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Archive for January, 2016

Being mortal: The praxis of aging

Posted by Ron George on January 29, 2016

Autumn Leaves: Reflections on Aging Photography by Howard Zehr

Autumn Leaves: Reflections on Aging
Photography by Howard Zehr

He was a bright young man, my new physician. Thirty-something. I believe a graduate of Texas A&M’s medical school in College Station. Yet another Aggie who never left town. He had a message for me that particular day in my 52nd year: Use it or lose it.

He even used the forbidden phrase, “Men your age …”

“Men your age lose muscle mass as they grow older,” he said. “If you’re not working your upper and lower body regularly, then you’re losing strength. Eventually, you will be weak in ways that pose significant risks.”

I’d had all this put to me before, but this time – more or less – it stuck. I’ve been working out two or three times a week ever since. I haven’t bulked up or developed a six pack, but I have maintained a modicum of strength and aerobic conditioning that many men my age seem to have lost.

Now comes Atul Gawande, a prominent physician whose best-selling book Being Mortal assures me – all of us – that while healthy habits and good genes do work for us as we grow older, aging and its debilitations are inevitable, relentless and, finally, fatal.

I’m in a reading group plowing through Gawande’s book, and most of us are of that certain age where these issues have an immediacy they would not have for a youth group. Gawande, however, says these are issues that everyone should have in mind all their lives; which is unlikely for, say, the 20-something crowd, but certainly by age 40, we ought to be pondering the aligned processes of aging and, yes, dying.

Gawande’s concern is that American society has not developed a compassionate way to deal with the growing percentage of its population living well into their 80s. One might well ask, paraphrasing Ebenezer Scrooge in A Christmas Carol, are there no nursing homes in America? Well, yes, says Gawande, and that’s the problem. The medical solution has been to create institutions that regiment the elderly in ways that make their lives miserable; or, at the very least, unlike any other way of life that most of us would call normal. Nursing homes, says Gawande, may be better than the poorhouses of India, but they are far from desirable as a matter of public health.

Autumn Leaves: Reflections on Aging Photography by Howard Zehr

Autumn Leaves: Reflections on Aging
Photography by Howard Zehr

The problem seems to be twofold – and, I must confess, I haven’t finished Being Mortal, but some implications seem clear enough halfway through.

First, the manner of our aging and dying – how these are managed in America – have medical components but they are not medical problems. They are social problems requiring that society take them up and commit to humane solutions. Gawande makes clear enough how the history of eldercare in America came to be in its present state; but it’s also clear, based on numerous studies, that the evolved system robs the elderly of their dignity and generally pleases no one – not the elderly themselves nor their families nor their physicians nor even those who operate the current “continuum of care” from assisted-living to skilled-nursing facilities.

Scholars in the field lament that it’s too late to provide humane solutions for the so-called Baby Boom generation (mine), but it’s certainly never too late to develop a way of life for those who grow old – my children and grandchildren, for starters – that will not so radically impinge upon their freedom and self-respect. At the very least, it will require financial incentives for doctors to specialize in gerontology and significant medical and social research aimed at new best practices.

It’s simply not enough to advocate for the good old days that never were when extended families cared for the elderly. Research indicates that such arrangements nowadays are seldom satisfactory either as a matter of healthcare or social policy. It’s high time to come up with something attuned to the rapidly changing times in which we live. It will require significant investments of time, talent and treasure. The payoff is a social system that works not a medical system than doesn’t.

(It’s distressing that these issues don’t appear to be on America’s public-policy radar. It seems that we’re far more interested Super Bowl 50 and Mr. Trump’s feud with someone named Megyn Kelly. Is she on TV or something?)

Autumn Leaves: Reflections on Aging Photography by Howard Zehr

Autumn Leaves: Reflections on Aging
Photography by Howard Zehr

Second, we who age – everyone – ought to engage some kind of intentional reflection on this universal and critical dimension of human life. Aging and dying are matters of personal formation – or spiritual formation, if you prefer; but formation nonetheless in either case. Our humanity – the conscious fabric of our being – ought to become accustomed to and let itself be formed by the inevitability of aging and dying; and that from an age much earlier than we’re accustomed to thinking about it; say, no later than 35 to 40.

What would be the elements of what we might call the praxis of aging? Here’s a rough draft in no particular order.

  • Formation in this case begins with information. The goal is to become wise about the process of aging and making peace with death, which is not the enemy but the natural end of a remarkable journey – a conscious human life. Making death our enemy is picking a fight we can’t win; making death our friend is a way of living without fear.
  • Imagine being old. Our wonderful minds are capable of pondering the future; and, in this case, we’re capable of reflection and perspective in ways unique to our species. I began imagining my elder years at age 52, which was probably too late, but the young doctor in College Station made a point that got my attention. There’s more to this than figuring out one’s savings plan and pension, but that’s part of it. Calling to mind the story of our future can be meditative, if you’re into that; or, it can be a matter of thoughtful recollection. Denial gets us nowhere. Familiarity in this case does not breed contempt. It’s a way of making peace with the inevitable end of our lives.
  • Cultivate relationships with elderly people. This is a corollary of imagining being old. Our reflection deepens as we learn from the experience of those who already are passing through the debilitating years. This is hard learning, sometimes, because wisdom may come in forms that are indirect and even unpleasant – complaints, for example, irritability, anger. Listen and learn. You may have an opportunity to be part of the solution, but simply listening and spending the time it takes certainly will keep you from being part of the problem. There also will be moments of tenderness and opportunities for affectionate personal contact that matter a great deal. Most of  us elders enjoy hugs.
  • Take care of business. The will. The DNR, if that’s what you want; and, frankly, if you’re secure with these issues, you probably will. Get help. The praxis of aging takes a village.
  • Take care of yourself. The basics are modest, regular exercise; healthy diet; annual physical and regular dental care and eye exams. In theory, at least, you want to be as healthy as possible in order to weather the storm of aging. Exercise your brain, too. There are no guarantees against catastrophic illness; and, of course, nothing prevents aging, but our hope would be to walk this difficult path as well prepared as possible.
  • Keep the family in the loop. This means children, if any, but also anyone else related by blood, marriage or friendship. It’s a form of denial to pretend that I’m not aging and that someday I will die. They may not want to hear it, but our children, especially, need to know what we’re thinking and how we feel about aging and dying. There are the usual practical matters to deal with, but don’t leave unsaid the emotions that attend these issues – and encourage the kids to begin their own praxis of aging.
  • Let the family off the hook. Let them love you when the time comes. Let them do what’s best for you. It’s a time to put your faith in those who love you the most. It’s no time for empty pride or unreasonable demands. Be gracious. Prepare for this. It will take time and internal practice, a steeling of the soul. It may be the most difficult thing of all.

Finally, pay attention when your thirty-something physician gives you some advice about being of a certain age.

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