I have been secure in the knowledge that I have had a relationship with my God, and that he was going to take care of me. My childhood experience in my parents’ religion has changed in what I call having matured. I don’t think of faith any longer as a child does, and yet I have retained that spiritual relationship with a God that I had as a child—because it gives me a feeling of serenity to do so. I’m not a regular churchgoer, but there again, that’s part of the maturity I’m talking about. I don’t think I need to go to church. People used to ask me in interviews what church I go to and I’d say, “Yes, I’m in church right now.” I’m in church wherever I am. I’m in church at home, I’m in church here. My relationship with God is a personal one.
Thoughts of faith led to questions about belief in afterlife.
I don’t know about that, and I’m not concerned about it. Right now I am in a life. I’m secure in my relationship with my God, and I don’t need to worry about an afterlife and don’t need to have a sense of insecurity about what’s going to happen to me. To me, that is part, again, of what I mean by maturity.
The maturity seems to go even further than DeBakey is prepared to say. I could not resist pondering just how much this most self-reliant of men actually does expect from his God. I may have found the answer in a brief article he published only four months before my visit, in the academic journal Surgery, revealingly entitled “Kismet or Assiduity?” The article appeared as part of a series in which distinguished contributors are asked to write brief narratives of personal history or surgical lore. In it, DeBakey tells of taking the oral examination of the American Board of Surgery in 1938, and being asked to evaluate a forty-year-old man ten days post-appendectomy, who had developed fever, right-sided abdominal pain, and an elevated white blood cell count. The young candidate correctly diagnosed an abscess under the diaphragm, a conclusion aided by DeBakey’s having recently published a paper on the subject that had, by seemingly lucky coincidence, been read by one of his two examiners, Dr. Fred Rankin. (To this day, that paper is considered a classic description of the problem.) When a few years later Colonel Rankin heard about DeBakey’s army enlistment shortly after the attack on Pearl Harbor, he arranged for the new recruit to be assigned to the Surgical Consultant Division in the Office of the Surgeon General, of which Rankin was the head. It was there that DeBakey made his important contributions to the origins of the MASH units, the National Library of Medicine, and the system of veterans hospitals described earlier. In time, he succeeded Dr. Rankin as head of the division.
In the final paragraph of “Kismet or Assiduity?” DeBakey muses over whether it was destiny or his own hard work that conspired to make his good fortune. “In classical literature,” he writes, “fate was sometimes defined as ineluctably predestined,” and then he goes on to quote the famous Rubaiyat verse about the immutability of words written by the Moving Finger. But in the end, the ninety-six-year-old author of the article comes down solidly in favor of hard work, concluding his piece with a stanza from Longfellow’s “A Psalm of Life.”
Let us, then, be up and doing,
With a heart for any fate;
Still achieving, still pursuing,
Learn to labor and to wait.
Religious belief, kismet, and enviable DNA notwithstanding, there seems little doubt that Michael DeBakey has made his own psalm of life. Its theme is assiduity.
Having spoken of the past, the present, and the afterlife, I broached the question of DeBakey’s future years. What sort of hopes does a ninety-six-year-old man have for the time left to him? Though blessed with constitution and having found that “something else” we had been delving into, he was nevertheless ninety-six, and though it is “just a number,” nothing can change it. There are, after all, limits to how far even his prodigious endowments and philosophy can take him. Has he set goals for his remaining days?
I don’t dwell on it, and so as a consequence I don’t come to a final schedule. Philosophically, I suppose, the basic reason for that is that I don’t want to make a schedule. If I do that, it makes me dwell on the schedule and that makes me dwell on its termination.
I’ve long accepted the fact of my own death. I’m ready whenever it comes, in the sense that I know I can’t stop it. But I don’t dwell on it. As long as I feel physically and mentally like I feel now, and stay asymptomatic and have a schedule of things that need to be done, I don’t think about whether or not I’m going to be alive to do them. So, knowing that sooner or later something is going to happen to me, I just go ahead. When I get on a plane, for example, I’m absolutely sure I’ll arrive to where I’m going.
“I’m absolutely sure I’ll arrive to where I’m going.” The sentence echoes in my mind. I’ve listened to it over and over, rising up from the tape that recorded it. It seems to encompass Michael DeBakey’s reflections on the grace and rewards of aging.
Kismet, assiduity, and every other factor that has made Michael DeBakey the man that he is—all of them came to a focus on February 9, 2006, eight months after my visit to Houston, when a team composed of several generations of surgeons who had trained under his supervision operated on him for a life-threatening thoracic aneurysm, an acute disruption of the largest blood vessel in the body a few inches beyond its origin in the heart. The operation they performed on their chief, which is one of the most hazardous and complex in all surgery, was an updated modification of the one DeBakey had introduced in February 1954. The equipment and technology that made it possible were all the result of his originality and inventiveness.
Only a few years earlier, a team of surgeons from the DeBakey Department of Surgery at Baylor had published a paper in the Journal of Vascular Surgery entitled “Emergency Surgery for Thoracoabdominal Aortic Aneurysms with Acute Presentation,” reporting on 112 patients operated upon between 1986 and 1998, with a mortality of 17 percent, a remarkably low figure for such a lethal condition. But perhaps even more remarkable than such outstanding results was their finding that “age did not influence survival rate.” The mean age of the patients in the series was seventy, plus or minus eight years. On the day of his operation, Michael DeBakey was ninety-seven.
DeBakey not only survived, but applied his assiduity to a vigorous program of physical rehabilitation that might have cowed many a younger man. In September 2006, a few days after his ninety-eighth birthday, and shortly before he flew to New York for a research awards luncheon, I received a letter from him in which he wrote, “I am doing very well and hope to have the pleasure of seeing you again sometime soon.”
MAKING CHOICES
The unexamined life is not worth living.
—Plato, Apology of Socrates, ca 400 BCE
If you look at a problem long enough, you can see the part you play in it.
—Miriam Fox Gabler, Ozarks Senior Living, 2005
The name of Miriam Fox Gabler will not be remembered half a dozen decades from now. Her son and daughter—both adopted—are in their late forties and childless; her long line of DNA will die with her final breath. She will leave no personal legacy to any generations of descendants. Almost certainly, no one will think about her late in this century, to remember the deeds she did and the lessons she taught. After a time, all memory of her will disappear. It will be as though she had never lived.
The name of Plato, on the other hand, and the words he recorded as those of Socrates will echo through the culture of civilization as long as humankind survives. Plato could not have known there would be a Miriam Gabler. To Miriam Gabler, Plato is a barely perceived figure from the classical past, a vaguely known and ancient philosopher with whose thoughts she is unfamiliar. She has never read his aphorism quoted above, nor any other sentences he wrote.
But were Miriam Gabler ever to see those words, she would surely know what to make of them, as they have meaning for her own life. She would understand them to express her conviction that it is incumbent on those who have achieved a good measure of contentment in their lives to conjure with themselves abo
ut its sources and its continuity, and about the choices that might so easily have led to its opposite. She is not content to be content without context: Like Plato, Miriam Gabler believes that earnest examining of one’s life opens the way to conscious decisions to improve it, and thereby adds to its value and its rewards.
And so, Miriam studies the reasons for her contentment. She has made herself aware not only of the portion of it that seems to have been dealt her by chance and circumstance, but of the part as well that she has been able to “play in it.” And in at least this way, Plato and Miriam Gabler—an immortal and a woman destined to be forgotten—walk together.
I met Miriam in the final days of 2005, a scant three weeks after the death of her husband. He had a decade earlier first developed the confusion that proved to be the earliest indication of Alzheimer’s disease—so gradual in manifesting its ultimate destructive effects that it could not be diagnosed until five years later, in 2000. Progression was more rapid after that time, and by September 2001 he had to be admitted to a nursing home. Miriam spent hours of every day with Don, as his ability to know or even recognize the world around him lessened with each passing week. It was a terrible time for her, a time of sadness beyond measure—and of desperate yearning for the love she had found so late in life and was now losing.
Miriam’s first marriage, in 1947 to Frank Marshall when she was twenty-one, had been difficult almost from the start. Because she underwent a hysterectomy at twenty-three for a fibroid uterus, the couple adopted two children, Mark and Debby. The marriage became more strained and distant as time wore on, and a divorce was agreed upon in 1970, when Miriam was forty-four. After eleven years of bringing up her children as a single mother, she met an electrician named Don Gabler, and something in her came to life again. It was of no consequence to either of them that she was six years his senior. “Together we found everything that was missing in our first marriages.”
After Miriam and Don married in 1989, their joy in each other only continued to increase. “I was sixty-two at the time of our wedding, a no-nonsense woman with graying hair. He was fifty-six, youthfully handsome and a terribly sweet guy.” Even long after Don began to experience the disturbing episodes that appeared at first to be only mild confusion, the couple’s happiness seemed assured. But after six years of gradual worsening and a trial of day care, Miriam finally agreed to let her husband be admitted to a nursing facility near their home in Mystic.
It was two years later that Miriam one day came to her moment of realization, a moment characteristic of her enduring ability to clarify issues, especially those involved in the series of misfortunes she had endured before meeting Don. In her usual contemplative way, she had been looking hard at her problem, and could now finally recognize the part she played in it. The culmination of that self-examining was the recognition of what had to be done. She recognized it so well, in fact, that she was able to clearly articulate her decision to herself and also to those who would later read about it in a brief article she wrote that very evening, for a monthly publication called Ozarks Senior Living. The date was January 12, 2003, the anniversary of her marriage to Don.
LONG OVERDUE
Today I made a choice. I could cry and be miserable because my husband is in a nursing home, or I could rejoice that on this day fourteen years ago, I became his wife.
Don is a victim of Alzheimer’s. It has been a long grieving process. Today I chose to be thankful for the beautiful life we shared before he became ill. No one ever loved me as he did. I no longer believe love is blind. I believe love sees what nobody else can see.
He was a youthful forty-nine when we met—tall, dark and deliciously handsome. I was six years older, a nononsense woman intimidated by our age difference and captivated by his playfulness. In early January, 1989, surrounded by four of our six children, we were married.
A million times since that day, he stroked my wrinkled face and patted my silver hair.
“My gorgeous wife,” he murmured, his bright eyes shining. We never tired of talking, sharing our most intimate thoughts. We laughed, danced, and thrilled to the ecstasies of renewed youth. Neither time nor progression of his disease can erase the beauty of our relationship.
This morning I baked an angel food cake, Don’s favorite, and carried a slice with me when I visited him. I broke it into tiny pieces that he could manage. I hugged and kissed him, and told him it was a special day. He looked at me with faint recognition. “I love you,” I said, proud of myself for not crying.
Driving home I acknowledged that it was indeed a special day. Not only did it commemorate fourteen years of marriage to a beautiful human being, but it was the day I received the grace to make a healthy choice…long overdue.
Miriam gave me a copy of the article as we sat talking in the living room of the small house she had shared with Don in Mystic, a Connecticut seaport town very near the Rhode Island state line. She lives on a quiet street of only four houses, called Misty View Avenue, so named, no doubt, on account of the thin fog that frequently rolls in from the nearby confluence of Long Island Sound and the Atlantic Ocean. It was late on the Friday afternoon before Christmas, and we were talking about her life.
At that time, I was about eight months into the study and writing that eventually became this book, and I was becoming intrigued by an issue too infrequently addressed in the literature on aging: How is the quest for so-called successful aging affected when it must be carried out in the face of a history and the aftereffects of life-threatening illness? It is all well and good for age sages to promote the virtues of optimism, creativity, and a healthy lifestyle, but how has the achieving of such goals been accomplished by men and women who have had to deal, for example, with cancer, stroke, or one of the many other stumbling blocks that all too often clutter the path toward the sixties and beyond? Do not such burdens thereafter weigh too heavily on the mind to allow any significant measure of the emotional serenity that is so necessary to a rewarding old age?
Over the previous month, I had been pondering the possible answers to such questions. It was clear that the obvious and expected was true, namely, that those men and women who were able to put their diseases into perspective and who had not allowed themselves to become emotionally crippled by them were most likely to go on to rewarding older age. In other words, the response to the physiological insult is more important than the insult itself. That part of the problem is self-evidently simple. But what determines any given individual’s response, and what are the ingredients of such a response?
I would in time find that some of these successful men and women had significantly altered their perceptions of life and their values as a result of their sickness, while others had somehow been able to remain blithely untouched by it. But the quality uniting all who overcame such problems was that they had not allowed their determination to be derailed, whether they had integrated their experience into a changed philosophy of living or had treated the experience like a mere bump in the road, now passed and well behind them.
With all of this in mind, I was curious to know the details of how such successful people had dealt with their setbacks. What might some of the factors be that determine whether having been seriously ill has a positive, a negative, or no effect on the ability to deal well with the aging process? How important are bonds of love and friendship—the support that comes from close relationships of trust? Does having a self-sufficient personality, for example, exclude the need for the devotion of, and for, others? What role does religion play? How do those who have overcome the burden of illness think about death and the possibility of an afterlife? And finally, in speaking to men and women who have overcome so much and gone on to rewarding years of older age, I wanted to know how they would wish to be remembered.
All of these questions were on my mind as Miriam Gabler and I sat talking together in the small living room of her comfortable little house on Misty View Avenue. Even our one distraction was of a piece with the unpretentious snugness of t
he atmosphere she had created in that place: the frequent nuzzling against my leg of Miriam’s little beagle, Lucy, loving even a stranger and so certain of being loved in return that she expected to be stroked and petted by every visitor.
Miriam and I had pulled our chairs up to a small round table from atop which a soft shaded glow spread outward to supplement the declining light of the late December afternoon’s setting sun. Bending just a bit forward toward each other as people do when absorbed in conversation, we could have been mistaken for two elderly friends come together for tea and a congenial chat. Everything about that room and the feeling it invoked in me, I soon came to realize, was the reflection of Miriam herself, and of the contentedness she has found in the everyday richness of her life.
I had come the sixty miles from New Haven because of a letter I had received the week before from a woman whose name was unfamiliar to me, Miriam Gabler, thanking me for the chapter on Alzheimer’s disease in How We Die. Authors of expository books receive many such letters, and each is so interesting in its own way that I have answered almost all of those that have come to me over the years, and Mrs. Gabler’s was no exception. But reflecting on her words a few days later in light of some of the questions I was then thinking about, I realized that she might be precisely the sort of person I had been wanting to meet.
The Art of Aging Page 8