The Art of Aging

by Sherwin B Nuland

  That Patricia Neal has been “still here” and a very productive, happy presence for forty years following the episode that nearly took her life is a testament to sheer determination—hers and her husband’s. She and Roald Dahl were divorced in 1983—he died in 1990—and everything she accomplished after that is to her credit alone. Despite her certainty about his role, whether or not she could, in fact, have begun on the long road back without his browbeating will never be known, but the woman I sat speaking with in that New York apartment had clearly made a choice early in her period of recovery, whether it came from something within or was, as she insists, forced on her by Dahl. In the end, it was her own stubbornness, her own refusal to be beaten, that kept her going even when she thought the obstacles facing her were insurmountable. Her remuneration has been the long years of middle and now older age in which she can say, as she did to me that morning a few days after her eightieth birthday, “I’m so happy now. I really am.”

  So much of Patricia Neal’s life has been lived in the public eye, and she has revealed so much more in her candid and detailed autobiography, that an observer cannot escape reflecting on the effect that her fame may have had on the extraordinary recovery she was able to make. The wire services reported her death on the morning after the stroke, but she was soon afterward in the midst of what must have seemed a miracle to more than a few of her admirers, distant and close. Awareness that her progress was being carefully monitored by tens or hundreds of millions of people the world over must have added to the incentive not only to recover but, in more recent years, to achieve such a useful and rewarding older age. In a way, this puts her accomplishment into the category of one aided by the expectations and needs of others. But it only adds to the credit due to her alone if some of the armament in her battle was the driving desire to show the world that it could be done, and that she was the woman who could do it.

  The influence of a watching world will be granted to very few of those who must overcome disability in order to achieve a fruitful old age. Were I to gaze as far as I could toward the opposite direction, I could find no one on whom it had a lesser effect than another person crippled by a stroke whom I met in the course of preparing to write this book.

  Hurey Coleman is a tall, powerfully built African American man who works as a machinery operator in an industrial plant near New Haven. Strikingly handsome at the age of sixty-four, he is in his own way as attractive and interesting a personality as Patricia Neal is in hers. But other than his friends, his wife, their four children, and their seven grandchildren, the world will little note nor long remember what he did here. The incentive for his overcoming the massive stroke he suffered at the age of forty-eight was quite simply that he needed to get back to work in order to provide for his large family, but it was incentive enough. The strength and encouragement of his wife, Donna, and the children helped him considerably, but—unlike Patricia Neal—he never doubted that he would overcome his affliction. To his mind, continuing debility was not something God would allow to happen.

  Mr. Coleman had never been very attentive to his hypertension. Not only had his doctor somehow not been able to hit on the proper medication to control it, but the patient himself was inconsistent in taking what had been prescribed. Late one Friday afternoon in January 1990, tired from having worked overtime at the plant, he came home and decided to wash his car. He was standing on the porch just after finishing the job when he suddenly felt the onset of severe pain in the back of his head. At almost the same time, he began to feel weak and dizzy, as though he were about to black out. To avoid falling, he sat down heavily on a porch chair, and then found himself unable to get up when he wanted to. Luckily, his wife returned from shopping only a few minutes later. When she saw that he was confused, garbling his speech, and immobile, she immediately called 911. On arrival at the emergency room of the Yale-New Haven Hospital, Mr. Coleman was found to have suffered a stroke that paralyzed his left side and made him aphasic—unable to express himself by speech or to fully comprehend what was being said to him. He spent twenty days at Yale-New Haven and was then transferred to the Gaylord Hospital, an inpatient rehabilitation center in the nearby town of Wallingford. And in that place, he resolutely went to work on his recovery. When he came home, it was with the determination to get back to work. Within four months of the stroke, he had done just that.

  Mr. Coleman is justifiably proud of what he was able to accomplish. When I met with him and his wife in their neat, tastefully furnished house in West Haven, it had been fifteen years since the day of the stroke, and those years had been surprisingly good. But he still remembers how astonished everyone was at his rapid recovery. “Everybody was surprised at how fast I was able to do it,” he said, with a touch of well-justified self-satisfaction.

  But “everybody” does not include his wife. Donna Coleman works in the medical records department of the Yale-New Haven Hospital, and she had the opportunity to spend a great deal of time with her husband, watching his progress day by day. She knew from the first forty-eight hours in the hospital that Hurey would survive, and it would not be much longer before she also knew that he would do everything it might take to resume his normal life as rapidly as possible. And all of this in spite of the extensive nature of the damage that doctors told her had been done to his brain, in the face of which so many men and women give up in despair and reconcile themselves to a life of debility. The basis of her certainty was faith in God.

  “I never thought he wouldn’t be able to go back to work again. They told me he was going to be a vegetable, or that he’d never walk again. But I never believed that. They thought he wouldn’t make it. They kept telling me something negative and I kept telling them something positive. Positive thinking is important, and our faith is strong.”

  With that remarkable confidence—that God would bring him through—Hurey Coleman never questioned his part of the bargain. It was to work, work, work—and to remain cheerful in the assurance that all would be well. He did what he could to help others try as hard as he did, but he was not as successful in that self-appointed mission as he’d wished.

  “When I was at Gaylord, a lot of the people there had the attitude—well, they’d just get so upset. When the therapists came to start the PT early in the morning—sometimes as early as five o’clock—those angry people would be swearing about having to get up, and I’d try to encourage them. ‘We need this help,’ I’d say. ‘They can come and get me anytime they want. I’m not going anyplace anyway. As far as I care, they could wake me at three A.M. for therapy.’ They thought I was a lunatic, but that’s how I felt. I saw so many people give up and not cooperate with the treatment. What gave me strength was faith in God. That was what really kept me.”

  God had some pretty important help, not only from Hurey himself but from Donna and their children. “By my having a good wife and my children always coming to see about me, the family got even closer than before. We got strength from each other.”

  Mr. Coleman has been left with a somewhat weakened left arm and leg, and he uses a cane to steady himself when he walks. But he still goes to work every day, doing the same kind of job he did before the stroke, and he is obviously pleased with the way his life has turned out. When he says, “Everything has been pretty good. Everything is fine,” there is plenty of evidence to show that his assessment is accurate. Of course, his activities are restricted somewhat by the weakness, and he can no longer go fishing as he used to, except rarely and then from a boat. Life has slowed down. But he still spends plenty of time with his friends, both with the men and with Donna as a couple, enjoys his family even more than before, and is considering—but only considering—whether to retire next year.

  “I’d like to do more traveling—taking vacations. We’re looking into a cruise, and we’ve never done that before. I’m thinking about retiring next year when I’m sixty-five. That way, I won’t have to hit no more clocks, and I can do what I want.”

  Hurey’s attitude is rein
forced by the way he sees himself. I have spoken to many men and women who have overcome major health problems and gone on to rewarding later years, and one characteristic unites them all: The crisis was an event in their past, now behind them and perhaps necessitating certain changes in their lives, but not something that marks them as sick people. For some, the overcoming of the episode has become a subsequent source of strength; for others, it has seemed in retrospect merely a bump in the road; for still others, it has been a wake-up call to care better for themselves, or even to radically alter their approach to the necessity of maintenance. But none of these successful people—not a single one—considers her- or himself in any way invalided.

  Even a man like Hurey Coleman, who every day has to take a total of ten different medications to maintain the stability of his heart, blood pressure, and kidneys, and who makes regular and frequent visits to Dr. Leo Cooney, the director of Yale’s Dorothy Adler Geriatric Assessment Center, who has cared for him since his stroke—even such a man is not seen through his own eyes as less than well. And there is no time or energy wasted on bitterness. “I never thought of myself as someone who is sick. I think of myself as a healthy man who had this problem. I’ve never gotten angry about it, or about anything else that was big in my life.”

  When I ask Mr. Coleman how he would advise someone recently recovering from the acute effects of a stroke, his reply combines his own religious beliefs and the practical plan he himself follows. Both have stood him in good stead through the years.

  “The first thing I would try to do is to tell him to get faith in Christ. And then, go ahead and live a good life. Thinking about what you might have done in the past, or what might have been—well, there are things you might have done different, maybe gone in a different direction. But once that [stroke] has happened, you just have to go on. Have faith in God and take whatever medications the doctor puts you on. A lot of people don’t want to abide by rules, but you have to.”

  As Hurey said those words I could not help but think of a Frank Loesser song popular during World War II, said to have been based on an actual event that took place in the South Pacific. The song was called “Praise the Lord and Pass the Ammunition,” for the advice being given by their chaplain to a team of sailors when their ship was being attacked by enemy aircraft. He urged them to pray, but he also urged them to shoot back vigorously, even joining them in their efforts. Keep the faith, Hurey Coleman urges, but keep the fire-power too, for the Lord does indeed help those who help themselves.

  Except for the notion of faith in a benevolent God, Hurey’s words might well have been spoken by a man whose life, education, and socioeconomic status have been about as far removed from his as Hurey Coleman’s place in the public pantheon is from Patricia Neal’s. At eighty-one, Arthur Galston is the Eaton Professor Emeritus of Botany; an emeritus professor also in the School of Forestry and Environmental Studies; Senior Research Scientist in Molecular, Cellular and Developmental Biology; and a professor in the Institution for Social and Policy Studies, all at Yale University. At various times during his long career, he has done extensive research in Vietnam, China (where he was the first foreign scientist invited to work in the People’s Republic), Japan, Australia, Israel, Sweden, England, and France. Though his scientific bibliography is lengthy, among the works of which he is justifiably most proud is a book he wrote in 1973, Daily Life in People’s China, the outgrowth of a summer spent working in the Marco Polo Bridge People’s Commune, located in the countryside about twenty miles from Beijing. He is a navy veteran of World War II, one of our nation’s most effective spokesmen on the dangers of Agent Orange, and well known as a leading academic figure in campaigns against the sort of injustices that are created when our federal government misuses or overreaches its authority—the Vietnam War is an example. He taught Yale’s first course in bioethics, which he initiated in 1977, when virtually no such teaching existed in science departments anywhere in the United States. His remarkable career has been spent in a whirling vortex of research, teaching, and activism.

  But Art Galston’s arteries are like anyone else’s. He suffered a debilitating stroke in 1981 when he was sixty-one years old, and a cardiac arrest eleven years later. Recovery from the stroke took six months of commitment to intense physical therapy, and left him with a slight but noticeable limp and some diminution of strength in his right arm, effectively ending a long-standing and passionate relationship with the game of handball.

  Recovery from the cardiac arrest involved high drama and sheer luck. Driving to his laboratory one morning in 1992, Art began to notice what he thought was indigestion, and decided to stop in at the nearby Yale infirmary to see if something could be done about it. After checking in at the desk, he went into the men’s room and was just stepping out the door when he suddenly blacked out. As he was told later, several nurses sprinted to his aid and found him to be unconscious, pulseless, and in full cardiac arrest due to the sudden irregularity of rhythm called ventricular fibrillation. Except perhaps for an emergency room, Art’s heart could not have picked a better place to stop. The defibrillator was rushed to his side as he lay motionless there in the corridor, a few jolts of current were sent surging through his chest to reestablish a regular beat, and an ambulance was called. Intubated and his survival still in doubt, he was sped to the Yale-New Haven Hospital, where he was stabilized and later underwent a three-vessel coronary bypass operation.

  I have worked closely with Art Galston for only about ten years, since our mutual interests first brought us together at the Yale Interdisciplinary Center for Bioethics, on whose executive committee we both serve. But his reputation around the university and in the greater worlds of science and public activism have for far longer been well known to me, though I was not aware of his stroke or of the cardiac disease until recently. In fact, I had always thought of him as one of the university’s many vigorous and vastly productive emeritus professors whose rewarding later years were made possible by their good fortune in avoiding major illness or infirmity. A few months before I began working on this book, a colleague told me of the problems Art had had, by then including his wife Dale’s recent admission to a long-term care facility because of progressive dementia.

  When Art and I spoke about these things, he had been living for several months in an apartment at Whitney Center, a comfortable and very homelike retirement community in my own town of Hamden, about two miles from the center of the university. The house in which he and Dale had brought up their two children—Beth, a sculptor, and Bill, a professor of philosophy and public policy at the University of Maryland—had been sold. Surrounding himself with some of the carefully selected memories of a lifetime, Art was determined to go on as before. Given his long daily visits with Dale, work in his office, his writings and teaching, and his contributions to the activities of the bioethics center, he was so amply busy that I had to find time in his schedule for our talk.

  Art was one of the first people to whom I spoke when I was beginning to wonder about finding value in the later years, for men and women from whom serious illness has taken away so much. I had no idea that his thoughts would be echoed in the responses of virtually everyone with whom I would later meet. Not surprisingly, he was so articulate in presenting them that I have chosen to quote him extensively here.

  When his stroke occurred, Art said, he was sure that his career was over, until he began thinking about all he would be losing if he let that happen. The words came easily as he recalled his ponderings during that time: “I loved what I did; I loved being an academic. I loved having a research project I was engaged in. Most aspects of the academic life were very, very appealing to me.”

  Looking back on the pleasure he had taken in his career helped Art to emerge from the depressed state of mind into which he had allowed himself to settle. Realizing that he wanted the pleasure and fun back again, he determined to exert at least some control over his future, and not just let things happen to him. The mere thought of taking su
ch a step gave him the enthusiasm to start on some positive action, and before long his enthusiasm was on the march again. “My attitude turned on a dime when I realized that there was a way out.”

  But a good attitude would not be enough.

  When I had the stroke, I was despondent at first, but when a way appeared for me to work toward something, when the will took over, it didn’t just happen. I had to work at it. But success fed upon success as I applied myself, first with the therapy and then with my career. Capabilities were restored, and I was encouraged. Before long, I was pretty much restored to the status quo ante. At sixty-one, I felt once again the young tyro on the make. I wanted to do things; I wanted to be active. I had remarkable support from my wife and children.

  I was aware that this machinery we’ve been given runs down. And this caused me to make some real changes. I started to be more observant about my diet, and I no longer flogged my body. I substituted a morning walk for the handball, and I began to take rest periods late in the afternoon.

  The thing I knew was that I couldn’t stand a life of inactivity. The human spirit, whatever it is, had to have some aspiration that was bigger than me, something I had to work toward in order to achieve. So I knew I had to have an activity. I had had such a good time starting up the bioethics course in the biology department which was very successful. After I retired in 1990, that became even more important to me.

  Art’s career soon restored itself, though in a somewhat modified form. But following the heart attack in 1992, another reevaluation would be necessary.

  After the cardiac arrest, I said to myself, “Okay, I’ve now had two major episodes and my mortality has become a little more real. I don’t want to lead myself into activities I can well do without.” In other words, I became a little more crafty in planning things I wanted to do. That required me to evaluate what it was that I really wanted out of life at the age of seventy-two and after these two major health problems.