York at the age of 116 on May 12, 2016. Like many people, when I first hear about these super-centenarians (110 or older), I wonder if they have any secrets to share to explain their longevity. What I discovered was that Ms. Jones, the daughter of sharecroppers and a granddaughter of slaves, slept 10 hours per night and was a lifetime non-smoker and non-drinker. OK, sounds like good advice to me. On the other hand, I am not sure I am going to adopt Ms. Jones’ daily breakfast routine – four strips of bacon, eggs, and grits.
As I read about Ms. Jones’ life, I couldn’t help but to think about all the events and changes that she lived through – two World Wars, the Great Depression, the rise of the automobile, household electricity, air conditioning, in home refrigeration, air-travel, space travel, computers, and yes – sliced bread. The day I read the announcement on Ms. Jones’s death was also the day that Neil Irwin’s fascinating piece, “What Was the Greatest Era for Innovation?” appeared in the New York Times. He colorfully describes what life was like for people in the 1870s, 1920s, 1970s, and today – a just a tad longer than Ms. Jones’ life span.
Several different thoughts and feelings flooded through my mind as I read about the death of the oldest living person:
1) The details of Ms. Jones life reminded me of the many elderly patients I have cared for in hospice and how important it has become for me to know their individual stories. Good hospice care means knowing the patient, and knowing the patient means knowing their story.
2) The process of “life review,” which patient and loved ones often go through at end-of-life, is a beautiful and valuable process. For the survivors, it forges a connection to the past and helps to cement memories. It’s a chance to hear stories of courage, faith, love, forgiveness, hope, regret, adventure, etc. – all those things that make us human. One of the regrets survivors often experience is not having taken the time to do such life review with their elderly or ill loved one while they were well enough. It’s another reason why it’s important to be able to speak about death and dying and acknowledge that it will happen. When we deny death, we miss opportunities to engage in important ways.
3) Ms. Jones was the third of 11 children but outlived all her siblings. She did not speak much toward the end of her life, but family members quoted her as saying, “When are you coming to get me?” which they knew was addressed to her deceased family members. It is so common for the very elderly to be ready to die. Though they might be fearful of experiencing pain and suffering, they are often not afraid of dying and even look forward to the day.
4) Though the very old, like Ms. Jones, and the very ill can often come to peace with the idea of dying, there always seems to be at least one family member who cannot find that peace and insists on putting the patient through more painful procedures or tests or treatments which the physicians feel, at best, will just prolong an uncomfortable dying process. I hope and pray that Ms. Jones’ family members were at peace and that no one was pressing, at age 116, to take her out of her home, bring her to the hospital, and place her on life support and artificial nutrition/hydration. Patients who are dying, want to remain in whatever place they currently consider home. Whenever possible, bring hospice care in – don’t send the patient out.
5) I hope Ms. Jones had completed a “living will” and had designated a health care surrogate to make her health care decisions when she could no longer do so. These documents should be completed before one is sick or very old. Without these in place, wishes will less likely to be honored and family members are more likely to fight. Completing these advance directives now is one of the most important gifts you can give to yourself and your family.
6) Ms. Jones left Alabama for New York around age 23. She worked primarily as a nanny. She was married once, but divorced quickly, and never had her own children. She was very close with her 10 siblings, their children, and their grandchildren. She was reportedly generous with all and even co-funded a scholarship program to help African-American women attend college. I am reminded that we are social creatures and even if not married, can have meaningful and enduring bonds. Strong social connections, making a difference in others’ lives, and having a sense of meaning and purpose all appear to contribute to longevity.
As a hospice/palliative physician, I realize how much my life has been enriched by the stories shared by those, like Ms. Jones, with advanced illness and those at end of life. My spirituality has been shaped by their spiritual questions and by their chosen life paths. By listening and watching, I have learned, among many other things, to appreciate the miracle of death -- death makes life finite thereby giving it value. If life were infinite, we would not have the incentive to appreciate the awe and wonder of each day.
By the way, with Ms. Jones death, the title of “oldest living person” falls to Emma Morano . Ms. Morano lives in Italy and is also 116. You can read her equally fascinating story in USA Today (http://tinyurl.com/h2y4tc2).
Raul Zimmerman, MD, is a palliative care specialist with Halifax Health.
