I don’t want to end up simply having visited this world.
—Mary Oliver1
69. Have You Conquered Your Fear of Getting Old and Dying?
WE’VE SPENT A LONG TIME TALKING about health, but we mustn’t forget that integral to the process of life are sickness, pain, and death itself. It’s not skillful in the least to pretend, as I’ve seen many of my patients do, that death doesn’t exist, or that somehow you’re exempt. Living with a consciousness—not to say an obsession or other form of neurosis—about death improves life and health. In fact, according to the eminent philosopher Jean-Paul Sartre, “It is only when we are aroused by our own deaths that the potential of our lives will become known to us.”2
But it’s important to note that you needn’t—you shouldn’t—wait until you’re about to die to make your life worth living, to make it a “good day to die,” as we’ve previously discussed. I’m afraid I learned this lesson the hard way, but I’m grateful now that I did. It’s a painful story to recount, and a very personal one.
When I was twenty, a junior in college, I was spending the weekend away at my family’s country home in upstate New York with one of my best friends, Brad, and his girlfriend, Suzy, as well as my first love, Mindy, the woman I believed would one day become my wife. While driving along a winding country road on a balmy summer day, our axle snapped, and the car flipped over numerous times. Mindy and Brad were killed instantly, and Suzy was horribly injured. Somehow, perhaps because I was the driver and had the steering wheel to hold on to, I walked away from the accident unscathed. However, the crash ripped my world apart. There I was one second with the windows down feeling the warm afternoon breeze beside the girl I loved, at the very height of my youth and hope—and one second later, it was all tumbling over the asphalt, landing in a heap of torn metal, glass, and the blood of the people I loved.
In an instant, I became profoundly conscious that I’d taken it all for granted. I realized I’d been living like one of those mythological princes I enjoyed reading about as a child—like Percival, maybe, from the King Arthur legends—a little prince forced out into the dark wood. And now, as I watched strangers cover Mindy with a sheet on the side of the road, I knew some cruel power beyond me had torn me from my fairy-tale childhood forever. It was already a mystery to me, seeming as dim and distant as that primordial forest. This—the hot pavement, the sirens, and the stench of gasoline—was the “real world” of which I’d heard my parents gently warn, a very mean place where love lies bleeding.
Chalk it up to youth or immaturity or the mind’s inbuilt defense mechanism, but I was able somehow to shift my focus away from the awful loss, and on to more practical concerns. This is perhaps more common than you might think, I’d later learn. After the accident, I turned my attention to completing college and getting into medical school, which as you can imagine, takes particular discipline and hard work. Everyone said I was “well-adjusted, considering.” I might have even believed it. After medical school, I started my residency at a prestigious medical center in New York City, and immediately following that became the training director of the program I had just completed. I was on the fast track. I was certainly a “survivor.”
However, I found something amiss when I looked in the mirror: my heart was broken. I could picture it there, on the side of a Catskill highway still, where I left Mindy and Brad, who would never wear caps and gowns or get advanced degrees framed, who would never wear wedding rings or see their own children smile for the first time.
I was beginning to grasp in retrospect that I subconsciously chose medicine for a reason. And that medicine, too, was in a similar state, heartless and bereft. And as I began to inventory our parallel conditions, I realized with some horror that I’d accepted this state of darkness and incompleteness, both personally and professionally. Ostensibly, it was a successful career and life, but for me, it was a kind of self-imposed exile. I saw that I’d continued to pursue this, my childhood ambition, at least partially as a result of the guilt I experienced, feeling responsible for the lost lives of my friends. Perhaps on the plus side, the accident compelled me further into medicine, and a desire to save lives and heal hurts. But for more than twenty years, I lived in the shadow, not feeling worthy of coming into the light.
But, I did wake up with the recognition that my condition was compromising my new, even more important, role as a father. I worked especially hard to let go of all excess emotional baggage and transform any residual negative energy into something more positive, creative, and hopeful. I opened myself to the assistance of those who offered it—which wasn’t easy. Doctors are notoriously bad at seeking help. And so are victims of survivor’s guilt.
The gradual integration of my professional and personal life resulted in a more whole individual, and my path toward the light became clearer as I got a better glimpse of my life’s purpose. I returned my focus to serving others, but knew I had to take care of myself to accomplish that. In order to truly take care of myself, I had to let go of much of my attachment to Mindy’s and Brad’s lives and the circumstances of their tragic deaths. I had to understand that people die, they move on, and as they do, they give us the gift not only of everything they taught us and shared with us, but something more profound, almost holy: they give us a renewed gratitude for our own breath, our senses, our time on earth. They remind us that our time is finite, but the resources we can draw on during that time are all but boundless. While my marriage didn’t survive the fallout, my children are precious reminders of the potential for resurrection, and now I’m in love with the woman with whom once again I expect to spend the rest of my life. I’m no longer stunned and heartless at the side of that road, because I willed myself to turn and walk back into my life—because they loved me, and that’s what they wanted me to do. And as I did, it felt as if they both climbed out of that wreck and brushed themselves off and, together, went the other way with equal hope.
I don’t know exactly where they went, but I know it was a good place. And as I emerged from that darkness, and drew closer to my true calling, it was a good place for me, too. The universe conspired to bring information and people and resources my way. Indeed, as I began to write this book, the stories of the individuals I’ve included in the text came one by one, often in sequence, almost as if I was being channeled with the appropriate experiences to illustrate.
I don’t want to dwell on the agony of that crash scene. But I want us to remember that such “accidents” leave an indelible impression: they remind us of the certainty that life can and often does change in an instant, a flash, the blink of an eye. More than twenty years after the accident, I was introduced to the philosophy of Tibetan Buddhism, which stresses this same lesson. Buddhists maintain that while it might remain impossible to be certain about what happens after we die, there are only two realistic possibilities:
1.Either some part of us continues in some kind of afterlife; or
2.Nothing.
Therefore, Buddhists believe, quite pragmatically, that we should at least prepare for the possibility of Number 1. Something might happen in the afterlife. At worst, it’s a 50/50 proposition. Sounds reasonable to me. Because if we assume there’s nothing waiting for us, we might become more prone to lapse into a nihilistic existence, and give up caring about what we do and where we’re going. We might wind up treating others and the place we all live like crap. This is not a “religious” chapter. But don’t we have a shitload to lose if we choose wrongly, if we miss the point?
Indeed, I’ve seen this play out. As a practicing physician, I’ve been with people in those profound and meaningful moments right before death, hearing their last wishes and their final regrets. This experience, coupled with the accident that altered my life, compelled me to start living every day to its fullest and to teach others to do the same. So, in a way that might seem weird to you, but makes perfect sense to me, I’ve written this book with as much attention to your dying as your living—because they’re one and the same if you consider them skillfully. Certainly, to deny the lessons in death by turning away is to give up the potential of life.
It hasn’t always been easy for me to take this path, for me to help people understand the yin/yang nature of life and death. It required a lot of effort at first. Basically, I had to learn to express myself with even deeper compassion and empathy. I had to summon a great deal of tenderness and a delicate hand to connect to people when they were the most raw and anxious. I proudly confess I eschewed the advice I received in medical school to remain dispassionate and emotionally detached from sick and dying patients. I wept with my patients. I prayed with them. I laughed out loud. I still feel these patients’ living presence and vital life force, which were so obvious to me when they were alive, lingering in my consciousness, having become, in some way, part of me, the same way I carry part of Mindy and Brad so many decades later. And some of them, like a patient named Steven, had such a momentous impact on my life that they fundamentally changed me as Mindy and Brad did.
As if on cue, Steven came into my life as I sat down to write this chapter, reaffirming how critical it is to live fully with every breath. More so, Steven proved to me that this process can work, that there is always hope, and until our last breath, joy can happen and healing can occur.
STEVEN’S FINAL CHAPTER
Steven’s session began the way I start all my sessions, with the question, “What brings you here?”
And his answer was typical in many ways: “I have metastatic cancer, and I’m looking for something beyond conventional medicine to help me.”
Steven was seventy-one, a domineering presence, a man who liked to maintain as much “control” over his life as possible. His considerable affluence allowed him to hire people to do his bidding. By his own admission, he was demanding, difficult to deal with, and nearly impossible to please. He often made the people around him feel they were never doing enough to meet his needs. I admit there were times I empathized with those people. Several of my fellow doctors had booted Steven from their care because of his demanding ways and unremitting self-destructive behavior. But I appreciated that there was more to him than what was on the surface, and I was willing to take him as he came.
Naturally, Steven tried to exercise the same dominion over his illness and impending death as he did over every other part of his life. While it was clear that he was not afraid to die in theory, he wasn’t exactly keen on the gruesome particulars of the dying process itself, which, for him, represented the ultimate loss of his (illusory but all-important) control. So, he kept his focus on living, which was a good thing: he did everything possible to feel alive, every day he could. He could have hired a chauffeur but insisted on driving his own car. He got out of bed each morning and dressed himself, even when this and other mundane tasks that he used to take for granted became more and more difficult. He spoke of his desire to travel and shared his fantasies of making love to women again. It moved me that Steven never lost sight of living, though he was certainly coming closer and closer to death. Through it all it seemed that Steven wanted to heal his life—to become whole—before he died. I agreed to help him with this most noble and profound mission, even as I assisted with ways to ease his physical pain and stave off some of the ravages of his disease.
The details of Steven’s illness revealed that his condition was rooted in his liver, the organ most associated with anger in many traditions, which was riddled with metastatic cancer (on top of his alcoholic cirrhosis). He had pages and pages of notes, in fact two giant loose-leaf binders filled with medical documentation, part of his efforts to control the illness. I mostly listened for the three hours it took him to review the history. But after all that time I responded with one simple question: “Steven,” I said, “what are you so pissed off about?”
He was taken aback, I could tell, surprised by the “un-medical”-sounding question. But I could see he was holding back tears; my question had hit the mark. It seems that ten years earlier, Steven’s ex-wife got a court order barring him from seeing his only child. The boy was now nineteen and had virtually no relationship with his father. Needless to say, Steven was extremely bitter, and very hurt. Yes, I needed to help Steven deal with the practical, “conventional” medical matters, and suggested some complementary treatments. But I also knew that in order to heal, he had to address his anger, which was literally killing him. He had no ambivalence about how essential that was, and I found him open to everything I offered.
I wound up seeing Steven every week for about a year. We went through the questions I outline in this book. We spoke of many profound things, the meaning of life and suffering chief among them. He began to resolve for himself one issue at a time. In an interesting way, Steven certainly embraced the idea that he was going to die. He planned his memorial service down to the finest detail, going so far as to compile a list of seven or eight people who would offer eulogies and writing explicit instructions for the orange ribbons he wanted distributed to the guests. He arranged the bagpipe processional, the music, the hymns he wished the mourners to sing. It was as though he wanted to really experience that service, and he got genuine joy, contentment, and peace from “playing it out” in his mind.
But he was still alive. And while he was alive, he vowed to tackle one challenged relationship at a time, calling on forgotten friends and even reaching out to some old nemeses for reconciliation. He really made a point of tying up loose ends. I admired him for that, and helped him whenever I could. Steven was a man on a mission, and was visibly excited as he completed each task. I was honored to be part of that process.
But throughout our time together, his relationship with his estranged ex-wife and their son remained very much “unresolved,” to put it clinically. Really, it was full of pain and regret. After we discussed this subject over a period of many months, Steven finally realized that the person with whom he was most angry was himself. Out of respect for his family’s privacy, I won’t tell you exactly why he was so angry at himself; it doesn’t matter, really. All that matters is that as he came to this new level of awareness, he began to sense a deep course of healing unfolding in front of him. Though he had called both his ex-wife and son on many occasions, the conversations never went very far, typically ending in acrimony and hurt feelings. It was unclear whether they would ever forgive Steven for the slights they perceived, and he admitted it would be difficult for him to ever forgive his ex-wife for alienating his son from him. As he ruminated over the state of these relationships, his intense feelings and anger percolated, and, not surprisingly, his medical condition deteriorated. This is important: you often have to walk through the jungle to get to the waterfall. Steven was persistent and persevered.
Over the next several months, Steven reached out to his son more often, and with (what I believe was) greater and greater humility. There was a softening of their relationship and a developing rapport. Most interestingly, results from CT scans showed a coincident improvement and partial resolution of many of the tumors, even though he was no longer receiving any conventional medical therapy. Steven was noticeably stronger, getting out of bed more and dreaming once again of the ladies. He was more “present” in our sessions, and seemed more hopeful than at any time before.
Then, one day, his son called to say he was coming to visit! This was an incredible moment. I could sense the life returning to Steven. He immediately got on the phone and planned an excursion for the two of them to visit an old family friend in the Berkshires. He looked bright and animated. I was excited for both of them, and looked forward to hearing about their adventure when I returned from my own upcoming vacation. I had no reason to suspect that this would be the last time I would see Steven. He was as well as he had been for more than a year. Still, before I left that day, I was compelled to tell him how our professional relationship had become much more than a job for me, and he, much more than a mere patient. He had let me into his life in an intimate way, and this was an honor I didn’t take lightly. Then, as I started to say that I was looking forward to seeing him when I returned, he interrupted with a foreboding tone to say he wouldn’t be seeing me then. He was going to travel, he said, as he’d always wished. I had a peculiar premonition about that “travel.”
And so it came to pass. His day with his formerly estranged son was indeed an adventure, and we never did see each other again. Steven collapsed while walking up the stairs to his bedroom just after he returned home from that healing trip with his son. He died minutes later. His final act, I’m told, was pulling out the endotracheal tube that the EMS team had inserted in an attempt to “save” him: Steven was ready to die, and did just that, with a smile on his face and his son in the room.
I don’t tell this story to depress you—just the opposite! There are many uplifting and instructive lessons to be learned from Steven’s story. First of all, both Steven and I were interested in the sites of his physical ailments. His condition started in his lungs, which are associated in many traditions with the complementary emotions of grief and courage—and the practices of letting go and moving forward, as we discussed in the last chapter. The liver, where his cancer took hold, is primarily associated with the energy of spring and new life and the emotion of anger. Indeed, the greatest challenge for Steven was to let go of this terrible anger and hurt, his compulsion to control, and to gather enough courage to confront his demons so he could effectively transcend his condition, even while it took an inevitable toll on his physical body.
The second interesting thing about Steven’s story is how his body began healing as he started repairing his fractured relationships. So why did he die, and why wouldn’t we consider his death a failure? And why did his death come just after the moment where he finally let go of the worst pain of his life? The fact is, I believe Steven was at a high point when he died, and this is a story of success. He’d suffered a long time, but in a way, he chose to die while he was still fully alive, when he had, like those medieval knights I worshipped when I was a child, fulfilled his quest. His quest was for forgiveness. His holy grail was his lost son. He rediscovered that lost boy after a very long journey. And he opened his heart and shared it with him, and vice versa. And with his heart open, he became more alive on that last day of his life than he had been for many preceding years. I’m certain he intended to leave his son with a positive image of his father, so the young man could move forward unambiguously with his own life, knowing he had been loved and missed by his father. And that he was a man who, despite deep human flaws, was worthy of love and forgiveness. I never expected to know what they said to each other—that was between them—but I was sure that in that one day, they went so far toward healing that Steven was whole (i.e., healthy) when he died.
But it turns out, I did find out! Steven’s son gave the final eulogy for his father, which turned out to be a heartbreaking reminiscence of the day they spent together in the Berkshires. As I listened to Steven’s son tenderly describe his father’s delighted expression as they tried to evade security guards on the grounds of an old asylum onto which they had trespassed like boys, Steven came alive in my mind. I was struck with a profound sense that he was okay, that he had moved on now—in short, that he was in some kind of “heaven.” His son went on to say that he was so grateful that in the last week of his life, his father was able to let go of all the things that had interfered so awfully with their relationship. They had come full circle, he said; what had felt like “work” for his whole life was complete now, and they were both free.
Plutarch writes, “The measure of a man is the way he bears up under misfortune.” This to me is the most accurate way to measure the impact of Steven’s life and all our lives. We’re all going to have to deal with hardship and a measure of misery. Ultimately, we’re all going to succumb. Who will we be when we do that? What legacy do we wish to leave? What impact will we exert on the ones we love? How will they remember us? I’ve been to scores of my patients’ funerals and heard hundreds of eulogies. It’s led me to the conviction that to live a life worth living, you should consider “beginning with the end in mind,”3 as Stephen Covey proposes in The 7 Habits of Highly Effective People(“effective” and “skillful” are synonymous here): take a notebook and write out the eulogies you’d like to get from family, friends, and coworkers many years down the line when you die. Then go and live a life worthy of that high praise.
For me, I’d like people to say I was a skillful gardener. I sowed seeds in my personal and professional relationships that bore a lot of sweet and healthful fruit. I’m completely confident that what I offered Steven was life, and a connection to people, that extends today through his son. Steven made it through the jungle, transcended his past, and reached a new plateau, well beyond the limits of his physical condition. And, once again, his life touched mine and offered other lessons as well, concerning parents’ relationships with their children and our culture’s fear of aging. Let’s discuss those.
70. Are You Willing to Learn from Children?
A few years ago, I was driving my then nine-year-old son Benjamin to the airport to go see his grandparents. Because he tended to get anxious about traveling at that time, we left several hours before his flight was scheduled for takeoff. Looking back, it was an unreasonable amount of time—four hours!—and it was a mistake, perhaps, for me to give in and enable his anxiety. What if he was bored or started to fidget? What if the amount of time we had to wait actually contributed to his anxiety rather than allaying it?
It turned out that because we arrived at the airport so early, he was a lot less anxious than usual, and that immediately put his daddy at ease. More important, we had the opportunity to talk, have lunch, and cuddle. It really didn’t matter that we were at an airport or that we had to wait hours for his flight. At that moment, we were just present with each other and enjoyed ourselves by people watching, giggling at silly things, and marveling at the jets outside the giant panes. But the place and time were of no consequence, really. As he was boarding the plane, a thought crossed my mind. That was the best experience I had ever had at an airport. Although I quickly could have grown bored and restless, I was with someone I love, and the hours we spent waiting for his flight gave us an opportunity to spend time together. In retrospect, the “mistake” would have been to leave later.
I learned to simply be present in the moment, something most kids are better at than we adults. I got to see an airport, which I’d come to accept as a mundane and quotidian place, through the eyes of a child, for whom everything is still new and every day is an adventure. Recent studies show that infants’ brains remain constantly lit up the way ours do only when we’re experiencing those rare brand-new adventures. Of course! For a child, it’s all new. I was reminded of this moment when Steven died. He got to spend his last day with his son—and that was a tremendous gift of renewal.
Could you find real fulfillment and joy by simply being in awe of a jumbo jet as a child can? How about by wondering at the cycles of plants and animals in response to seasonal and climatic changes to their environment the way kids do? My children and I used to spend countless hours sitting beside a small pond on our property, mesmerized by the iridescent quality of dragonfly wings. One early spring day, my daughter Caroline and I tried counting the many different shades of green we could see beside the pond (we lost count at twenty). These are the kinds of things that kids still notice—it’s called visual acuity—but which we adults forget or ignore or deny, often because as we “mature,” the ways we learn to communicate limit our understanding, rather than foster imagination and possibility. “Yes, green. I know what it is,” we say. “The whole park is green.” “Sure, spring. Buds and birds. Lovely.” And then we go do our taxes.
Do you want to feel young and vigorous and excited again? Learn how to do that from the masters: your kids. Or somebody’s kids. Offer to babysit. Help out with Sunday school. Volunteer for the Scouts or 4-H, or Big Brothers or Sisters. Do you remember that near-perfect moment in the 1972 film The Godfather when Vito Corleone, the murderous patriarch of the most dangerous family in America, spends his last moments with his little grandson, Anthony, in his tomato garden? Just before the Godfather dies, he’s making the boy laugh by inserting an orange section in his mouth to form an exaggerated smile. The masterful scene (I don’t know whether Mario Puzo, Francis Ford Coppola, Marlon Brando, or all three are responsible) is all about forgiveness, letting go, the cycles of life, reconnection to Eden, and making oneself ready for the transition to whatever comes next. After all the terrible things Don Corleone does in a lifetime of crime, he ends at peace, bringing joy to a child and feeling young again, in a place of growth and life. Often it is children, as was the case for Steven, as well, who bring us back to focus on what’s really important.
LIVING WITH OUR EYES OPEN
The Godfather was ready to go, just as Steven was, in a way that’s still difficult for me to grasp at times, especially when we’re not talking about old men. Perhaps Mindy and Brad might have been ready on some level, too, but that remains a challenging thought. Still, we needn’t understand this entirely. Indeed, it’s easier to accept when our subjects are aged, having lived full lives. It seems fairer that way. But then others who have done just that remain unwilling, kicking and screaming along the way. Steven’s story offers a strong message about placing the emphasis on living in the now, not on the imaginary monster up ahead, and goes on to show us that the concept of “anti-aging” is absurd on its face. Its foundation and justification is to protect us and save us . . . but from what? Death is completely natural. Avoiding it is therefore completely unnatural. Contrived and misdirected in this way, anti-aging efforts simply foster fear and create imbalance. And because the anti-aging mentality supports our desire to avoid confronting the very fact of our own mortality, the sine qua non of finding a meaningful life, in the end, it leaves us bereft and broken instead of whole and ready for the next plateau, as I believe Steven was.
In the end, we will reap the seeds we sow. Thus, if we cultivate a negative mind-set about death, which we do when we deny the significance of our impermanent state, then we will surely experience dread whenever we think about death. In turn, that will negatively affect our health. Alternatively, we can establish a brighter foundation on which to live and a more natural and healthful attitude toward the inevitable end of that life.
Unfortunately, too many people’s lives end well before their physical body dies. And others wish to go on living forever, which is not the way it’s meant to be. Instead, without becoming morbidly fixated on death, we need to look at it squarely and learn to accept it. With clearer vision, we’ll be able to embrace the journey and the transition. Only with our eyes open will we be able to see the challenges as opportunities for continued growth. As long as we’re growing and learning and doing, we live. When we stop, we die. And that’s okay, if the time to stop is right and we’ve made that decision skillfully.
ACTION CURES FEARFUL AGING
This is not to say that we should ignore our physical health along the way. Quite the contrary. But as I have been stating all along, taking care of our physical health is dependent on our attentiveness to the health of our mind and the attitude we maintain in living our life—our relationship to all life and awareness of our greater purpose. But it’s also dependent on a healthy attitude and perspective with respect to aging and death. Without that, we will suffer more.
Why wallow in fear of getting old and falling apart when we can stack the deck in our favor by taking control of our physical health—but also manage our state of mind, dealing with inevitable health challenges along the way skillfully, meaning with foreknowledge and the right attitude? The right attitude embraces the reality that we’re all human—and that state, by design, is ultimately fatal. There’s a cycle of life, and we’ll move on our continuum until we cease to be, to make room for new life, as Steven did, as happens in the garden every autumn. As we mature and grow, we learn and expand; we let go of unhealthy attachments, and we can experience more joy, life satisfaction, and self-esteem than ever. Life should get better, not worse—but it won’t happen by accident.
This issue came into focus for me recently when a colleague introduced me to another physician, Paul, who knew a little about my work and was eager to tell me about a three-year certified course in anti-aging medicine he had just completed. Genial and eminently likable, Paul seemed, at first glance, like the sort of person who could become a friend. He was convinced we would have a lot in common.
I certainly respected Paul’s knowledge, as well as his passion and genuine dedication to helping people live better. However, something about his approach put me off. So, in as tactful a manner as possible, I commented that it’s interesting how much emphasis our society places on aging. It’s even gotten to a point, I offered, where we no longer view aging as a normal part of life, but as a disease state. There is, in fact, now a specialty in medicine devoted to solving the problems associated with this “condition.” While I didn’t disagree with Paul’s assertion that there’s much to learn about healthy aging, I said the problem most of us have with growing old—isolation, fear, loneliness, lack of respect, and disenfranchisement from society—cannot be solved through a primarily technologically and physically oriented approach. He agreed but indicated that his training didn’t cover that.
Indeed, unless we stop viewing aging as a problem that needs fixing, we might extend the life span itself, but this will have a mere marginal effect on the quality of our lives. If I could have prolonged Steven’s life but had not helped him to heal his relationships, I would have only extended his suffering. Similarly, the billions we spend on vitamins and supplements, lotions and creams, plastic surgery and life-extension research will not ensure that we’ll live well and die in peace, free of regret. Nor will the countless hours we spend building our physiques keep us from leaving a trail of broken relationships. From my experience, those who put so much emphasis on turning back the clock and prolonging their lives are going to wind up feeling terribly depressed and defeated when the realization hits that they have been fighting a losing battle. The intense focus, not to mention money, time, effort, energy, and thought, that we put into warding off aging offers us little insight into ourselves, or into how to develop anything other than our physical bodies.
We mustn’t reject the wisdom that comes with growing old. The anti-aging quest robs old age of its inherent value and meaning. How have other cultures dealt with death? What does religion say? How does science deal with it well and poorly (i.e., what’s the difference between helping your health so you can live better and trying to short-circuit nature by trying to live forever)? This question is likely on the minds of most of you. The “New Old,” I’ve heard you called: the baby boomers. You’re dealing with living longer, better, happier, healthier lives. But at the same time, as you get older, you inexorably will get sicker, eventually. The oldest of the nation’s seventy-seven million baby boomers (those born from 1946 to 1964) are entering retirement—and more than ever are focused on proactive ways to improve their health.4 Boomers are rightly worried. The years are catching up with you. In general, you’re not taking it lying down. A recent Harris Interactive poll found that baby boomers are increasingly preoccupied with their health and wellness, with 73 percent of those surveyed concerned they won’t be healthy during retirement.5The good news is, you’re seeking out new and different ways to stay healthy and live skillfully. And your expectations are different from past generations. You expect to be healthy for as long as possible. In fact, your interest in staying healthy, coupled with your sheer numbers, is taxing the health care system more than any group in history. You represent the largest group of health care consumers in the country. It’s clear that you and your compatriots are not ready to give up the fight.
Sure, you want to extend your life. I get it. As long as you’re not simply interested in “life extension.” Ideally, you’re looking for “quality extension.” What’s the point of living to one hundred if your life is devoid of purpose, meaning, and emotional connections—not to mention if it’s full of pain?
This is a fairly new concept in American culture. The Japanese celebrate a holiday called Keirō no Hi, or Respect for the Aged Day. The Japanese people take this holiday a lot more seriously than Americans take, for example, our Grandparents Day—just another Hallmark-enabled pseudoholiday. Did you even know we have a Grandparents Day? Know what day it is? Neither do I. But in Japan, neighborhood volunteers distribute free bento boxed lunches to elderly people. Smaller villages hold keirokai shows in which young people and schoolchildren perform dances and songs in a special ceremony for their older kin.6
In The Gift of Generations: Japanese and American Perspectives on Aging and the Social Contract, Akiko Hashimoto observes that an older Japanese woman’s “adaptation to old age—and preparing for the likelihood of widowhood—has been deliberately planned,” in contrast to an American woman’s plans of “resorting to a nursing home as an eventuality that was wholly unanticipated and unplanned.”7 One way the Japanese do this is by building extended families, even sometimes informally “adopting” new surrogate children or grandchildren. Why are our cultures so divergent? Japanese culture has long revered the old, and it actively prepares people for old age. Only recently has America begun to plan skillfully for quality of life in old age. I want you in that camp. I want you to plan a little further than simply “I’ll work until I’m seventy, then I’ll retire, and then . . . well, who knows?”
71. Do You Actively Pursue Your Goals and Legacy, Even as You Age and Suffer Loss?
You probably all know people who worked actively their whole lives, then retired, and died very soon after. We must learn that a retirement spent in a rocking chair—with no goals and nothing to live for—will deliver death pretty quickly. Yes, you can relax a bit in your retirement, but I’d suggest some mission-based activities that fulfill and inspire you, some worthwhile challenges that take the long view instead of the short.
In short, we have to maintain desire, a lust for life—and we have to keep in the game, trying to better ourselves and our surroundings, rather than giving up or resting on our laurels, feeling that we’ve earned some rest. James J. Dowd, a sociologist at the University of Georgia, reminds us that we must continually and continuously work on bettering ourselves, fanning the flames of our passions, and continuing “to grow, develop, and learn about the world in which [we] live.” Dowd argues, “It may be naive, idealistic, or quixotic, but behind many efforts of human beings to engage themselves in the world is the utopian wish to create, if not an ideal world, a world that is better than if we had not acted as we did.”8 It’s never too late to think about this legacy. Never. It’s just as important in maintaining a positive outlook as you grow older as it is when you’re young and it seems your whole life is ahead of you, as surely Mindy and Brad thought up till the day they died.
To me, Mindy and Brad are immortal. Immortality comes not only from our own accomplishments and contributions, but also from our survivors and the following generations remembering and commemorating the things we did and the people we were, even long after we’re gone. Your legacy and your life purpose can begin when you’re young, as Brad’s and Mindy’s did. And it needn’t be as universally profound as curing polio or walking on Mars. But, just as important, it should continue as you get older. Dowd recommends that you “undertake a challenge such as traveling to remote parts of the world, running a marathon, learning a new language, nurturing a new relation.”9 You can use retirement, the move to a new place, or even something as traumatic as the death of a spouse to spur positive change and a different outlook on life, writes Dowd.
Your legacy is your legacy, and while it might have been intimately tied to your spouse, one of you will likely die before the other, and the other will have to go on. I know it’s tough when you’re grieving, but studies show that if you can find your way to incorporate into the bereavement process some positive emotion—gratitude for the time you spent together, enduring love, hope, and so on—you’re going to be more likely to survive intact, even more likely to develop long-term plans and goals. That means that a year later, you’re more likely to come out of the process skillfully.10 I’ve already mentioned that it took me much more than a year.
We’re coming along to this kind of enlightened perspective on aging, but we’re not there yet as a culture. According to a study originally developed by Leo Srole and further developed by the renowned gerontology researcher Ethel Shanas, two-thirds of us still believe that “nowadays a person has to live pretty much for today and let tomorrow take care of itself.”11 I’m all for living in the present if it means letting go of past pain—but that doesn’t mean we don’t plan skillfully for a healthy future. So what can we do to prepare for it?
One key to quality of life in old age is taking care of your physical body. You’re going to die of something. Chances are it’ll be heart disease12 or one of the other Big 8. You can greatly stave off that inevitability by staying physically active—and you’ll feel better for longer if you do. You don’t have to run marathons: physical activity will improve your mood and your vigor after just ten minutes, with progressive improvements over twenty minutes.13On a positive note, many boomers have already gotten this message. Did you know that boomers make up a majority of the membership of swimming, cycling, and running organizations?14 If you’re one of these active boomers, keep it up! But if you’re on the couch right now, get up and read the rest of this chapter while on a treadmill or in a park you have to walk to.
Beyond physical activity, skillful eating also plays an important part in maintaining a healthy lifestyle long into old age. Here, we’re not doing so well. Increased health and nutrition literacy is critical, especially for older men who are dependent on their spouses for knowledge of these two subjects. That means don’t let your wife control your health—it should be in your hands. Researchers continually observe a phenomenon that we discussed earlier, that “many of the [older] men considered themselves to be healthy [even] if they took medications that alleviated symptoms or pain . . . a number of the men are taking a plethora of medications for illnesses and ailments” and “the cavalier manner in which these medications are taken is alarming.”15 To ensure not just longevity, but quality of life, we have to go beyond conventional medicine. It’s not another pill that you need, regardless of what your doctor prescribes.
One recent study sums up everything I’ve been advocating: the key to skillful aging “can be defined as a balanced outlook toward old age—following the natural laws of one’s body, maintaining tranquillity of mind, cultivating a sense of harmony with oneself and one’s surroundings, and gaining the wisdom of handling challenges and thus making adaptations accordingly.” The study, by sociologists from Western Washington University and Miami University, Ohio, calls this “harmonious aging,” and it’s very much in line with Eastern philosophy: growing old should be “regarded as a life stage that embraces both continuity and change . . . older people would define their meanings of life in terms of its own opportunities (such as spiritual growth) and challenges (such as physical change)”16 (italics mine).
However, some of us need a reality check, which is part of the balance you need when considering aging and death. James J. Dowd points out that “desire needs to be regulated in the sense that it would be self-destructive to continue to desire to be able to do something that one is no longer capable of doing. Irreversible losses or impairments must be recognized and adjustments made.” You must reorganize your goals and life plans following a life trauma or a medical impairment; by “resisting the expected tendency to withdraw from [your] usual levels of activity, those with desire will adjust, reformulate, and continue on with a new plan.”17 In short: Roll with the changes. Adapt. Move on.
And while you do that, feel good about yourself and your continued achievements. Research conducted in Hong Kong suggests that you should surround yourself with those who support you:
Older adults’ self-affirmation of their strengths, aspirations, and more importantly their resiliency to isolation, rejection . . . and other adversities, such as not letting others look down on them, contribute a positive mentality that comes together, forming a “resiliency” to illness and other adversities.
This study reiterates what we’ve already discovered: paradoxically, when things go wrong as we age—such as illness or the loss of a spouse—we should concentrate on the “possibility of converting negative experiences into impetus for generating resiliency.”18
Study after study backs up this notion of resiliency in old age: “Sources of strength that turn out to influence positively one’s sense of mastery include a positive perception of one’s situation, openness about one’s vulnerability and responsiveness to help.” The key here is “openness about one’s vulnerability.”19
This reminds me of how my patient Steven handled the “death sentence” his doctors gave him. We’d probably agree that a metastatic cancer diagnosis is a real health crisis. In the Chinese language, the symbols for the word “crisis” translate literally as “opportunity riding on the dangerous wind.” Therefore, every crisis is really an opportunity. They are synonymous. Learning to persist, evolve, and communicate effectively during a crisis is the essence of personal growth and Skillful Living. Steven was fortunate in a way. I’m certain that had he never developed cancer and faced imminent death, he never would have been motivated to heal his life and his relationship with his son. His physicians gave him no hope, which, paradoxically, turned out to be his greatest opportunity.
72. Do You Experience Feelings of Joy and Exhilaration?
Sometimes when I’m at risk of feeling discouraged, I think about Steven and his son running from the security guard that day at the abandoned mental institution in western Massachusetts, where for some reason those two chose to trespass. I think about the smile on their faces. The poet Rainer Maria Rilke writes, “All emotions are pure that gather you and lift you up; that emotion is impure that seizes only one side of your being and so distorts you.”20People are moved and motivated by emotions. Just look at the common root of those words—mot, “to move.” Life is a constant process of moving in the direction of satisfying emotional needs and wants. Why are our emotions, or feelings, so important to our health? Positive psychology researcher Barbara L. Fredrickson argues, “The capacity to experience positive emotions remains a largely untapped human strength. The possible benefits of positive emotions seem particularly undervalued in cultures like ours that endorse the Protestant ethic, which casts hard work and self-discipline as virtues and leisure and pleasures as sinful.”21 Get over that! Positive emotions are the health gifts that keep on giving. Positive emotions, if you know how to tap them skillfully, can and will lead you toward extraordinary health: they will make you feel better, and they will make you more psychologically and physically resilient in the face of life’s challenges.
There’s an evolutionary basis for the benefits of positive emotions: Fredrickson notes that our ancestors used them to build “their personal resources, including physical resources (e.g., the ability to outmaneuver a predator), intellectual resources (e.g., a detailed cognitive map for wayfinding), and social resources (e.g., someone to turn to for help).”22 We build these resources when we’re safe and secure, and we can turn to them when things are bad, as they surely will be, occasionally. It’s only when we are feeling excessively or inappropriately bad—stressed, angry, frustrated, hateful, and so on—that we see short- and long-term individual and societal ills resulting. These problems range from anxiety disorders and depression to heart disease and cancer. Norman B. Anderson, author of Emotional Longevity, enumerates what he calls “the big three” of negative emotions: “sadness/depression, fear/anxiety, and anger/hostility.” It’s not that these emotions, although negative, are “useless or should be avoided.” They have their place. It’s only when we experience these negative emotions all the time and whole hog, unskillfully, that they can have “profound consequences.”23 We’ve seen a lot of evidence already that, as author Stephen G. Post puts it, “the consequences of these negative emotional responses are increased susceptibility to disease and worse health outcomes”24—not to mention their negative effects on the quality of our life today.
But it works the other way around as well: you can channel positive emotions into an effective prevention, coping, and treatment plan for counteracting depression and other negative feeling states. Simple, regular happiness might not cure disease, but it looks like it can protect us against illness and disease in the first place,25 even in old age.
So get happy about something. Get genuinely interested in something. Better yet, get genuinely excited. What do you have to be happy about? How about your job? Your hobby? Your kids and grandkids? Your health? Your pets? Art? Nature? Music? Friends? Politics? Okay—maybe not politics! But there’s a world of possibilities out there if you open yourself up. Whenever I see my chickens and their new babies running around the yard, I feel joy. Whenever I see my patients smiling. Whenever I taste great homemade cheese. I could write a whole book about the stuff that makes me happy. You could, too.
Sustained excitement and joy will entice you to continue to explore, grow, and learn. These are all fun things, but they’re also necessary for survival—the longer you maintain them, the longer you’re likely to live, and the happier and healthier you’ll be as you live. And the better you’ll be able to cope during the inescapable bad times: resiliency. The resources you’ll develop, Fredrickson points out, become “durable resources that can be accessed in later moments, and in other emotional states.”26
You don’t have to jump off waterfalls or go skydiving to experience exhilaration and joy. Simple physical activity can do it, because it allows us to experience catharsis for our anger and hostility—emotions that might otherwise be directed toward the self in the form of depression,27 while at the same time releasing endorphins and other feel-good hormones. And here’s something interesting: a recent study observed the benefits of simply writing about positive and exciting experiences, which “enhanced . . . positive mood” and correlated to generally better health than those in a control group.28 No wonder I’ve felt so good while writing this book for you! Why don’t you start a journal today, and write about what makes you happy.
The resiliency-causing emotions, joy and exhilaration chief among them, as well as the fear-slaying positive outlook required for skillful aging, all come down to one factor: your willingness to see life, even the end of life, as a great adventure worth undertaking with vigor and enthusiasm, as Steven did deliberately, and as Mindy and Brad did serendipitously, just because they were young. Participating in and having a sense of adventure (such as kayaking or hiking) benefits “character development such as self-esteem, determination, dependability, ambition, and independence,”29 according to researchers in the field of “adventure education.” An adventurous life helps with overcoming fears, enhancing the ability to cope, the opportunity to experience new activities, increased compassion and respect for others, and better self-expression and communication skills.
But adventure’s not just about kayaking and skydiving or even physical challenges at all. People experience individual adventure in multiple ways.30 It’s about challenging yourself, whatever that means. Maybe it means joining a choir, building a birdhouse, or trying an online dating service. I’ve been thinking about planting some new crops in my garden this year: that’ll be an adventure. Adventure is about doing new things regularly. It’s about your spirit, which we’ve learned is inextricable from your well-being.
At its heart, embracing the adventure of the life you’ve been given is tantamount to finding the elusive “meaning of life.” In Emmanuel’s Book: A Guide for Living Comfortably in the Cosmos, authors Pat Rodegast and Judith Stanton share wisdom from Emmanuel, a symbolic name for a powerful spirit they “conversed” with: “The purpose of life is exploration. Adventure. Learning. Pleasure. And another step towards home.”31 I believe these wise words could provide the basis for our common understanding of the meaning of life and extraordinary health. I have seen in my patients and in those to whom I regularly speak a hunger to explore this and other critical questions posed in the quest for Skillful Living.
73. Is Your Outlook Basically Optimistic, or Can You Envision Yourself as More Optimistic?
74. Are Playfulness and Humor Important to You and Do You Have a Sense of Humor?
In the 1997 Italian film Life Is Beautiful—based on a true story—a Jewish waiter played by Roberto Benigni literally laughs and jokes his way through the nightmare of the Holocaust. He’s not crazy. He does this for the sake of his loved ones, especially his young son. He convinces his son that the concentration camp is just an elaborate game in which the quietest, least-complaining boy will win a new tank. How could anyone maintain humor and tenderness in the face of such unspeakable horror? Simply, he chooses to create for his son an alternate, more optimistic reality, one that is necessary for the boy to endure in order to survive the hellish conditions. If he cannot overcome his situation, he has to create a new one altogether.
History is full of such hopefulness in the face of horror. A group of Tibetan lamas (Buddhist monks) who were imprisoned for years in a Chinese gulag realized through meditation that their confinement was an opportunity for personal and spiritual growth. The lamas were so appreciative of this “opportunity” that they sent a thank-you letter to the Chinese government. They literally found, as a friend of mine observed, “freedom in confinement.” Now that’soptimism!
Every day we see examples of people who are impoverished in some manner but whose lives are nonetheless filled with beauty, contentment, and peace. On the other hand, how many of us are relatively well off in the world, but wallowing in misery? To see which side of this equation you fall on, look in the mirror. Listen to the script in your head. Listen to yourself as you speak to your friends or think on your drive home. Reread your Facebook posts for the past year. Who is that person that is you? Is she grateful—or resentful? Joyous—or bitter? Hopeful—or hopeless? Thankful—or ignorant of the bounty around her? Free—or “imprisoned” by circumstances?
If you don’t consider yourself an optimistic person, can you at least find a part of you that might still have the capacity for optimism? A hint, at least, of the desire to rise above your condition? If you have any doubt, I suggest that you don’t give up. Yes, you will likely discover that you cannot change certain things in your life, such as your job or difficult family member. But, as James Baldwin writes, “Not everything that is faced can be changed; but nothing can be changed until it is faced.”32 So really look in the mirror and focus on what you can change. That can start with your attitude. Your beliefs. Your perspective on yourself and the world around you.
It won’t happen instantly. Optimism is a muscle. You have to flex it if you expect it to get stronger. So start off small. You can certainly resolve to eat more skillfully, to get more in touch with nature, to drink more water, or to reconnect with a long-lost friend or relative. You can resolve to be kind, empathetic, and compassionate in your dealings with others, perhaps especially that recalcitrant relative. You can pay attention to your senses. You can cultivate a purpose for your life, and act on it. You can let go and forgive. You can be for someone else in your life a model for this kind of extraordinary health.
At the least, learn to laugh at yourself and at life. There’s no need to be so serious.
PRACTICAL PRESCRIPTION 8: FOLLOWING YOUR OWN ADVICE
Each of us has wisdom and experience worth sharing. How many times have you provided good counsel to your friends, relatives, children, clients, coworkers, or employees? Now it’s time to do this for yourself—to follow the advice you so eagerly give to others. You’ve gotten to this point in the book, so I’m certain you’re more in touch with who and where you are in your life than you were when we began this journey. Remember, I might be the doctor, but you’re the greatest expert about your health.
After reading this book, you might feel especially prepared to offer others advice. As important, I hope you will find that you are in a better position to take care of yourself first. Now is the moment of truth. Now is the time to break through and release the habitual patterns of thinking and behaving that no longer serve you.
Try the following exercise, which I developed along with my sister, Deborah, after some trying times. Starting today, then every few months or so, write yourself a letter full of wise, personalized advice, just the way you might write to a beloved friend. Don’t preach, though. This letter should be loving and conversational, gentle and compassionate. It’s important to avoid the overbearing, moralizing tone that usually provokes denial, ambivalence, and rebellion. This letter should be conversational. Here’s a brief example one of my patients shared with me:
Dear Darren,
I hope you’re well. I’m just writing to give you some advice, which I hope you’ll take in the spirit in which I intend it: love and respect. I’ve noticed lately that you’re getting down in the dumps about the twins moving out. I’ve noticed you haven’t done much more than watch TV for a few weeks when you get home from work. I know you’re not happy about this. I have some ideas. Sure, you’re sad about the empty nest, but what about concentrating on those eighteen amazing years you all got to spend under one roof? What about remembering that time the girls tried to build that tree house and found the cardinal’s nest? Or the trip out West when everyone got carsick together after all those doughnuts? And how about this: How about letting that pride swell inside you that both girls got into great colleges, and even got scholarship money? You know how much a part of their development you played. How about focusing on the joy you feel that they’re starting their exciting lives now, full of possibilities? Before you know it you’ll be shaking hands with promising young men in tuxes, and then, the babies will come! But, meantime, I’ve got some more advice, too: How about now that you’re alone with Diane, you work on some of that stuff that’s been bugging you all these years? How about being more attentive? How about getting more involved in her volunteer work, as she’s been hinting at? How about getting intimate more often, and more spontaneously? How about you finally let yourself spend some time and energy on you—your health and future? How about it, Darren? I think you’re totally worth it.
Love, Darren
P.S. You could stand to put down the Twizzlers, man!
QUESTION FOR FURTHER REFLECTION
75. Do You Feel a Strong Need to Be Right or in Control?
Well, what if you’re wrong? What if the paradigm you have subscribed to is off base, and all your “rules” are misguided? Not possible? Are you that sure? This is a question that asks you to consider a more humble approach to living, and the possibility that there’s something more you can learn that will ultimately prove beneficial. I’m not suggesting that you toss out all that you believe in. I just want you to consider how things might be different if you let go of your attachment to other people’s points of view, in particular. In the end, the test is, are you thinking for yourself?