The closer I get to my 80th birthday (I am 78), I have noticed that in a variety of conversations I bring up my age much more than I ever did before. I don't do it intentionally; at least I believe that is the case. As I think back, I may mention it in a joking manner, as an excuse to avoid work, or as a way to lower expectations of what I am about to say. It also comes up as a reply to someone I meet after a long hiatus who says, “You don't look a day older than when I last saw you.” Of course I am older, though the change in appearance is less apparent in someone like me who has been bald or near bald most of his adult life and has no visible handicap. Using a cane or sitting in a wheel chair may lead an observer to assume one is “older.”
As I think about aging in general, I recognize that we make adaptations; they can be automatic, voluntary, involuntary, physical, mental, professional, or social and they tend to differ between individuals. I have made my share. So let me list some of the adaptations to approaching and becoming elderly that I have made over the years.
The first is physical. I became an avid runner at age 42 and gradually increased my daily mileage to four to five miles a day; I even ran in races on weekends. I never ran a marathon (too much commitment for me), but the main thing was how much I enjoyed it regardless of weather or travel. I always took my running shoes and clothes on trips. I ran in many foreign cities—a great way to see the sights. And I did occasionally feel the “runner's high,” the sense of pleasure that made it seem that I was running without touching the ground. But mostly I just enjoyed being outside and exerting myself.
Then I developed pain in my leg that wouldn't go away. I had an iliotibial band syndrome (doctors use “syndrome” as a catchall for conditions they don't completely understand or have good treatment for). Despite many trials of rest, stretches, yoga, and the like, I just could not run without the pain and stiffness. So I had to quit, involuntarily, and started power walking. I gradually adapted to that kind of regimen, which I have maintained for 18 years.
The second adaptation is professional. I had personal, day-to-day responsibility for the care of patients from my first day of internship, through all my training and my 24 years at St. Jude Children's Research Hospital, a total of 31 years. When I became director there, I continued caring for patients, although fewer, because of the administrative responsibilities.
After leaving Memphis, my jobs left no room for having daily responsibility for patients. My clinical judgment and knowledge remained ample while my technical skills atrophied from disuse and my knowledge of newer antibiotics disappeared. Although I kept my medical licenses active, I gradually became less competent as an active physician as some critical knowledge began to fade. The last to drop below acceptable levels was confidence in my clinical judgment.
Finally, I voluntarily surrendered my licenses; I had used the renewals to delude myself that I could go back to active practice any time. I have had no regrets, and potential patients are safer because I am fully retired from medical practice.
The third adaptation is medical. Before age 60, I saw a physician only for required examinations, a fractured knee cartilage and a cholecystectomy. In my early 60s I developed hypertension and began taking medications, which kept me normotensive. The iliotibial band syndrome popped up at this time.
In my 70s, medical issues grew. I developed sporadic atrial fibrillation and began taking anticoagulants. Due to cataracts, I had a lens implant in my right eye and I will soon get another one in my left eye.
During this period I had angiograms of the renal arteries when I developed hypertension (normal) and a cardiac angiogram after the atrial fibrillation because the S-T segment on my EKG “looked a little funny.” It showed no blockage in the major arteries. I had a “laser ablation” of my prostate due to BPH and recurrent cystitis; it was uncomplicated.
I also have had major dental work now and then. I have not had a noticeable drop in mental capability (as reported by my wife and my doctor), but my short-term memory is not as sharp as it was. And I am still very active physically.
So it seems that over the past decade I have spent a lot of time under a physician's care despite having no life-threatening disease and being in generally good health all that time. All of these events required some form of adaptation. For example, the new lens helped my vision, but it took a long time for the light flare from streetlights to become unnoticeable, especially when driving at night. And I spent many hours in doctors' waiting rooms.
The fourth adaptation for both my wife and me is the progressive change of the focus of our daily lives. Pat (18 months younger) and I restrict attendance at social events. We prefer to socialize with family and just a few friends. But mostly, we love each other's company. Even if she is off sewing or quilting and I am in my office writing, we feel each other's presence with a sense of comfort and joy. We often go to the grocery store together, mainly to keep one another company.
Going to church has more meaning for us now than when we were younger, probably because we are more aware of our mortality, but also, I believe, because of the wisdom and experience that one accumulates over the years. We are more aware of what we don't or can't know, which is far more than we realized. We are even more reluctant to dismiss the transcendental or spiritual because it is irrational and unscientific, which is the position of a majority of scientists today.
I believe everyone, beginning in one's 50s or 60s, faces these and other issues. It is part of aging, and if one welcomes the gift of a longer life, adapting to the changes and limitations will be a part of that process.
Frankly, we are enjoying the journey.
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