Experts say Joe Paterno's dismissal could have hastened his death

Did the hammer blow to Joe Paterno's lifelong legacy hasten his death?

At least one national expert on aging said Paterno's firing as football coach at Pennsylvania State University, and the accusation that he should have done more to prevent a sex-abuse scandal, could have diminished his will to live.

"When you feel that you've lost your place in this world, death is never far behind," said Bill Thomas, a Harvard University-trained geriatrician and a pioneer in improving the quality of life for the frail elderly.

At the very least, said several other experts in end-of-life care, even if Paterno's will to live was not eroded, the immense stress from the chaos in his life would have weakened him in his fight against lung cancer. Furthermore, the swirling scandal and tumult could have prevented him from doing critical things a patient in chemotherapy needs to do. So, in a very practical way, the controversy could have made death come sooner.

Paterno, 85, who coached at Penn State for 62 seasons, first as an assistant and then as head coach, and won more games than any other major-college football coach, was fired in November after Jerry Sandusky, a former assistant, was indicted on multiple counts of child sex abuse. Many at Penn State and around the world thought Paterno should have done more to stop Sandusky once he became aware of the allegations in 2002.

Around the time the scandal broke in November, Paterno announced he had lung cancer and would begin chemotherapy. He quickly deteriorated from complications associated with the treatment, and his family decided Sunday to withdraw life support.

Paterno had long refused to retire, always believing that without football, he would die. He was shaken by the fact that Bear Bryant, another football legend, had died a month after he retired as coach at the University of Alabama. (The 29th anniversary of Bryant's death is Thursday.)

"What am I going to do?" Paterno once said. "I don't fish. I don't golf. I don't cut the lawn. I don't want to die. Football is my life."

Thomas, the aging expert, who founded the Eden Alternative and the Green House Project, major efforts to end the institutionalism of nursing homes, said people must have meaning and purpose at the end of their lives, and must feel the swirl of life around them to survive.

Paterno, he said, "built his identity around his work. That doesn't mean he didn't have a loving family; of course he did. But his identity was largely framed around his work and his football team and his university. His legacy suffered a grievous blow that disintegrated a big part of who he saw himself as - a direct assault on things he held dear.

"To come to the last days of our lives and to be judged publicly on the least admirable things we ever did, that's a major blow."

How much that contributed to Paterno's death, he said, one could only speculate.

"I've seen many cases like this, many, many," he said. "Joe Paterno is famous, but he's not the only one who's had this experience. . . . Old age is about heart and soul. We think of it mainly in terms of biology. He's 85. He's got lung cancer. Those are important, but it's the heart and soul of it that matters more."

All the experts interviewed Sunday - none of whom knew Paterno, but all of whom have spent their careers working with end-of-life care - said it was appropriate that Paterno made the decision to fight his cancer aggressively. That is who he was.

"He's been a risk-taker and made an entire life based on risk - that's the game of football," said Sean Morrison, director of the National Palliative Care Research Center at Mount Sinai School of Medicine in New York City. "In this case, he weighed his option and decided to go for it."

The experts said lung cancers were slow to become detectable - one can live for a year or two with few symptoms. But afterward, the cancer moves swiftly, and death can come within months.

"There's a period where people do really well, and right before death, there is a very rapid decline," Morrison said. "And we also know the presence of extreme psychological stress can worsen the prognosis and lower survival rates."

"Life is brief," said Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and author of Dying Well. "And we're all going to be dead a long time, and if you feel well enough to undergo aggressive treatment. . . . I often meet people who say, why not give it a try? And in large part I agree with them. It's a highly individual decision," many times "worth a try."

But Byock also said "death from lung cancer was nearly inevitable. At age 85, our vital organs have little reserve, and his really courageous fight against cancer" may have increased his quality time, "but it was a fight he was destined to lose."

Byock disagreed that the controversy would have hastened Paterno's death.

"I hope he achieved some sense of peace," he said. "A serious illness gives a person a different perspective than those of us who are reading about him."

Byock added that Paterno's "legacy has been tarnished, but it's also awesome, and he is revered by many people for his true leadership and astounding accomplishments. For me, the take-home is humbling. While we may achieve great things and be truly great people, we're not perfect, and we're capable of serious mistakes.

"His legacy isn't static, it's still being written. Attitudes and people change over time."

John Hansen-Flaschen, chief of the pulmonary, allergy and critical care division at the University of Pennsylvania Lung Center, who was working Sunday in the medical intensive care unit, said he did not believe the controversy reduced Paterno's will to live. But on a practical level, it could have harmed him and shortened his life, as it may have distracted Paterno from critical jobs required of every patient undergoing chemotherapy.

Hansen-Flaschen said he could only speculate, but said the crisis might have influenced Paterno's decision to seek treatment in State College, Pa., rather than in better-known cancer centers in Pittsburgh, Philadelphia, Cleveland, or New York. He said that chemotherapy was arduous and that the patient's role was every bit as important as the doctor's and the medicine's.

"Did he bow out two cycles short on his treatment?" Hansen-Flaschen asked. Or did he not get out of bed and walk enough, or not eat enough?

"If somebody is distracted or despondent," he said, he or she might not be making the best decisions.

"I don't buy some mind-body thing," Hansen-Flaschen said. "I think it's how much you engage in the treatment."