Magazine article The Human Life Review

O Come Now, Emanuel: A Teenager's Notes from a Nursing Home

Magazine article The Human Life Review

O Come Now, Emanuel: A Teenager's Notes from a Nursing Home

Article excerpt

"Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years old."

- Ezekiel Emanuel, Hastings Institute bioethicist and health-care advisor to President Obama (Lancet, Vol. 373, June 31, 2009)

All by myself, at age 15, I could have explained bioethicist Ezekiel Emanuel's argument about health-care rationing. He may have thought he was being profound when he claimed there is "no invidious discrimination" when favoring 25-year-olds over 65-year-olds in health-care "allocations" because (surprise!) all 65-year-olds were once 25. 1 knew about all this as a young teen, shortly after I landed my first job: doing laundry in a Southern California nursing home. It was grunt work that got hot and smelly at times, but I was happy to earn the money.

Since those days, I have come to a different understanding. I now see that healthy youths can be just as short-sighted as Mr. Emanuel. My own experience as the laundry-room girl reflected that tendency.

The "ewww" factor

I didn't have enough savvy to hide my undesirable employment from my peers. One day after work, sweating from the summer heat in my polyester whites, I walked into the neighboring Sav-On Drug Store to buy a soda. I was immediately greeted by a familiar voice.

"Hi, Stella. Oh, you have a job! Where are you working?"

It was Lisa, one of those glowy high-school cheerleaders, standing brightly in air-conditioned comfort at her post by the cash register. She caught me off guard, but I was brief, identifying only the location of my employment.

She pressed on: "Oh! Well, what do you do there?"

Having ineptly confessed with the single word "laundry," I was rewarded with that long, lowing syllable of female adolescence: "Eeeeeeewwwwwwwww!!!"

Which, I think, illustrates something about the far-reaching social dynamic embedded in Emanuel's position. My shame-by-association in the eyes of Lisa was simply a socially conditioned and superficial kiddy response: nursing-home laundry = old people's incontinence = "eeewww, gross." I wonder if Emanuel consciously wants to discourage us from growing up and shedding this reaction. By providing a scholarly patina to a shallow argument, he helps to rationalize a good part of the Lisa mentality - which makes it easier to lay fhe groundwork for health-care rationing on the basis of age.

Facing the truth

Lisa's sway on me was limited, though her reaction did discourage me from sharing my experiences with others at the time. Most important for my future were my interactions with the patients themselves, because it was they who directly influenced my ponderings about end-of-life care and "quality of life."

Mr. and Mrs. B., who both lay comatose in their beds, probably had the greatest impact on me as I made my daily rounds collecting and distributing the laundry: A real-life dying couple gave me something to brood upon. Yet at the same time, other patients were always cheerfully greeting me, eager to chat. One was Mr. C, a delightful Italian immigrant, larger than life, who used to wrack the nerves of the nurses by regularly going AWOL. Upon returning, he always confided in me, once showing off the high-top Converse All-Stars (shoe size 14) he purchased on an escapade to the local department store.

Many of the patients lived in a personal twilight zone. Mrs. W., no older than 60, struggled with depression after her only child's death. Yet she tended to cheer up when I came by, especially the day she invited me to pass out on her bed. I had gone woozy and white as a sheet after witnessing the extraction and cleaning of Mrs. H's tracheotomy tube in the room next door. When I recovered, Mrs. W. was more talkative and animated than I had ever seen her. …

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