Burning Bridges

When you get old, you will need help. The vast majority of us will die a slow death. That is to say, we will have medical problems that slowly get worse until at some point one of them manifests itself in an acute way, such as a heart attack or stroke. Hopefully that end is not actually slow, but not living well for some months to years is the norm. By not living well, I mean not living independently, not doing the things you want to do, not having the capacity to attend to your own needs. Peter Attia has written about the Centenarian Olympics, with the idea being that most of us want to do activities and be able to function well when we are 100 years old. But as he points out, most of us can’t do those things in our 60s or 70s, and we certainly are not going to suddenly regain capability we lost decades ago.

There is plenty of data pointing to the benefit of community for our long-term health. Having community is known to improve mental health. Having even a single person that you trust that you can bounce ideas off of, such as a trusted therapist, is what allows so many forms of mental health therapy to have some effect. Without getting into specific forms of therapy that all have their pros and cons, just having someone to engage with is a step in the right direction. We think when we talk, and someone who can probe your ideas when you talk and tease out what some problems might be and help guide you toward solutions is a simple first step. As Jordan Peterson says, talking is thinking.

On a more practical level, you will need help when you get older with the logistics of your life. Life is challenging enough, but not having anyone who can give you a ride, check on your house, check on your pet, or get your mail makes it worse. That person can be a friend or family, but that person cannot be generated spur of the moment. No one who is 75 years old and has been relatively alone for most of their life suddenly accumulates friends. Friends don’t happen overnight. They take work to maintain. You should find and be community in your own life. To quote Tim McGraw in “Live Like You Were Dying,” “I became a friend a friend would like to have.” You can’t start that process when you’re old; you don’t have the time, and you probably don’t have the skills if you did not do it earlier in life.

I won’t claim to have a solution to all the dysfunction that occurs in families or between friends. There are myriad issues that can separate us. In fact, it’s probably more the norm that we let hurts and slights become festering issues and lose contact with friends until they become acquaintances instead of friends. But if you want life to be less complicated as you get older, you have to actively work at keeping friends. As James Clear points out in Atomic Habits, our success in anything is a lagging measure of our habits in that regard. Financial success is a lagging measure of our saving and spending habits. Our health is a lagging measure of our eating and exercising. Our community is a lagging measure of the work we put into maintaining it and our ability to forget hurts and forgive.

The bigger problem with burning bridges and not having community is not having anyone to get you home from the ER or hospital. We’ve all heard the line, “You don’t have to go home, but you can’t stay here.” It’s not only true about the bar when the ugly lights come on; it’s true in the ER as well. The ER is not a place designed for patients to hang out while waiting for a ride. They are designed with beds made for CPR, not comfort. They don’t have amenities like a hotel. There is no continental breakfast every morning next to the lobby where you can watch the morning news shows and see what the weather is going to be. (All while you eat the cheapest fake food the hotel can buy and still pass it off as real food. Muffins are cupcakes without frosting.)

Just because you have no one to come and get you, admitting you to the hospital is not likely to happen. Hospitals only get paid when patients are admitted with an actual diagnosed medical problem that meets certain criteria. Being scared to go home, not having a ride, wanting to rest, or not wanting to bother anyone because it’s now 2 a.m. are not qualifying criteria.

So now what? Well, I’ve seen patients handle this in various ways. Some will refuse to walk or insist they are not safe to go home because they cannot care for themselves. There is a general rule for ER docs which says, “If you can’t walk, you can’t go home.” Granted, there are patients that have limited mobility at baseline, so that rule does not always apply. But for someone who normally walks, even if normally with a walker or a cane but now insists they cannot walk and refuses to try, I can’t solve that problem. I can’t throw people out of the ER who refuse to walk under these circumstances. Refusing to do something that you medically should be able to do is a trump card.