This morning I attended my grandmother's funeral. She passed away at age 84 due to complications from a fall that broke her hip. To say that seems to oversimplify the situation a lot; her health had been deteriorating for quite some time. I wanted to write about my grandmother not only because I am grieving for her, but also because this is an opportunity for reflection on some issues in conservative health care.

To start with, my grandmother was never one for holistic health awareness. Her approach has always been allopathic. "Prevention" was certainly not in her vocabulary: She gave up decades of cigarette smoking only after a heart attack (which she insisted was "just heartburn"). Her diet was meager, and far from balanced--a little cottage cheese and some prunes were a feast for her. Water was something only for bathing; black coffee was her preferred beverage.

Yet with all of this, she lived for eighty-four full years. It only reinforces the notion that longevity is primarily genetically determined, with lifestyle factors as modulators. This is not to discount a healthy lifestyle; but it can only carry one so far. Many people with a far healthier lifestyle have died at a much younger age; who can fathom the multifactorial reasons? To paraphrase Bernie Siegel, there must be a lot of support groups in Heaven for people who ate right, exercised, took care of themselves--and died anyway!

The point is, what really matters is the life in your years, not the years in your life. My grandmother lived to a ripe age; but what was it like? The last few years were not easy. Steadily declining physical health, depression and loneliness after the loss of my grandfather--these were the hallmarks. And that's the best reason to take a holistic, preventive approach to health: to improve the quality of the time we have. Perhaps exercise and a healthy diet won't add a single year to my life; but if it keeps me functional and independent, it will be worth it. I don't expect yoga and meditation to provide enlightenment or immortality; I continue to practice because they help me to reduce stress, increase patience, and empathize with others. Developing habits like these now can only seem to lead to more happiness with age.

The second reflection I had was that conservative care can only go so far. I remember more than one occasion, my grandmother asking if I could "fix" her neck. Recalling the MRIs I had seen over a year ago, showing a severe spondylolisthesis in her lower cervicals, I could only make some gentle excuse as to why it was out of my hands (figuratively and literally). It had not been repaired surgically because the risks outweighed the benefits, given her age and condition.

Conservative care has its limitations in that sense; that is where the need for allopathic care arises. Also, during her last few weeks, the possibility of conservative management was out of the question. We do not take on the role of "healer;" we merely provide direction or remove obstacles so that the body can heal itself. Unfortunately, that is just not possible in every case. Should that frustrate us? Does that justify those who claim that we are not "REAL doctors"? Of course not. We have a tremendous impact on the quality of life of people in that vast spectrum between perfect health and severe injury or degeneration. Even if it's not as glamorous or heroic as an episode of ER.

Finally, I believe we need to reconsider our definition of healing. We would like to see every patient return to a state of full function. But in some cases, perhaps the patient would consider the achievement of some personal goals to be healing. And for others, after a full life and much suffering, healing may be the opportunity to pass on peacefully, surrounded by loved ones, and without the indignity of high-tech heroism to "save" them.

In chiropractic, as in any health profession, we are going to have to face the death of patients. This is something for which we need to prepare ourselves. Our culture tends to treat death as a taboo subject; it is shunned by the lay person, and battled single-mindedly by the allopathic profession. Therefore, the death of a patient may be regarded as a failure: a failure of conservative treatment, a failure of even the most invasive measures. In Tibet, dying is an accepted part of life; it is prepared for, and there are particular rituals associated with it. The term bardo is used to describe the process of dying; this means "transition." Death is not an ending, but a bridge from this life to what lies beyond. Perhaps we should consider this point of view in our own practice, no matter what our religion or philosophy. Only then will we gain an acceptance of this natural process, and help patients and family members do the same.

Reprinted from The Synapse, April 1997.