The Art of Aging
Page 13
I thought, “I’m still a vigorous, aspiring scientist-teacher-academic. These things have happened and they’re little roadblocks on the way to what I want to do, but I’ve seen that I can overcome them and I’m going to continue to overcome them,” and that’s exactly how I still feel.
In one’s eighties, the nature of overcoming may need to change with each passing year. Art Galston addresses this issue in a brief essay he recently wrote for a planned Yale book on aging: “Could I continue to operate professionally at the age of 85? If I could, what would career #3 turn out to be?…This issue still has not been resolved, but one conclusion seems clear: any formal retirement emphasizing inactivity is for me not a viable option. I find the world much too interesting to permit me to sit on the sidelines as a passive observer. So I continue to seek participation in some constructive activity that will keep my mind and body active as long as that is possible.”
And so, in fact, what does lie in the future? When I asked Art what he looks forward to, his reply was of a piece with everything he had already said.
I know my powers will diminish—they are diminishing. I’m a little less steady on my feet; I have to use a cane. I appreciate being here at Whitney Center. I realize this is a place that’s better for me than my house in Orange was.
What do I hope for? I hope to continue in the ability to have a life outside of Whitney Center. I don’t covet a total existence determined by living here. I still have my car; I try to go to my office every day; I’m still an active teacher. I’m teaching an advanced course in bioethics for upperclassmen and I need to be sharp—you don’t want to embarrass yourself before a group of bright Yalies. And I continue to do some writing. I’ve edited two books for the Institution for Social and Policy Studies based on invited essays. The third thing is that I wrote a botany textbook in 1960, whose fourth edition I’m working on with a collaborator who is now the senior author. Between the textbook writing and my own creative writing of the essay type, and teaching—well, I’m pretty busy and if possible I intend to stay that way.
Confronted with the profound religious faith of Hurey Coleman and Miriam Gabler, the spiritual sense of a benevolent supreme being expressed by Patricia Neal, and the utter rejection of such concepts by Pete Barker—and my own studied skepticism—I was more than a little interested in Art Galston’s thoughts about God and the afterlife. I asked him what role religion has played in helping him regain his life after two such major threats to it. His answer was direct, and what I might have expected from a scientist—especially one whose research interests have been to explain the phenomena of growth and development in nature.
None. I have very little patience with organized religion. I must say, though, that having had close relationships with ethicists has brought me into contact with theologians for whom I have great respect, but that does not change my thinking about the existence of God.
I certainly don’t think there’s a God in heaven, sitting up there in the clouds. But I do ponder how it all began. I’m sure that there’s a primal force of some sort. In the beginning, there was energy, that’s all there was. And energy became matter. That’s the way I look at things. The necessities propel us inexorably along the evolutionary path.
And being a biologist, I think of death as a part of life. I don’t believe there’s an afterlife. I think things just stop. I’m not afraid of death. Unless I’m suffering with some horrible, painful disease, I’ll accept it. Of course, I can’t guarantee that.
Even if “things just stop,” a life’s work lives well beyond the life itself. And so does the world’s memory of us. How would Art Galston want to be remembered?
I’d like to be thought of as a dedicated and able teacher who advanced knowledge of his field, a man with the courage to espouse unpopular points of view.
I surprised myself by my willingness to stick my neck out. I’d like to be remembered as somebody with a little guts, who stood up for what he believed in and was willing to pay the price it sometimes cost me. Everything has its costs.
As I think back on Art Galston’s saying those words, surrounded in his small apartment by the books most important to him and the mementos of a life dedicated to science and the rights of those whose spokesman he has often been, it is the word “costs” that forces itself forward into my reflections. What is its meaning in the pursuit of a rewarding old age? The fact is that we have a choice in whether or not to pay those costs, especially when they must be paid in advance. It costs us to prepare for aging when we are in our forties and fifties and would rather not think about it—so sure that our bodies are still running pretty well without much upkeep. It costs us when we are in our sixties and seventies and beyond and we must scrupulously carry out the maintenance that allows what we hope for. And it costs us most dearly of all when there is crippling sickness to contend with, and a long and demanding road back that must be traveled. But in fact, it costs only in the same way in which an investment costs. We may sacrifice time and energy and perhaps some other variety of capital during the period when the necessary work is being done, but value is constantly accruing and the ultimate returns come in the form of the invaluable gifts deriving from all we have done to earn them.
When the Preacher of Ecclesiastes enjoined his listeners to “cast thy bread upon the waters; and it will return ere many a day,” he was departing from the generally grim and pessimistic tone of his philosophy in order to shine a small but very strong light on the necessity to think of the future, for it will come all too soon. “There is a time to plant,” he admonishes us, and if we choose not to plant, we will never earn the dividends that brighten the “time to pluck up that which is planted.” And that, ultimately, is the message to be read in the lives of Miriam Gabler, Pete Barker, Patricia Neal, Hurey Coleman, and Art Galston: Making the right choice pays off; the fortitude pays off, no matter its difficulty. The hard work is an investment; the overcoming is the triumph; and the years of contentment and contribution—the years of plucking up—are the reward not only for ourselves, but for everyone to whose lives our lives contribute.
A FRIENDSHIP IN LETTERS
The companionable hike, the long lunch, and the rambling bull session are powerful inducements to thought, and they help produce staunch contributions to a book as it is being written. To write about aging requires not only the study and experiences of a lifetime, but of the lifetimes of other men and women as well, whether they are learned authorities or merely those accompanying us on the long journey from birth to the grave. When that other, shorter journey—the writing of a book—is interrupted to allow the author to rest and reflect, it must be done on the three-legged stool of facts, knowledge, and, one can only hope, accumulating wisdom. Each of the three is distinct from the other two; none of the three can be omitted without destabilizing the traveler in his ruminations.
Throughout the development of this book, one of the sources of all three ingredients of my reflection has been a colleague of some four decades, Dr. Leo Cooney, who founded and continues to direct the Section of Geriatrics at the Yale School of Medicine and its affiliated hospital, Yale-New Haven. He is not one of the companions with whom I have hiked or lunched, but I have relied on our bull sessions as a bulwark against error and as a fountainhead for the getting of wisdom. I have depended on his counsel since writing the section on aging in How We Die fifteen years ago, and he continues to add to my understanding of the issues with which I am grappling as these pages evolve. In the field of geriatrics especially, vast experience is needed if facts are to be transformed into knowledge, and knowledge into any degree of wisdom. I have learned nothing so well from Leo Cooney as I have the importance for aging men and women of the interconnection between their lives and the lives of others.
The supremacy of that concept over other factors in successful aging is epitomized in something Leo said while we were one day discussing those many studies demonstrating the importance of exercise in maintaining vigor of body and outlook. “But e
xercise is not the Holy Grail,” he pointed out. “If there’s a Holy Grail, it’s relationships with other people. In fact, if you have to decide between going to the gym or being with your grandchildren, I’d choose the grandchildren.”
This led into a discussion of the need for each older man and woman to maintain a significant role as a distinctive individual within his or her familial and social encirclement—to have purpose, to have value, to have dignity—not only in self-perception but in fact as well. Those who are younger owe this much to their elders; those who are older owe it to those who are younger that they live in such a way as to merit being valued. Always, it gets back to contributing to the lives of others. Always, there is a mutuality in it.
Had I ever any doubts about these notions—and I never have—they would have been dispelled by a series of letters in which I became engaged in 1994, about six months after the publication of How We Die. In that book, I wrote of the depression so often suffered by older people, and of the increased rate of suicide caused by it. According to a 2005 census report, approximately 20 percent of the aged are reported to be clinically depressed at any given time, and the actual figure is probably higher, because so many do not seek treatment. Ruminating on suicide is frequent among the elderly, and the actual act would no doubt be more common if means of achieving it were easier to access. It was about access and means that a woman wrote to me from an address in Madison, Wisconsin, in early July 1994. Her letter was handwritten in a neat, easy-to-read penmanship on sheets of lined yellow paper torn from a legal pad. After a few comments about the book, she closed her first paragraph with a sentence telling why she had written: “There is an important matter on which I seek your opinion. No, it would be guidance.” And then she described herself.
I am Indian, a widow, seventy-three years old. I spend a few months every year in India, and the rest of the time in Singapore, with my only son, who lives there with his wife. I have two granddaughters. One is studying in the U.K., the other is doing research in biochemistry in Wisconsin. I am now in Wisconsin for a month. I return to Singapore on the 22nd of this month.
And then, the crux of the matter.
It is about dying when one has lived a full life with both happy and sad experiences and feels that the capacity of enjoying life is slowly ebbing away due to old age, should not one end one’s life? I think that would be a happy ending. My vision is badly impaired. I cannot see in one eye, in the other a very limited angle of vision. When I go out, I have to depend on somebody else most of the time. My hearing is failing also. The doctor said it was due to weakness of the auditory nerves. I cannot move at a fast pace. This is degeneration due to old age. I am going the path of your grandmother [whose acceleration into beginning senility and her death at ninety-six I had described in the book]. I fully realize how she felt. There is nothing wrong with my health otherwise. I feel it is time I should die. That is, I should end my life myself. I don’t want anyone to know about it. It needs to be done secretly or it would cause pain to others. What is the easiest way to do it secretly by one’s own hands?
Oh, Dr. Nuland, I know it is foolish of me to write in this way and it is likely that you will ignore this letter. I will understand. But I also have a faint hope that you may show me a way out of the future that I would not like to face.
Yours sincerely,
Ruby Chatterjee
How should such a letter be answered? Which of Mrs. Chatterjee’s inner forces could be called on to change her mind and mitigate her wish to die? Clearly, every sentence of my response would have to be wrought with care, in order to transmit not only my genuine concern for her but also the message that her life had value though her single-mindedness was preventing her from perceiving it. I wrote back hoping to find an untapped vein of hidden optimism buried within the despondency that might still be seeking a solution to her despair. I chose to think of her letter not as a cry for help in self-destruction, but as a cry for help to establish a connection with another person, who might understand and suggest a way out. I responded several days later.
Dear Mrs. Chatterjee,
Your very eloquent and moving letter has touched me in important ways. I hope that I can respond properly to it, and help you to understand the importance of your life as it is at the present time.
Sometimes, Mrs. Chatterjee, it is necessary that we live for others. Yes, it is true that the various incapacities that are taking hold of your body are due to the gradual changes of age. However, it is also perfectly obvious that you do not have any major disease process that is likely to cause you a great deal of suffering, at least not in the foreseeable future. As you describe your son and your granddaughters, and as I have seen Indian families who are friends of mine, I recognize the enormous importance that you, without doubt, fulfill in their lives. I cannot, with any conscience, suggest that as basically healthy a person as you, whose mind is clear enough to write such a beautiful letter, should even consider taking her own life.
You must live for the sake of those who love you, because they need you. They need not only the reassurance of your physical presence on this earth, but they need your wisdom as well, in ways that you may not really appreciate. I would have been devastated had my grandmother taken her own life in her mid-seventies, and it would have had a profound effect on my ability to face the future. What can I do to encourage you to think optimistically, with the assurance of how important you are to those few people who really matter in our lives, the few that surround us in the loving circle of a family and close friends?
Please think of the things I have said, and remember that your humanity and your life are a gift that you are giving. Also, please understand that I am telling you these things from a great deal of experience in such situations, as I have watched them develop over many years. You must believe me, and you must also believe in yourself.
Mrs. Chatterjee’s response was dated five days later. It was only a single paragraph long, but its six sentences gave me some optimism that she had understood. The letter ended with words I had only hoped for: “How can I not believe you? I shall do as you say. Thank you very, very much.”
I thought the exchange was over, and felt relieved that such a difficult problem had been resolved this way. But months or perhaps years of morbid thinking on debility and death are not dispersed with a single letter. Three weeks later, Mrs. Chatterjee wrote me from her son’s home in Singapore.
If I were your patient in any kind of illness, my illness would just linger on because I would want you at my bedside explaining the truths of life.
You have said one should live for others. That is indeed the essence of happiness and peace…. But in real life there are some difficulties. Truly speaking, in my condition there is little that I could give to benefit any other person. When I was young, I could—and I enjoyed giving of myself. My husband was of poor health; shouldering the responsibility of running the household and bringing up my son was all mine. Although a bit of a struggle, it did not really weary me. My husband was bedridden for four years before he died five years ago. It was in India. It seems very far behind. All I do now is tend the garden and water the plants and occasionally cook some dish that does not always turn out a success. I read quite a lot and sometimes sew, which is for my own satisfaction. As time passes I will be a burden to myself and also to those who care for me. I wish I could spare them this distress. In the midst of these disheartening thoughts life still offers some joyful moments.
Your book and your letter reach deep into the mind and I cannot turn aside the message that one has to face the inevitable in the best way possible. I have been just rambling on, please forgive me.
I had to be sure that there would be no reconsidering, no backsliding into the disheartened torpor that sought relief in death. I replied with much the same message as in my earlier letter:
Dear Mrs. Chatterjee,
I was very pleased to receive your letter, and to note that you are now safely back in Singapore.
Of course we are all (healthy, aged, and every category) a burden to others, but we are also a burden that carries with it sweetness and love. Such burdens are a joy, and we should therefore rejoice in falling into that lovely pattern.
You have said in your letter that if you were my patient in any kind of illness, your illness would linger on because you would want me at your side. Please think of me exactly that way. There are those who think of life as an illness. It’s a very mild illness, in fact, but it does require a certain amount of doctoring, which we should accept from those we love and those who become our friends.
Please remember these things.
In response to this, I received a letter containing a new and worrisomely unrealistic element in Mrs. Chatterjee’s argument: Why not seek death at a moment of ineffable happiness, so that such an instant would somehow be forever part of one’s eternal existence?