Over theyears, with medicalprogress,the bottomhas
tendedtodropoutlaterandlater.Theadventofsanitation
and other public health measures sharply reduced the
likelihoodofdeathfrominfectiousdisease,especiallyin
early childhood, and clinical advances dramatically
reducedthemortalityofchildbirthandtraumaticinjuries.
Bythemiddleofthetwentiethcentury,justfouroutof
every hundred people in industrialized countries died
before the age of thirty. And in the decades since,
medicinefoundwaystocutthemortalityofheartattacks,
respiratory illnesses, stroke, and numerous other
conditions that threaten in adult life. Eventually, of
course,wealldieofsomething.Buteventhen,medicine
has pushedthe fatal moment ofmany diseasesfurther
outward.Peoplewithincurablecancers,forinstance,can
doremarkablywellforalongtimeafterdiagnosis.They
undergotreatment.Symptomscomeundercontrol.They
resumeregularlife.Theydon’tfeelsick.Butthedisease,
whileslowed,continuesprogressing,likeanightbrigade
takingoutperimeterdefenses.Eventually,itmakesitself
known,turningupinthelungs,orinthebrain,orinthe
spine, as it did with Joseph Lazaroff. From there,the
decline is often relatively rapid, much as in the past.
Deathoccurslater,butthetrajectoryremainsthesame.In
a matter of months or weeks, the body becomes
overwhelmed.Thatiswhy,althoughthediagnosismay
havebeenpresentfor years, deathcanstill comeas a
surprise.Theroadthatseemedsostraightandsteadycan
stilldisappear,puttingapersononafastandsteepslide
down.
Thepattern ofdeclinehaschanged,however,formany
chronic illnesses—emphysema, liver disease, and