A dear, sweet friend wrote to me last week on learning of my recent ulcerative colitis diagnosis and considerable weight loss. Among the many kind and empathetic words she wrote were, “I hope that your quality of life is not too impaired.”

This got me thinking. “Quality of life”? What’s that? I literally had to research its meaning. In that moment, the concept felt foreign to me.

According to Crispin Jenkinson, writing in Britannica, “quality of life” is defined as “the degree to which an individual is healthy, comfortable, and able to participate in or enjoy life events.” The term is inherently ambiguous, he says, and highly subjective.

“Whereas one person may define quality of life according to wealth or satisfaction with life,” Jenkinson writes, “another person may define it in terms of capabilities (the ability to live a good life in terms of emotional and physical well-being). A disabled person may report a high quality of life, whereas a healthy person who recently lost a job may report a low quality of life.” (For the whole article, go to: https://www.britannica.com/topic/quality-of-life.)

What would I report? I wondered. Lately, because I’ve been feeling so punk due to this life-altering (but non-life-threatening), incurable chronic disease, I confess my report would read “low.” It’s a whole new life challenge, I’m finding, and at the moment I’m failing to see any “quality” in it.

Sometimes, when I get stuck on a thought, my mind runs in endless circles. I ruminate (too much?), like the bovine (Taurus) animal I am. Can a high quality of life be created? Constructed, like a high school science project? Baked, like a cake, into one’s life? If a cake, what are the exact ingredients? Everybody knows cakes require exact ingredients to rise.

What sort of quality of life does the woman [not me] trapped in a dried-up, loveless marriage have? Or a man serving a life sentence for a crime he never committed? Or someone who’s suffered a tragic loss and can’t stop grieving? Or migrants who’ve fled a hostile country only to find themselves in an inhumane, overcrowded camp on the border of an inhospitable country? Or a person, like my mother was, dying of brain cancer but being kept alive by “heroic” (read: avaricious) doctors years after her quality of life was gone?

Is it inevitable that one’s quality of life gradually declines with advanced age and ebbing health? Is this just one of the many challenges to be faced and dealt with (with wisdom and grace, one hopes) in our latter years? Having never been here before, I don’t know. I’m only just now learning.

Clearly, quality of life isn’t fixed. It changes, like the seasons; it varies, depending on one’s current circumstances. Yesterday on my walk I was stopped by an image that seemed emblematic of the fragility and ephemerality of “quality of life” for me, so I tried to capture it in this photo:

To escape the swirling thoughts in my head, I reached out to some friends here in San Miguel de Allende to learn their personal views on the subject of quality of life. I sent an e-mail to a small group of women my age (I’ll be 76 next month), who, like me, are single, independent, self-supporting, retired professionals. Three of them responded:

Suzanne: “Quality of life is a subject near and dear to my heart ever since I read Atul Gawande’s book Being Mortal: Medicine and What Matters in the End. What comes to mind was my decisions to travel to Boston for the summer and return to SMA in the fall. Both decisions were based on the quality of my life during those time periods. I knew it was risky to travel, but I could not give up the summer in New England. Nor could I fathom living anywhere but SMA for the winter.

“The winter here was long, but to wake up each morning to birdsong, the occasional whoosh of hot air balloons, barking dogs, church bells and thankfully distant roosters reminded me that life is indeed continuing, despite the fear and uncertainty that the pandemic has caused.

“The color, culture, and courtly behavior of the Mexicans add to life’s quality here, too. When I first moved to San Miguel, it was about the weather. Over the years, the weather has dropped to maybe number ten on my reasons for living here.”

Helaine: “I equate the term ‘quality of life’ with ‘peace.’  If I am at peace, I consider my quality of life excellent.  ‘Peace’ includes mental, emotional, and spiritual levels. It means good friendships, the company of people who are reasonably content with their lives, and living in a place [now San Miguel] that nurtures me.”

Toni: “My quality of life is excellent! My two-room apartment is affordable on my Social Security income. I have Internet that works, a landline phone that is under $20 a month and includes free calls to the U.S., and a Mexican cell phone that provides everything for $140 a year. I can afford to have a maid who does all the cleaning chores I always hated. Doctors and dentists are affordable, and for anything big I have Medicare. The sun shines every day. And best of all, I am living in a community where there are a gillion women in my age group who share the same joys and concerns that can only be understood and appreciated by kindred souls.”

So now it’s your turn. What does “quality of life” mean to you? Please share your thoughts on this subject in the Comments section.