The Art of Aging

by Sherwin B Nuland

  Though speaking specifically of the unique position of physicians in their ability to maintain, save, or give life, DeBakey was saying far more than he may have consciously thought. Doctors are indeed in a unique position for achieving this kind of gratification, but it struck me that there are wide-ranging implications in what he was describing, beyond sustaining physical health alone, or even life. As our discussions proceeded, I came to conclude that he was more generally referring to the broad range of interrelationships between individual people in which one can feel that he or she is doing something for another, whether it be a tangible thing like medical care and life, or primarily what might be called the emotional or spiritual, such as giving comfort and support, or encouraging the development of young people. What counts here is the giving, specifically the giving of one’s abilities and consequently the giving of part of oneself to another. Simply put, the overall concept is the habit of living to ease the lives of one’s fellows.

  The dividends of such a life can come to each of us, in an awareness of having contributed something of value. The dividends of such a life come in an awareness of the climate of good that our own actions have fostered. The dividends of such a life come in an awareness of all that we represent to those who benefit from our time on this earth. The dividends of such a life come in an awareness of being appreciated and even cherished in return. And that is a form of love, which is the greatest dividend of all.

  In such ways, the literal giving of health is revealed to be only one of the possible manifestations of the figurative. To put it another way, if “health” is defined, as it most properly is, as a state of well-being—whether physical, emotional, or spiritual—then it is within the province and capability of each of us to provide it for others. To give sustenance to another is the highest gift, both to him or her and to ourselves, that any of us can imagine. One hardly need be a doctor in order to do the giving. “The gratification comes from the feeling that you’ve done something for people.”

  Most of us know these kinds of things, though they have been robbed of a great deal of meaning because they have become the stuff of too much ponderous pap delivered from pulpits, the pages of maxim-filled hortatory literature, and the self-satisfied lips of an occasional latter-day Polonius. But in spite of the windy pontifications in which these ideas are sometimes expressed, mindfulness of them is inherent in human perception, though they are often ignored, forgotten, buried, or simply dismissed as the staggeringly banal pronouncements of would-be sages. But when expounded as the way of life of a man of DeBakey’s worldly experience and philosophic gravitas, and—of perhaps equal significance—when brought forth as a strategy for long and useful living, the reminders for us to be of benefit to others are imbued with a power well beyond the turgid moralisms in which they are often couched. Examples of the truth of giving to others abound in everyone’s life story, but I will here interrupt my DeBakey narrative to describe one to which I have been witness, as follows.

  After recovering from a long and perilous illness about forty years ago, the then chaplain of Yale University, Reverend William Sloane Coffin, said a few words to me that changed my perception of the relationship between doctors and patients—indeed, the relationship between those who give and those who must receive, whether in respect to healing or in any other form. Having spent many weeks being treated on an acute care division of a busy university hospital, Coffin one day shortly before discharge made an observation about what he had seen: “We patients,” he told me, “do more for you doctors than you do for us.” By this he meant that the gratification of being able to help others is an abundance of reward rarely considered in the calculus of healing, or of any other form of giving of ourselves. Men and women who devote themselves to doing for others live enveloped in the nourishing aura of appreciativeness that oxygenates self-confidence and motivation. We are told in the Book of Acts that it is more blessed to give than to receive, and that ancient maxim has a lot to say for itself. Physicians and all manner of men and women actuated by the will to do good may not be consciously aware of it, but in their very giving they are blessed by those who receive. Seeing oneself reflected in the grateful eyes of a fellow human being to whom one has brought sustenance is surely among the most enriching of self-perceptions. It is in the very real sense a bountiful gift, one that must surely manifest itself not only in emotional but in physiological ways as well. That the encouragement of service to others is often expressed in flatulent aphorisms does not in any way lessen the worth of this service, and certainly does not diminish its value in relation to a long and satisfying life. It is not my purpose here to write a tract on saintliness as a path to longevity, or moral rectitude as a geriatric tonic. I am merely trying to focus on the ways that we may make the most of our final phase of life, and to extend it if we can.

  And, of course, it is never too late. The getting and spending, the clawing rivalries, the need to prove ourselves to ourselves, the pragmatic drive to “succeed”—which so often motivate decision-making in earlier decades—are susceptible to softening as we reach our late-middle years, and continue to lessen their influence on our thinking as the decades pass. In these ways, the word “maturity” reassumes the meaning it had before the AARP and the pop psychologists of aging appropriated it for the purposes of feel-good. Of all the beneficences granted us by the evolving emotional changes that begin to make themselves manifest as we reach perhaps our early fifties, this maturity must surely be among the most valuable, both to those around us and to ourselves. Some of us are later than others in this kind of growing, and a few will never attain it. For many, it requires conscious effort to realize that it can be reached and to bring it to fullness. But in the ripening process of becoming ever more mature, far more of us than might be thought are increasingly able to leave off the shadowboxing of striving careerism, and emerge to a vision of ourselves that was unattainable at an earlier time. Done right, it most properly begins in middle life.

  The fundamental notion of beneficent interactions between individuals emerged in many stated and unstated ways as DeBakey’s musings traveled far and wide over the landscape of the “something else” that enables one person and not another to continue to function at a very high level—well beyond the age at which such high-level functioning is expected. But for a moment, it is necessary to return to that other factor, without which the “something else” cannot as effectively come into play. Even vast emotional rewards can affect longevity only up to a point if the physical fiber—so much of which comes with our genes—is wanting. Ourselves are held back without our stars, to turn Cassius’s admonition to Brutus on its head. All the “something else” in the world avails only so much when the constitution lacks, whether that constitution’s ingredients are inherited or have been maximized by good fortune and life’s experiences. And here, DeBakey enters the race with that combination of DNA, resistance to rust, and good luck that forms the basis for the something else. His father died at ninety; his mother at almost eighty of malignancy; three of his four siblings are still alive in their nineties; the other, a sister, died of cancer in her eighties; he has never suffered a major illness or accident; save for his first wife’s premature death, his life has been free of tragedy or the debilitating unhappiness inflicted by the sorts of externals over which one has no control.

  The age of DeBakey’s siblings is of particular interest in view of the findings of the New England Centenarian Study, which to no one’s surprise found that centenarians are four times more likely than others to have a sibling who lived beyond the age of ninety. But even this is not in itself indubitable evidence that DeBakey’s long living is heavily indebted to heredity. As those who did the study would be the first to point out, members of the same family share more than DNA—they tend to have similar values, and they tend to share such characteristics as eating habits and attitudes toward exercise and intellectual stimulation.

  And then there is the matter of DeBakey’s diet. Altogether, we sh
ared four meals during my visit, which included two dinners and two lunches. As he always does, my host ate very little, and he does not hesitate to point out that he thinks this may be a contributing factor to his longevity and to his generally robust health. He bases his opinion on a series of experimental studies indicating substantial prolongation of the lives of laboratory animals fed a diet very low in calories. As I observed DeBakey at each meal, I would estimate that the volume of food he ate was about half mine, or less. At dinner on our second evening, he ordered a dish of pasta and ate one-third of it, which he told me is his usual habit.

  And thus, DeBakey has been mightily equipped by nature, circumstance, and choice with qualities necessary for what the seventeenth-century physician-philosopher Sir Thomas Browne in his Hydriotaphia called “the long habit of living.” At ninety-six, DeBakey looked no older than seventy. Though he has not done a whit of fitness exercise since his youth, his five feet ten inches are lean and wiry at 150 pounds. To demonstrate his muscle tone, he at one point pulled up the sleeve of his lab coat and contracted a biceps that projected like a tennis ball from his upper arm, and with the same firmness.

  Though there can be no doubt that DeBakey has in such benisons of fate or good fortune been better provisioned than most of us, that cannot alone explain what he is today, in the second half of his tenth decade. There has to be far more, and the more must certainly reveal patterns as useful to everyone as the concept of service to others. Of what, in fact, does the rest of the “something else” consist?

  Here is Michael DeBakey explaining it to me, and perhaps, by giving it a literal articulation, explaining it to himself as well:

  It is this aspect of seeking knowledge, and, to use an even more direct word, curiosity. Curiosity and the seeking of knowledge is a transcendent life force—almost, you might say, spiritual. It has a driven character to it. It drives you intellectually and, to an extent, physiologically. The brain influences the body in ways we don’t know about.

  Here DeBakey is describing what might be called a forward momentum created by the very process of seeking knowledge. As I thought about this notion, both while DeBakey was speaking and while ruminating on it later, it became increasingly clear that these few sentences elucidate not only a key factor in his continuing productivity, but also a clue to the success of his entire career. He goes to bed each night, he told me at one point, looking forward to the morning so that he can do those things he was unable to accomplish on that day. The propulsive momentum of the thing was evident in his description: work to be done, plans to be made, places to go, things to learn—ever new challenges to be taken up. Were I asked to put a name to it all, I would call it the anticipation of the interesting.

  Anticipation would seem to be just the right term, because it incorporates the notion of eagerly looking forward to promised intellectual stimulation whose taste can already be almost felt. This urgency of expectance would seem to be the essence of the thing about which DeBakey was speaking. When he uses the word “driven,” the force and magnitude of the anticipation are exactly what he means. He is driven by the imagined taste of coming pleasure. His mind already senses its flavor because he has known it all his life. Michel de Montaigne wrote about such things: “In every pleasure known to man the very pursuit of it is pleasurable. The undertaking savours of the quality of the object it has in view; it effectively constitutes a large proportion of it and is cosubstantial with it.”

  The notion of the imminence of immanent pleasure extrapolates to so many other circumstances, for so many other people. Like beneficence, it is available to all of us. And also like beneficence, it may be an acquired taste, taking hold of us or being deliberately sought not until middle or later years as more time is available and opportunities increase—or perhaps as the energy of career and striving transform themselves imperceptibly into the energy of learning and creativity for their own sakes. For DeBakey, such imminence is the fore-taste of new knowledge and the modified continuation of a career. For others, it may be in the anticipated pleasure of working in a blossoming garden; creating an artistic piece of pottery or woodworking; improving a game of golf; seeing old friends; traveling to new places; learning to play a musical instrument or studying a foreign language; finding joy in children’s children; or some combination of all of these and similar enjoyments. In the house of anticipation there are many mansions, each distinctive to the life of the man or woman who finds it. Some pleasurable pursuits arise from the edifice of a career and long-standing interests, as do DeBakey’s. Some are entirely new discoveries. Either way, these pursuits provide the promise of oncoming pleasure that can be the power source of a vitality that propels us forward. They are the drive of which DeBakey speaks. Each of these pursuits is a form of creativity, and each of them can—and should—be discovered long before we begin sliding into old age.

  But the propulsions that can drive later life come with necessary caveats that need to be observed. And in DeBakey’s advice about such things, we once again encounter the warning that one must look down even while looking up:

  When there are things to be done, they must be done whether you’re ninety-six or fifty-six. Those are just numbers. But I think that conceptually it’s important as you age to recognize some of the limitations that age produces. But once you’ve recognized them, then you are aware of those limitations and this allows you to be flexible within them.

  What is being said here is that knowing one’s limitations and learning to function within them allows the avoidance of the unmanageable. By doing this, it becomes possible to work most effectively in order to achieve chosen aims, without dispersing energy on what can no longer be achieved and then being forced to deal with the thwarting disappointment that necessarily follows. In an earlier chapter, this was described as letting our horizons come closer, and confining our plans to the realistic.

  While I know what my limitations are, I also know that by those limitations and by my realizing what they are and working within them, I avoid allowing them to interfere with what I want to do. It doesn’t in any way restrict my intellectual capabilities.

  By doing that, you see, you also avoid the frustration. This is important to do, in order to maintain the serenity that can affect your life and whatever you’re going to do. Frustration is an enemy in your life. It can be one of the very important negative factors upon your health and your life. So you must deal with it. Otherwise it harms you—it’s harmful to be frustrated too long, and I’ve learned from my early experience to deal with it and with anger in so many ways—even spiritually sometimes. The same is true with anger. Anger is in some respects a form of frustration. These are things you have to learn how to handle, and as you grow older they become more important, because age also tends to make things much less flexible than they were in your youth. One of the major advantages of youth is its greater flexibility, both mentally and physically. You can substitute for that as you grow older, with what I call wisdom.

  Until this point, DeBakey had been speaking of attitudes that serve to sustain intellectual and physical vigor, and, indeed, such matters formed the substance of our discussion. But of equal importance is to avoid patterns of thinking that have a negative effect on powers that might remain intact were they not actively lessened by counterproductive or harmful ways of thinking.

  One of the problems of aging is that the mind is ahead of the body. I’ve noted that some people—some of my colleagues, in fact—have allowed their bodies to deteriorate because they perceive themselves to be old. In other words, they have become impressed with the fact that they are old in years, and therefore respond by being old—and I’m using “old” in the sense of true physical deterioration. Of course, there is a certain amount of that, which does occur with age. Those people who have been blessed with a physical constitution that has maintained intellectual fervor, intellectual vigor, have to come to a certain, you might say, accommodation with the physical limitations that they are no longer able to control.


  And so, DeBakey is reiterating, once we understand our limitations and accept them, we can learn to work within them. This is the form of wisdom of which he is here speaking; this is the form of wisdom that brings the serenity that allows us to cope with frustration and anger. Obviously, all of this is circular, with each component feeding back into the others, strengthening them even as it gains strength from them.

  I did very little talking as we discussed these matters—there was no need for it. I was communing with a man who was not merely responding to questions put to him, but was, in fact, explicating convictions to which he had quite obviously given a great deal of thought over many years. The words came easily, because they were the expression of long-evolving certainties.

  I wanted to know about the role played by faith in DeBakey’s thinking, not only faith’s involvement in fortune, but also the ways in which faith contributes to the serenity on which he places so much emphasis.

  DeBakey was brought up in the Greek Orthodox church of his immigrant Lebanese parents, “in a religious atmosphere,” as he puts it. He has tasted of other faiths, and clearly has a wide knowledge of religious forms and practices. But his beliefs are nowadays not restricted to the tenets of an organized church; they are his alone, though he describes their most personal manifestations in terms that many other men and women might recognize as being similar to their own.