The Art of Aging

by Sherwin B Nuland

  She wrote:

  I had this feeling once when in Nepal among the Himalayan mountains. From a particular point one could see the highest snow-clad peaks on a sunny day. Well, the fog had lifted and there were the mountains in their sublime beauty. The sight was breathtaking. I felt I had to capture this moment forever. I wanted to die at that moment so it would never escape me. You have not written of this aspect of death. At our happiest moments we wish to die so that happiness is forever. For those who die in such circumstances, should we judge them harshly? Provided, of course, that there are no duties left undone, no promises unfulfilled. I have to wonder if there is something wrong with my reasoning, my mind. Is it that mild illness in life which you have referred to in your letter?

  Following on this, Mrs. Chatterjee returned to her earlier concerns.

  In cases of taking one’s life you have mentioned [in How We Die] cases where one is crippled or in pain when there is no relief. This is justified. But the knowledge that one is on the way to being crippled, is that not enough? What is the use of prolonging increasing pain and an accompanying sense of insecurity! Better to put a stop to it while one can do it without having to depend on anyone else.

  Dr. Nuland, most of the questions that I bring up are probably very odd and do not concern most people. But I cannot help thinking of these. I don’t know what else to say.

  Of course, not only was this last concern of Mrs. Chatterjee’s not odd, but it is, in fact, the stuff of anguish for so many people with progressive diseases of a neurological or other nature who foresee the inevitable debilitation and wish to ward it off by taking their own lives while they still can. It was important to respond to both of the issues that had been raised in this letter.

  I apologize for not having written in response to your last, and very interesting, letter. The obligations associated with How We Die have once more quickly expanded and I have been traveling quite a bit, including a week out of the country.

  Nevertheless, I think your fascinating question is answered without difficulty. We must never make decisions based upon an impulse of the moment, even when the impulse is based upon evidence of transcendent beauty. Decisions about irrevocable acts such as death are to be made after much concentration, thought, and philosophical cogitation, as we both know.

  Also, I question whether any of us have “no duties left undone, no promises unfulfilled,” the conditions that you make the proviso for death under happy circumstances.

  Again, I will urge you to think carefully about what I have said, because I know you give a great deal of consideration to the problems we have discussed, and approach them with the kind of maturity we all seek for ourselves.

  Sincerely your friend,

  Sherwin Nuland

  But my correspondent was not easily convinced. Though she was willing to agree with my objections to seeking death at moments of transcendence (“reading your comments on dying happy with no promises unfulfilled, etc., I felt quite foolish and rather ashamed of myself”), her next letter returned to a theme I thought had already been settled.

  I was reading your previous letter in which you said yes we are all burdens to others but a burden that carries with it sweetness and love. But I have known cases where the family members really feel the weight of the burden and it is a relief when the old parent breathes his last. And people don’t have very much time to sorrow for the departed. It is accepted in a very realistic way. Only when death comes early and unexpected is the grief intense and prolonged. I think it would be very sensible for aged people who have lived a full life to end their lives if they wished to, and feel it would not affect any person adversely to an appreciable extent. There will always be some sorrowing on the part of the loved ones, but that is expected and may be treated as a normal occurrence. I am sure there are many aged people who will gladly want to make their final exit….

  I feel very much that society should make some provision allowing the aged to end their lives if they so wish. There should be no stigma attached to it. My life is my own and I am free to do what I want with it as I would do with the material goods that I own.

  Soon after, following five months of such correspondence, I was able to reply with a letter that I believed would finally succeed in putting to rest the greater portion of Mrs. Chatterjee’s determination to do away with herself. By then, she was back at her own home in Calcutta.

  I’m afraid that I can’t agree with you when you say, “My life is my own and I am free to do what I want with it as I would do with the material goods that I own.” You will have to admit that comparing your life with your material goods is hardly much of an analogy. Life is precious, a gift of extraordinary value which has been given to us and which we in turn give to others, and not to be compared to inanimate goods. I certainly don’t believe that our lives belong only to ourselves, and you know how I feel about this particular matter. Once we have formed relationships, our lives become of great importance to others. Their manner of mourning and external manifestations of grief or lack of it often bear no relation to the deep wound that they may be unconsciously submerging. The mind has peculiar mechanisms to cover up injuries to its integrity and strength. I believe a decision to die is a decision that cannot be made without its being shared with those who do love us. It is also, in a sense, a community decision as well. Unchallenged, many people might wish to die, but after a reasonable communion with those who care about us, those decisions are often seen to be grievously selfish, and I don’t think that’s too strong a word.

  I do agree that on rare occasions (in my experience it has been very, very rare) there is a reason to end one’s life, but that must be a reason that is defensible to those whose lives are part of ours. I don’t see anything about your physical or emotional state that makes such a decision at all valid. As long as you can keep writing to me in that clear lovely handwriting of yours, with the depth of thought and emotion that you transmit, you are a woman who is very much a part of this world and makes contributions to it that are beyond your own ability to appreciate.

  Please believe me.

  The response to this letter came from Delhi, nearly a thousand miles northwest of Mrs. Chatterjee’s home in Calcutta, where she had been for about a month, following her time with her son. She was planning to spend almost two months visiting her niece in that distant city before once more returning home. Though her letter did say that she had “been stupid and selfish in my attitude to life,” it contained nothing else in response to what I had written. But she did report the surprising news that her son, Rames, was to be transferred to Connecticut from his job with Black & Decker in Singapore. “He expects me to spend the summer months at least in Connecticut…. Could I hope to meet you when I am in Connecticut?”

  Any expectation that my letter had resulted in my having achieved the objective of turning Mrs. Chatterjee’s thoughts toward the value of her continued life was dashed by a later communication I received on March 16, 1995. But there was now reason for cautious optimism. Though my correspondent chose to only obliquely address my arguments, her writing now began to take an unanticipated but, to me, a more hopeful turn. She continued to write about her worsening disabilities, but absent was any mention of the wish to take active measures that would soon end her life. And though continuing her formality of “Dear Dr. Nuland” in the salutation and “Yours sincerely, Ruby Chatterjee” in the conclusion, the body of her next letter spoke of the nickname I have had since early childhood, which she knew from reading How We Die.

  Dear Dr. Nuland,

  I am always writing to you pouring out my woes. Perhaps I should restrain myself in this matter…. I often think about you as Shep, not always Dr. Nuland. You are the only person to whom I can speak without any inhibitions. I know I keep harping on the same theme most of the time. But what else can I do? I can feel age increasing its hold on me slowly and relentlessly. My eyesight is getting weaker, my movements are extremely slow. Walking for more than fifteen minutes conti
nuously is very painful…. I wish I could speed up this process so I can cross the threshold of one of the thousand doors in no time. [The epigraph to How We Die is a quotation from John Webster’s The Duchess of Malfi: “…death hath ten thousand several doors / For men to take their exits.”] There were some people whose death affected me in the sense that I lost a valuable friend. But that does not mean that I expected them to live to an age where life would mean nothing to them. The time comes for each of us. I would expect my family to accept the inevitable in a realistic way. I have decided that when I become seriously ill I will refuse all medical treatment. That would hasten the end. I know I am selfish. I don’t want to die bedridden. But I also want to spare my family the pain of watching me sliding slowly down.

  Another surprise awaited me in the next paragraph. This seventy-three-year-old woman, already much limited in her activities and facing what she thought was worsening so imminent that she had had to be convinced not to end her life only nine months earlier, had not only traveled alone from Singapore to Calcutta and then from Calcutta to Delhi and back, but was planning an extended trip abroad, to a place almost 6,000 miles from her home.

  I will be going to Nigeria in late April. It may be for three or four weeks. My friends there have been wanting me to visit them for a long time. They are a very nice couple—about the same age as my son and daughter-in-law. I know, of course, that in my physical condition I will miss most of the sights and sounds that make Africa a very special place. But what I can take in is enough to keep me happy.

  But perhaps she would miss much less than she’d expected. In a letter of April 5, the day of her departure, she wrote:

  I am leaving for Africa today. My first stop will be at Delhi. Then it will be to Nairobi by Kenyan Airlines. It is possible that I will have an opportunity to see the wildlife there, as I will be in Nairobi for three or four days.

  The opportunity came to fruition in the form of a safari in the national park. There is no indication of the form of transportation, but I assume it to have been motorized; even in my wildest hopefulness, I could not imagine Mrs. Chatterjee on an elephant. The tone of the letter conveyed the excitement being felt by Ruby, as my correspondent was now signing herself, no doubt because I had called myself Shep in the previous letter. So we had now progressed from Mrs. Chatterjee and Dr. Nuland to Ruby and Shep. I began to feel like a rescue worker talking down a potential suicide from the ledge of a high window.

  And there were elephants, lions, giraffe, zebra, and what-not! The giraffe are really graceful animals, Nigeria has not much of game resources. It is more noted for its art and culture and music. The drums and stringed instruments are very interesting. There is a twenty-one-stringed instrument called the “kora.” There are flutes also, made from millet stalks, bamboo, gourds, as well as animal tusk horns.

  Reading these words, I could not help thinking about the memorable aphorism of the English novelist Charles Kingsley: “All we need to make us really happy is something to be enthusiastic about.” Often, but unfortunately not always, all we need to drive away or at least to mitigate depressive thoughts is to know that a moment of happiness is on the horizon.

  Another letter from Lagos three weeks later was filled with further interesting comments about Nigeria, its great game parks, its culture, and its people. Clearly, Ruby had done quite a bit of traveling within the country, and she made observations far keener than I might have expected from the dejected woman who had first written to me the previous summer. Though she had traveled to Lagos with a companion of her own age, she returned home by herself. The long and complex journey seemed not to have fazed her. In a letter from Calcutta dated June 7, she wrote:

  I arrived here last week. It took me five days going through many airports, changing flights, to reach Calcutta. And I was on my own. The lady who was with me when going to Lagos stayed back there. Do you know, Shep, I can face the unknown now with much more courage than I could before.

  She was to leave for Singapore in two weeks, stay there for a few days, and then proceed to Madison, for a visit with her granddaughter. Then on July 20 she would board another plane to the airport in Hartford, Connecticut, where her son would pick her up and take her to his home, “at a place called Woodbridge or something like that. They say it is near New Haven.”

  A stretch of the eastern border of Woodbridge forms part of the western border of the town where I live. Rames Chatterjee had bought a house exactly eleven miles from my home. Wonder of wonders—Ruby and I would soon meet.

  It would not be entirely accurate to say that I had mixed emotions about the imminent arrival on my doorstep of a woman with whom I had formed such a close epistolary bond. The fact is that I desperately did not want to meet Ruby Chatterjee. To be in her actual presence would be to lose the geographical remoteness, the unlikelihood of direct contact, that until then had enabled the intimacy of our relationship, to which I might have hesitated to commit myself had I so much as suspected that we would ever find ourselves in the same room. To me, the impossibility of physical closeness was an essential ingredient of the emotional closeness we had achieved.

  My wife, Sarah, felt no better about it than I did. Her main concern was intrusion. She was well aware that I had not learned that a surgeon’s sense of obligation to make himself accessible to everyone who might need him is precisely the opposite of the necessary privacy a writer must guard if he is to get anything done. Answering every letter and lingering with strangers on the telephone is conducive neither to efficient working habits nor, and more important, to the freedom of time for a close family life. Sarah had come to accept the writing of many letters, but what was in her view the invasion of her home was intolerable. She urged me to tell Ruby that I could not meet with her.

  For days, the two of us went round and round on this issue, our discussions made more difficult by the fact that Sarah had, appropriately, not read the correspondence and accordingly had no real notion of my concern that a rebuff might lead to a setback in Ruby’s gradual coming to accept the reasoning in my letters. And there was the additional fact that my correspondent had written several times expressing her anticipation and excitement that we would soon meet. I received a series of her letters, first from Wisconsin and then from Woodbridge. I would respond each time with evasive vaguenesses, as in a note I sent to her in Madison: “I have been away a great deal of the time, in addition to having just moved into a new home. Things are rather up in the air just now, but perhaps they will eventually settle down. You will remember that we began our correspondence when you were in Madison, and that alone should be a cheering thought.” The evasiveness was not lost on her: “You write that Madison should have cheering thoughts for me as it was here that our correspondence started. Will it also be ending here? I suppose I should take a realistic view of the matter as all things, however good, come to an end at one time.” Having said that, however, she then made it clear in the next paragraph that she would not be denied. “I hope things will settle down before long. Can we then get together?” It was now becoming a struggle between my determination to find a way out and her persistence.

  Ruby’s next letter had a Woodbridge postmark. She was now coming closer, literally and figuratively. Because I was still putting her off with claims, not entirely unjustified, of being very busy, she was now asking whether she could phone, and even suggested that I stop by if I happened to be visiting a friend whom I had unwisely told her lived on the same road as Rames. Both Rames and Ratna were busy with work and other obligations, so, Ruby said, “here I have nothing to do and I have enough time at my disposal.” My guilt at disappointing her was gradually mounting, but a new, or rather a revisited, element was now creeping into her thoughts. “Connecticut is a lovely place. To give you my first impressions in coming here, I have to go back to the subject of death. Looking at the green wooded areas stretching out at the back of the house, I thought—this is the place to die, to lie under the cool shade of maples and oaks and rest in
peace.”

  My unease with the thought of meeting Ruby was giving way to concern about the tenor of her thoughts, and I quickly scribbled a message across a sheet of office stationery and got it into the mail: “Call anytime. Sorry for the scrawl, but it’s the only way I could answer quickly.”

  Ruby did not, in fact, call. Or if she did, I never knew of it. I guessed that she was hesitant to take that step, in view of what was not difficult to interpret as my ongoing reluctance to a meeting. But there was a poignancy in her next letter that overcame my foot-dragging and even Sarah’s previously adamant refusal to extend an invitation.

  You are so close—only twenty minutes away, yet I cannot reach you, such is the irony of Fate. After crossing more than half of the world to come here and hoping to see you, here I am sitting helpless, not knowing when I will be able to see you. I came for a four-month stay and already nearly two months have passed so quickly. This feeling of helplessness stems from aging. I just have to accept it, and the maples and oaks are there for me to rest in their shade. No, I am not thinking of dying.

  A four-month stay! I had thought I would need to wait Ruby out for only about six weeks, and had been successful in that strategy. Four months, though, was beyond my capacity to keep delaying. But of even more consequence to my decision was the thought of the pain I was causing this increasingly disheartened and emotionally frail elderly woman to whom I had become so attached. She had in so many ways become my friend, someone about whom I cared deeply. And yet here I was, behaving as though the only thing of concern to me was my own privacy, and the notion that our relationship required distance if it was to continue to be valued by both of us. In view of the entire emerging picture of the forlorn, dispirited Ruby vainly seeking consolation from her lonely despondency under a Woodbridge tree only eleven miles from me, and the forlorn, guilt-ridden me vainly seeking expiation for my growing guilt, my decisions up to this point were more and more appearing to have been ill-advised. I showed this last letter to Sarah, and she immediately agreed that the time had come to change her mind.