Proactive Peeing

Tom Nickel
5 min readJun 8, 2017

The first thing we learn about peeing is how not to.

Next we learn to recognize when it’s now instead of no, and how get to the right place in time. Most of us have this crucial skill set down by about the age of three and we’re pretty much good to go.

I recently realized that I need a new approach. The inner dynamics between now and getting-to-the-right-place have changed. The time frame is shorter and the discomfort more evident. The need to seize the opportunity if presented has risen, for me, to the level of actionable awareness. It has led to a new personal operating principle (POP):

When Life Delivers You a Toilet, Pee In It

It was a big shift. Instead of waiting for body signals, a constant ecological scan now needs to be maintained at all times, checking for available facilities and remembering to use them. Preferably before the body signals. The signals aren’t working all that well any more.

I know this is just the beginning.

Anyone who has seen their own parents up close in very old age knows that peeing and its solid waste partner take on heightened significance toward the end of life. Old people value the functionality more because they don’t take it for granted, while at the same time they’re having unanticipated difficulties actually doing it. This is not a prescription for a happy ending.

Proactive Peeing is personal problem solving. The problem, beyond the proximal cause, is how do I stay independent? An infant has to master Peeing 101 to gain independence. It’s basically the second prerequisite after holding your own head up. Older people have to re-master it to stay independent, which we are driven to do.

Old Age itself is a series of transitions in a consistent direction — more support, less independence. But Dependence is almost never valued in our culture, only Independence and Helping Others, not Being Helped. How are you supposed to feel good about yourself when you’re having trouble peeing the way you’ve always peed? We all missed that workshop, or at least I did.

Less Mobility is the gateway to dependency. You think in old age you’ll take long walks with the one you love but actually your feet hurt too much and their knee is scheduled for replacement. Then there’s the iconic image of the car keys being pried from cold bony fingers. Self-driving cars will soon make this a rite of the past; but what monitoring, restrictions and loss of freedom will be programmed into those algorithms?

No one imagines themselves needing help with grooming and feeding. Most people are pretty vague about it, but they say they have some idea of their dependency limit — when they would at least start wishing they could die sooner than later. I hear the phrase, “a certain point” in end of life workshops I have led. There will be a certain point, many people say, which they will just know when it happens, when they won’t want to live any more.

Not everyone feels this way. Plenty of people don’t think about the end of their life at all, and for those who do — some will prefer full-out life prolonging measures until the legal definition of death is reached. But for those who do think about it, and feel there could be A Certain Point for them, this chart might be a way to help conceptualize the situation. Considering the details and options is kind of a rehearsal, which is often helpful in life. Acting things out internally is less consequential and can help clarify feelings.

As a long-time hospice volunteer, I have been with plenty of people who say they’re ready and willing to die, but don’t seem to be able to. In fact, I would say it is that way for most people, but my direct experience is limited to a select group who choose to die in a residential hospice setting. The original mission of modern hospice was to provide a comfortable place for people to prepare for the transition from life to death, but it’s not easy to know how to do that.

I have seen that pain can almost always be managed at the end. That’s why my image of that Certain Point was focusing more on incontinence. Not being able to take care of my own output seemed like a pretty good time to start the check-out process. Now my idea is changing.

I see that some people move into Pee and Poop Dependency very easily. It doesn’t have to be emotionally loaded. It can be just another transition, unlike Pee and Poop Independence, which was probably made into a big deal for most of us by our parents, because it was also a kind of independence for them. The flip side doesn’t have to be such a milestone. We need to be Independent so we can grow up and learn stuff. I’m guessing there’s something to be learned from major Dependence too, and that it’s not an easy course.

Calling it Proactive Peeing now is part of my course prep. I’m trying to feel like I’m on top of something that is inevitable, trying to have some fun with it. Trying to kid around, gently, with Death, as part of our on-going relationship, Death and I. Yeah, we’ve had something going for a while now. My Mom dying. My own Leukemia and Chemo. Retirement. Grandchildren. My Dad dying. All transitions, negotiated on the fly. Important previous protocols became non-operative. That’s what makes it a transition.

My wife would tell you that I complain about pee and poop changes probably more than any other topic, so it’s not like I’m Mr. Sunshine and Roses about it. I’m not just trying to put a happy spin on something that’s a drag. It totally sucks to have to pull over quickly and look for some place to pee in the park where no one’s looking because I can’t make it home.

Still, I believe there’s a way to be respectfully amusing about the whole thing. I like the way Proactive Peeing sounds. I feel good when I say it. Maybe it implies some kind of management. I also see that other people find the term mildly entertaining, even without the back story. Especially without the back story.

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Tom Nickel

Learning Technologist focusing on VR, Video, and Mortality … producer of Less Than One Minute and 360 degree videos