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  • Written by Sherwin B. Nuland
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  • Written by Sherwin B. Nuland
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A Doctor's Prescription for Well-Being

Written by Sherwin B. NulandAuthor Alerts:  Random House will alert you to new works by Sherwin B. Nuland



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On Sale: February 27, 2007
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Read by Sherwin B. Nuland
On Sale: February 27, 2007
ISBN: 978-0-7393-4401-9
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On Sale: March 06, 2007
ISBN: 978-1-4159-3843-0
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Synopsis|Excerpt

Synopsis

In his landmark work How We Die, Sherwin B. Nuland profoundly altered our perception of the end of life. Now in The Art of Aging, Dr. Nuland steps back to explore the impact of aging on our minds and bodies, strivings and relationships. Melding a scientist’s passion for truth with a humanist’s understanding of the heart and soul, Nuland has created a wise, frank, and inspiring audiobook about the ultimate stage of life’s journey.

The onset of aging can be so gradual that we are often surprised to find that one day it is fully upon us. The changes to the senses, appearance, reflexes, physical endurance, and sexual appetites are undeniable–and rarely welcome–and yet, as Nuland shows, getting older has its surprising blessings. Age concentrates not only the mind, but the body’s energies, leading many to new sources of creativity, perception, and spiritual intensity. Growing old, Nuland teaches us, is not a disease but an art–and for those who practice it well, it can bring extraordinary rewards.

“I’m taking the journey even while I describe it,” writes Nuland, now in his mid-seventies and a veteran of nearly four decades of medical practice. Drawing on his own life and work, as well as the lives of friends both famous and not, Nuland portrays the astonishing variability of the aging experience. Faith and inner strength, the deepening of personal relationships, the realization that career does not define identity, the acceptance that some goals will remain unaccomplished–these are among the secrets of those who age well.

Will scientists one day fulfill the dream of eternal youth? Nuland examines the latest research into extending life and the scientists who are pursuing it. But ultimately, what compels him most is what happens to the mind and spirit as life reaches its culminating decades. Reflecting the wisdom of a long lifetime, The Art of Aging is a work of luminous insight, unflinching candor, and profound compassion.

Excerpt

CHAPTER ONE

AN INCIDENT IN THE SUBWAY

About five years ago, I had a brief experience that since then has helped me to tell the difference between nurturing a sense of vibrant good health and nurturing the delusion of being still young. Put somewhat differently, I learned that a man of advanced years who has never felt himself hemmed in by chronology should nevertheless not allow himself to forget his chronology entirely.

The event took place late on a September afternoon when I, along with my wife and younger daughter, had just entered a New York subway car at the Times Square station. Pushed forward by the advancing throng of rush hour passengers, we were crammed together single file, with nineteen-year-old Molly in the middle and me packed in behind her. Between my back and the doors stood someone whom my peripheral vision had recognized only as a tall, broad-shouldered man, perhaps in his late thirties. No sooner had the train gotten under way than the fellow’s bare right arm reached around past me, its hand extending forward in an obvious attempt to make contact with Molly’s buttocks. As taken aback as I was by the man’s brazenness, I did have the presence of mind to do what any father might: I pressed my body rearward just firmly enough to push him up against the car’s door, putting Molly beyond the reach of his outstretched fingers. As though by some form of unspoken New York agreement, both he and I acted as though nothing had happened, and the train continued on its clattering way over the subterranean tracks.

But I was wrong to think that the episode was over. Scarcely half a minute had passed before I became aware of a barely perceptible creeping thing, surreptitiously entering the right-hand pocket of my khaki trousers. Any thought that imagination was playing tricks on me was dispelled a moment later when I was able to feel an unmistakable sensation through the fabric, of fingertips moving around inside the empty pocket.

In the flashing eyeblink of time that followed, it never occurred to me that I should consider the consequences of what I instantaneously decided must be done. In fact, “decided” is hardly the word—my next actions were virtually automatic. I plunged my hand into the pocket, transversely surrounded the bony knuckles of a palm wider than my own, and squeezed down with every bit of force I could muster. Aware that I was gritting my teeth with the effort, I did not let go until I felt more than heard the sickening sensation of bone grating on bone and then something giving way under the straining pressure of my encircling fingers. A baritone roar of pain brought me back to my seventy-one-year-old self, and made me realize that I had gone too far.

What had I let myself in for? Would not the simple act of removing the intruding extremity have sufficed? Or perhaps I should have done nothing—the pocket was, after all, as empty as it always is when I anticipate being in a crowded, chancy place. Made overconfident by hundreds of hours spent pumping iron in a local gym, I had succumbed to an unthinking impulse dictating that I crush the felonious hand. As the first flush of instinct faded, I all at once became certain that my victim’s revenge would now swiftly follow. Alarmed by that thought, I relaxed my grip and felt the mauled appendage whip out of my pocket.

But who could have predicted that the response would take the form that it did? With his torso still pressed up between my back and the train’s doors, my antagonist inexplicably shouted out a garbled accusation for all to hear, about my having “. . . TRIED TO STEAL MY BAG!” Being certain that I had misheard and anticipating a powerful assault, I awkwardly turned my body around in those compressed quarters, in order to confront the expected assault as effectively as my acute attack of nervous remorse might allow. Having managed that, I found myself looking up into the anguished but nevertheless infuriated face of a thuggish-looking unshaven tough three inches taller than I, and quite a bit broader. I noted with some relief that the injured right hand hung limply alongside his thick-chested body. Tucked up into his left armpit was a bulging deep-green plastic portfolio, its top barely held closed by a tightly stretched zipper. This, no doubt, was the pouch in which was held the loot of a day’s pocket pilfering.

Seeing the flaccid, useless hand dangling from the muscular but now inactivated forearm momentarily revived my unthinking and foolhardy courage. Looking directly into the bloodshot eyes glowering at me (and now able to smell liquor on the thick breath blowing down into my face), I roared back as though I were Samson, “YOU HAD YOUR HAND IN MY POCKET!” Something stopped me before I added “you son of a bitch,” which was a lucky thing because as soon as the first words were out of my mouth, I regretted them. Fearful once more, I prepared for the violent response that would surely follow.

But the fates were with me: Just at that moment, the train pulled into the next station and my foeman charged out through the doors as they slid open, clumping off toward an exit staircase as fast as he could, until his forward motion was slowed by a bunched-up throng of passengers tumbling out of the next car. He was swallowed up among them until only the top of his bobbing head could be seen. In a moment he was gone, leaving me standing there—thinking of how close I had come to my own annihilation.

I turned toward Molly and my wife, who later told me that my face was pale and bloodless. I felt as though rescued from certain death by a last-second reprieve. My hands were shaking and my knees seemed just a bit uncertain about whether they intended to continue holding me up. It was several minutes and another station’s traveling before they steadied themselves. But everything finally stabilized and I was then faced with the embarrassment of having to withstand the two women’s justifiably withering comments about how foolish I had been. During the short period of Sturm und Drang, they later told me, not a single person in that overcrowded subway car had so much as glanced in my direction or otherwise acknowledged that anything unusual was taking place.

I present this story as an example of a conflict within myself, a conflict that I suspect exists in the minds of many men and women beyond the age of perhaps their middle fifties. On the one hand, we recognize that age is ever increasing its effects on us and now requires not only acceptance but a gradually changing way of thinking about ourselves and the years to come; on the other, some narcissistic genie within us cannot give up clinging to bits of the fantasy that we can still call on vast wellsprings of that selfsame undiminished youth to whose ebbing our better selves are trying to become reconciled.

The same formula that enhances our later years—continued mental stimulation, strenuous physical exercise, and unlessened engagement in life’s challenges and rewards—sometimes fosters an unrealistic confidence that the vitality thus maintained means that we are virtually the same as we were decades earlier, even in appearance, ready to challenge youth in its own arenas. In outbursts of denial and bad judgment that are virtually instinctual, we at such times discard an equanimity that has taken years to develop, and indulge ourselves in behavior foolhardy and foolish, as though using it as an amulet to stave off the very process to which we have so successfully been accommodating by consciously sustaining our bodies and minds.

The tension between the two is very likely stronger in the case of men, but nonetheless common in women as well, though manifesting itself in somewhat different forms. This rivalry within ourselves reflects a rivalry with youth, and it serves neither youth nor age at all well. Self-images from an earlier time are not easy to give up, even when giving them up is in our own best interest. Those whose calling is to work with an older population know that the ability to adapt, to learn and then accept one’s limitations, is a determinant of what the professional literature of geriatrics calls “successful aging.”

Adapting is not mere reconciling. Adapting brings with it the opportunity for far greater benisons and for brightening the later decades with a light not yet visible to the young. Even the word itself is insufficiently specific to convey what is required. In the subtle but nevertheless enormously significant shades of meaning that characterize the English language, “attune” may, in fact, better describe the process than “adapt”: “attune,” in the sense of being newly receptive to signals welcome and unwelcome, and to a variety of experiences not previously within range, while achieving a kind of harmony with the real circumstances of our lives.

This book is about attuning to the passage of years, and finding a new receptiveness to the possibilities that may present themselves in times yet to come—possibilities conveyed in wavelengths perceptible only to those no longer young.

And the book is also about traps for the unwary, into which all of us fall from time to time and from which we must teach ourselves to emerge with a refreshed sense of purpose. The very word—“attune”— sounds like another word to which it has a not coincidental connection: “atone,” originally a contraction of “at one,” meaning “to be in harmony,” most cogently with oneself. To become attuned to an evolving perspective on a life is to be at one with the reality of the present and of the future years. Achieving such attunement can bring a form of serenity previously unknown, and perhaps unsuspected. The process begins with an acknowledgment that the evening of life is approaching. But with that approach come foreseeable possibilities. We have only to take advantage of all that those coming decades have in their power to offer. It is incumbent on each of us to cultivate his or her own wisdom.

So gradual a progression is the onset of our aging that we one day find it to be fully upon us. In its own unhurried way, age soundlessly and with persistence treads ever closer behind us on slippered feet, catches up, and finally blends itself into us—all while we are still denying its nearness. It enters at last into the depths of one’s being, not only to occupy them but to become their very essence. In time, we not only acknowledge aging’s presence within us, but come to know it as well as we knew—and still covet—the exuberant youth that once dwelt there. And then, finally, we try to reconcile ourselves to the inescapable certainty that we are now included among the elderly.

Realizing how much of our dreams we must concede to that unalterable truth, we should not only watch our horizons come closer but allow them to do precisely that. If we are wise, we draw them in until their limits can be seen; we confine them to the possible. And so, the coming closer can be good, if by means of that closeness—that limiting of expectations—we begin to see those vistas more clearly, more realistically, and as more finite than ever before. For aging can be the gift that establishes the boundaries of our lives, which previously knew far fewer confines and brooked far fewer restrictions.

Everything within those boundaries becomes thus more precious than it was before: love, learning, family, work, health, and even the lessened time itself. We cherish them more, as the urgency increases to use them well. Many are the uses of the newly recognized limits. Among their advantages is that our welcoming acceptance of them adds to the value, adds to our appreciation, adds to our ability to savor— adds to every pleasure that falls within them. The good is easier now to see; it is closer to the touch and the taking, if we are only willing to look truthfully at it there and gather it up from amid the cares that may surround it. There is much to savor during this time, magnified and given more meaning and intensity by the very finitude within which it is granted to us.

Aging has the power to concentrate not only our minds but our energies, too, because it tells us that all is no longer possible, and the richness must be more fully extracted from the lessened but nevertheless still-abundant store that remains. From here on, we must play only to our strengths. Some of the more meaningful of those strengths may be not at all less than they once were. The later decades of a life become the time for our capabilities to find an unscattered focus, and in this way increase the force of their concentrated worth.

Even as age licks our joints and lessens our acuities, it brings with it the promise that there can in fact be something more, something good, if we are but willing to reach out and take hold of it. It is in the willingness and the will that the secret lies, not the secret to lengthening a life but to rewarding it for having been well used. For aging is an art. The years between its first intimations and the time of the ultimate letting go of all earthly things can—if the readiness and resolve are there—be the real harvest of our lives.

It is the purpose of this book to tell of human aging and its rewards— and also of its discontents. And the book has as its purpose as well to tell of how best to prepare for the changes that inevitably demand accommodation, demand a shift in focus, and demand a realistic assessment of goals and directions, which may be new or may be a rearrangement of the trajectory of a lifetime. We do this at every stage of life without noticing the new pattern to which we are becoming attuned, whether it be in adolescence, the twenties, or middle age. Though the changes may be more obvious as we approach our sixties and seventies, they are, in fact, only a continuation of everything that has come before. For becoming what is known as elderly is simply entering another developmental phase of life. Like all others, it has its bodily changes, its deep concerns, and its good reasons for hope and optimism. In other words, it has its gains and it has its losses. The key word here is “developmental.” Unlike other animals, the human species lives long beyond its reproductive years, and continues to develop during its entire time of existence. We know this to be true of our middle age, a period of life that we consider a gift. We should recognize and also consider as a gift that we continue to develop in those decades that follow middle age. Living longer allows us to continue the process of our development.


From the Hardcover edition.
Sherwin B. Nuland

About Sherwin B. Nuland

Sherwin B. Nuland - The Art of Aging

Photo © Jerry Bauer

Sherwin B. Nuland, M.D., is the author of nine previous books, including Doctors: The Biography of Medicine, The Wisdom of the Body, The Mysteries Within, Lost in America: A Journey with My Father, and The Doctors’ Plague. His book How We Die: Reflections on Life’s Final Chapter won the National Book Award and spent thirty-four weeks on the New York Times best-seller list. His writing has appeared in The New Yorker, The New Republic, The New York Times, Time, and The New York Review of Books. Nuland is a clinical professor of surgery at Yale University, where he also teaches bioethics and medical history. He lives with his family in Connecticut.

Lost in America, Doctors: The Biography of Medicine, How We Live, and How We Die are available in paperback from Vintage Books.

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