The author begins this book with a fairly provocative statement: In the last few years I have given up on the many medical measures – cancer screenings, annual exams, Pap smears, for example – expected of a responsible person with health insurance.  The reason she’s done this – she says later in the chapter – is that she’s reached an age (she’s in her late seventies) where she’s old enough to die.  What she means by this is that she’s old enough that no one will consider her death a tragedy.  That being the case, she’d rather spend her time doing things she enjoys instead of getting exams and sitting in waiting rooms – Once I realized I was old enough to die, I decided I was also old enough not to incur any more suffering, annoyance, or boredom in the pursuit of a longer life.  I eat well, meaning I choose foods that taste good and that will stave off hunger for as long as possible, like protein, fiber, and fats.  I exercise – not because it will make me live longer but because it feels good when I do.  As for medical care: I will seek help for an urgent problem, but I am no longer interested in looking for problems that remain undetectable to me.  Ideally, the determination of when one is old enough to die should be a personal decision, based on a judgment of the likely benefits, if any, of the medical care and – just as important at a certain age – how we choose to spend the time that remains to us.

Her fairly drastic perspective makes you think, doesn’t it?  She goes on to give examples of tests and procedures that the medical community orders simply because it’s what they do, not because there’s any vital medical reason for them.  She also talks about how at a certain age it doesn’t really make sense to do certain screenings because death will come long before any problems detected can cause issues (she gives an example of a 100-year-old woman getting a mammogram or any elderly person getting a colonoscopy).

She discusses end-of-life measures and how people often direct that they don’t want their life extended if there’s no quality of life to extend.  Along those same lines she says: In giving up on preventive care, I’m just taking this line of thinking a step further: Not only do I reject the torment of a medicalized death, but I refuse to accept a medicalized life, and my determination only deepens with age.  As the time that remains to me shrinks, each month and day becomes too precious to spend in windowless waiting rooms and under the cold scrutiny of machines.  Being old enough to die is an achievement, not a defeat, and the freedom it brings is worth celebrating.

This first section is all part of the overall theme of the book which is summarized in the subtitle – “An epidemic of wellness, the certainty of dying, and killing ourselves to live longer.”  Said another way, how senseless is it to do things that make life less attractive all in the pursuit of extending an unattractive life?  Or, in some cases, why do things that actually shorten life with the thought that they will extend it?

It’s all thought-provoking stuff, but alas, it gets pretty dry after the first few chapters.  She launches into an extended discussion of working out, cellular medicine, and how society’s perspective on aging and dying has changed over the years.  Most of it isn’t all that interesting and her thesis becomes less and less obvious as the book progresses.  She describes what she presumably thinks are preposterous situations but she tends to do so without comment so the reader is left guessing what exactly her point is.

If the whole book read like the start of the book, I’d recommend it in a heartbeat.  As it is, I’d recommend getting it from the library and reading until you get bored – then putting it down and moving on.  It’s not the most upbeat book in the world (she tends to have a little bit of a ‘get-off-my-yard’ tone about her writing) but as you can tell from the quotes I’ve included, it’s compelling.  Or at least it is until it isn’t.  And that’s unfortunate because the good start deserved a better finish.  Perhaps she should’ve written a long-form piece about medical care and aging and put it online and everything would’ve worked better.  As it is, she packs 50 or so pages of good writing into 234.