Desmond O’Neill: Nordic insights into the art of ageing and dying well

Des O Neill 2015I hate to miss the opening ceremonies of European geriatric medicine conferences, with the individual interplay between this most complex of medical specialties with the national characteristics of the host nation.

Norway is notable for its ability to fuse simplicity and sophistication, typified by the striking new Opera House in Oslo where the sloping roof provides not only a promenade for its citizens, but also echoes of its mountainous and snowy landscapes. It is also home to an energetic and cheerful body of geriatricians who hosted the well-organized and cutting-edge 2015 Congress of the European Union Geriatric Medicine Society in Oslo last week.

Their opening session was thought-provoking and original, easily matching previous ceremonies which have featured Nobel-prize winning poets and astronauts. These forays beyond the conventional boundaries of geriatric medicine are not just superficial entertainment, but reflect a growing interest in cultural gerontology, an evolving field of inquiry into the social, philosophical, and humanistic contexts of ageing, one of the richest and as yet under-explored phases of life.

This was manifest in a discussion on life and ageing between the 108 year-old Karl Falck and Anette Ranhoff, Professor of Geriatric Medicine in Bergen. With a twinkle in his eye and in excellent English, he talked about how he attributed his longevity to good genes, humour, a little drink every day, and walking in the hilly forests enveloping Oslo.

In a moment reminiscent of the near-centenarian comedian George Burns, he demolished one of the most persistent canards of bar-stool gerontology, that what older people want is quality of life and that quantity is of lesser import. Asked as to what age he thought he would like to live to, he said that he used to think 110, but now he was more inclined to opt for 112!

His unsteady gait necessitated assistance to ascend and descend from the platform, provoking interesting discussion at the reception. A minority felt that the episode should have been videotaped to spare him the effort, but most felt that the vitality in the face of disability encapsulated the essence and complexity of optimal ageing.

An interlude with an excellent and charming marching band brought smiles when one of the French horn players, the CEO of a local nursing home, came to the microphone and invited us to see his poster at the scientific session of the conference!

The session closed with a captivating lecture on the portrayal of ageing through the self-portraits and words of Edvard Munch from a senior curator at the National Museum. Never one to shy from the angst of the human condition while creating art pulsing with energy, the iconography of his progression from fiery young artist to solitary older man living in his estate in Ekely outside Oslo was absorbing.

The array of images drew not only on familiar paintings but also on a wide range of graphic art and watercolours that were novel to the audience: Munch produced an almost unparalleled 200 self-portraits over a 62-year period.

The expertise of the art historian illuminated afresh celebrated pictures such as Death in the Sick Room, and how Munch highlighted the persistence of grief. Although his sister, the central focus of the painting, had died when he was fourteen years old, all the figures were represented at the age they were when the picture was painted 16 years later.

Two particular aspects struck me as a geriatrician. The first was Munch’s awareness of how critical our intrinsic vulnerabilities are to our identities and work. The haunting quality of his Night Wanderer mirrored his words that “anxiety about life has followed me since I make aware.. …it is necessary for me as is sickness: without anxiety and illness, I am like a ship without a rudder.”

Of equal interest was his tearing up the tracks of another cliché of ageing and death, the wish to die peacefully during sleep. Death and dying track like a leitmotif through his work and self-portraiture, and he wrote, “I don’t want to die suddenly or without consciousness of it, I want this experience as well.”

This resonated hugely with what I witness among my patients, albeit largely unarticulated and complicated by the differing perspectives of their bereaved relatives.

Nordic art is often characterized by the particular nature of its light. In harmony with this characteristic, we are grateful to our Nordic colleagues for reminding us of how the narratives of older people and great artists can illuminate ageing, death, and dying not only in our clinical practice but also in our personal lives.

Desmond (Des) O’Neill is a geriatrician and cultural gerontologist in Dublin.

Competing interests: None declared.