Flu Lessons: Being Old and Sick

The second he completed the rapid flu test in his office, my doctor put a mask on his face and threw one to me.  “Don’t go near anyone without it,” he almost barked.  That was unlike him and took me aback.  Then he lightened up:  “Don’t worry.  There’s only a 5% mortality rate for the flu with people your age.  You’ll be fine.”

For more than a week, Franny and I were felled and jointly quarantined by a flu that, in me, moved ineluctably from a faucet of a drippy nose to a sore throat to coughing that felt like a thousand knives to the chest, to an unsettled stomach, to … well you get the picture.

We spent our days like zombies, our minds clouded and glum, lazing about the house like two vaguely related objects in space, not touching, hardly talking, each in a solitary universe.  Hours and hours passed with junk fiction, television, naps, and almost no food.  I lost a pound every day and felt progressively weaker.  Boredom.  There was nothing to break the monotony of the days.

Sunday afternoon was the occasion of our sweet, two-year-old granddaughter Lucy’s birthday party. Franny and I maturely declined the invitation, not wanting to infect anyone.  In the morning, Gabe brought over a vat of  potato-leek soup, and left it on the door step for us.  We cracked the door to retrieve it, feeling like long-term, immobile residents of an assisted living facility, peering for a moment out into the world.

As a child, I hated being sick.  The drill in those days was to relegate people to their beds.  Even urinating took place in milk bottles.  And believe me, we weren’t treated tenderly.  The idea was to get us up and about as quickly as possible.  I agreed because bed rest was boring and, even while sick, I was physically restless.

And I still hate it.  It may be 40 years since I’ve been laid up with a flu.  During the last decades, whenever there’s been a hint of illness, my attitude has been simple: Ignore it…it’s just a state of mind…plow through.  I’ve virtually staked my identity on what I saw as my strength of mind.  On a similar but side note, one year I decided that feeling cold weather was also a state of mind, and spent the winter without a coat.  Superman lives here.

Then I moved into my 70s, where I began to take more notice of those stomach pains, the weakness I felt on some days, the aches in my joints. The imagery I have for old age is antithetical to how I conceived of myself as a young and even middle-aged man.  But indeed, Superman is gone.  I no longer believe that I can plow through.  Now these dis-eases signal something beyond the immediate experience.  They portend big time trouble.  Almost any ache or pain seems a signal that my body is weakening, and my days are numbered.

A few years ago, I entered a period of feeling tired all the time, and thought:  Oh, this must be what it’s like being old.  Instead of plowing through, I was inclined to resign myself.  Wasn’t that the mature way?  Just in case, though, I saw a doctor, who diagnosed me with anemia, caused by a hiatal hernia.  Surgery stopped the bleeding that led to the hernia and my energy returned.

It turns out to be easy to conflate illness and aging; in my desire to be wise in the way of aging, I resigned myself to decline far too readily.  Now I found myself in search of a more balanced view: being strong; being alert; taking care of my body and my difficulties; and finding a philosophical perspective to accept my increasing vulnerability.  I needed a perspective that found strength in holding all of these views together at the same time.

When the flu arrived last week, though, all of this wisdom flew out the window.  There was something disorienting about the inward focus it brought.  How to lay still, how to cough less, drip less, eat less.  How to time my medicine to minimize my headache.  In fact, I felt like an addict, looking forward to my next fix of Tylenol.  The outside world grew distant, unimportant.  My body was all.  I felt like I was floating through time, occasionally noting the outside world, as though threw the thick glass of an institutional window.

I imagined that this is what it feels like to be really old.  There is a transition that the researchers talk about between the “young old” and the “frail old.”  The young old are often still vigorous, active, optimistic.  The frail old are largely confined by their illnesses, their vulnerability, and their isolation.  Even when they are with people, the connection can feel tenuous, insubstantial.  Somewhere in my cloudy consciousness, I knew that I wasn’t yet at this point, but I could see it.  It was like the island at the end of life’s journey was well within view.

To combat the disorienting, floating, inward focus of illness, most of us seek an external anchor, like finding a large object to focus on when growing dizzy.  Often it’s some way to keep busy:  a simple task like folding laundry.  And keeping busy helps for a while.

The busyness exercise is also true when healthy, especially during retirement.  We busy ourselves to keep our mind off of our troubles, our fears, the inevitability that things will get worse.  Mostly we keep busy to avoid a dizzying internal focus.  So we keep to our routines, develop projects, travel plans.

To be honest, though, keeping busy has never been my cup of tea.  It feels useless and superficial.  It feels deceitful.  I can’t stop judging myself when I am “just” keeping busy.

Purpose—or a sense of purpose—feels better.  Purpose ranges from the very simple: I want to get well and will devote myself to it; I want to help with the grandchildren so my children can pursue their careers; I want to volunteer, to do my little part in making the world a better place.  All of these approaches take my mind, at least temporarily, off of myself.  When I feel purposeful, I don’t feel self-centered.  I feel part of something larger than myself.

Feeling purposeful, I suppose, is as strange an experience as the zombie-like disorientation of illness.  When we enter its zone, it’s as though a giant magnet gathers all the molecules that were drifting and colliding during our inward focus and pulls them in a single direction.  We feel aligned.  For a moment, at least, our energies and values flow together.  We get off that great, slow conveyor belt that has been pulling us into the world of the frail old person, who will one day inhabit our body and minds.  As we step off that conveyor belt, as we feel the magnetic pull of purpose, our vitality is restored and extended—at least for the present..

As my flu receded,, I pushed myself to attend a few meetings and got back to writing my blog.  I called friends to see how they were doing.  Nothing earth- shattering, but I felt more like a participant than a victim of some demonic process of aging.

I don’t want to act like Pollyanna here.  Most of us, if we’re lucky, are headed for that frail old stage.  During this part of our journey, feeling purposeful, feeling like we matter, will be harder to come by.  But the opportunities will always be there.

 

 

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Prologue

I’m writing a book.  It’s about the search for vibrancy in old age. That won’t surprise those who read my blog.  But another book at my age?  What for?  Why can’t I just enjoy what I’m doing now: family and friends, reading, exercise, meditation, travel?  Isn’t that enough?  Franny’s response to the question is simple:  old leopards keep their spots. I write because I always have.  And I like projects, big, messy ones that absorb me.  And I have always needed to be helpful.  So here’s the first chapter of my new book.  I could use your feedback.

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I am 76 years old, which means that I probably have about 10 years of good living left.  Maybe 15; maybe 5.  It’s impossible to tell.  But there’s no question that I’m in the midst of a period, however brief or extended, that is partly defined by a vivid recognition of my mortality.  It’s not all bad, though.  “Death is the mother of beauty,” according to Wallace Stevens; and I believe him.  What an extraordinary moment in a lifetime this is.

Beyond this moment, I’ll likely be pre-occupied by pain and anxiety—and by resentment because I’ll have to depend so much on others.  I don’t look forward to that time of life but, short of a quick and decisive heart attack or a lethal strike by pancreatic cancer, that’s almost surely my lot.  I’m no different than anyone else.

The harbingers are already clamoring for my attention.  I have arthritis in most of my joints, so it’s hard to hold heavy things in my hands.  I can’t take long walks without the help of Aleve or some other chemical aid.  I take statins to guarantee that my cholesterol doesn’t get out of hand — not because I absolutely need them, my good doctor tells me, but because they prevent problems and, studies attest, so far, show no serious side effects.  While no one would ever describe me as an obedient person, in this instance, I’m a compliant patient.

Just this year, I went over the acceptable glucose line and, my doctor tells me, I can now officially call myself diabetic.  I’ve been terrified of this kind of announcement for a few years now. Of course, it’s not so dangerous, he reassures me.  “If it were me,” he quips, “I’d be shaking.”  He’s 55 or so.  But diabetic symptoms take about 10 to 20 years to really set in.  So I shouldn’t worry.  “Why,” I ask.  “Because I’ll likely be dead in 10 to 20 years?”  He half blushes and half chuckles:  “Yup.”  I honestly didn’t know how to feel.  Reassured because trouble is a ways off?  Frightened because it wasn’t so far away?  Amused?  Annoyed that he was telling a joke at my expense?  But my immediate feelings didn’t matter.  What did matter was the dose of reality that I had to take in.

And, as the song goes, “that ain’t all.”  I’ve had torn rotator cuffs on both shoulders, a torn meniscus in my left knee, and a hiatal hernia—all requiring surgery.  As did my prostate cancer in 2001.  You could certainly say that modern medicine has stitched me together even when Mother Nature tore me apart.  As one doctor put it, he’ll soon own as much of my body as I do.  I’m sure I could list more of my troubles but let’s leave it there for now.

Except it seems important to say that I never expected a long life. My father fell to pancreatic cancer at 50.  I was so identified with him that, like a child magically convinced that his own fearful thinking could cause a plane crash with his parents aboard, I, a 26 year old man, was convinced that I would also die at 50.

I was so convinced that I prepared Franny and my closest friends for my imminent demise.  Even now they tease me about that tense period in my late 40’s.  After passing over that threshold, though, I slowly came to believe that I would go on living, and we all sighed with relief, as though a real threat had been averted.  Since then, I have been consistently grateful for my prolonged life, treating it like icing on the cake.  These 26 years have certainly been far more than I expected, brimming with fulfilling, often joyful experience.

So don’t get me wrong.  Even though I’ve just taken you through a litany of pain, for the most part it doesn’t reflect how I feel about life now.  Most of every day, I experience myself as a pretty healthy man.  I feel this way deep in my bones.  I eat well and exercise almost every day — and, as you all know, you have to feel reasonably healthy to exercise regularly.  Just last year, Franny and I flew off to Yosemite and climbed — well, that’s an exaggeration — we walked for hours and hours in those green and granite mountains.  I was in heaven.

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However challenging, this is an intense and intensely meaningful moment in life: the time between our understanding, deep in your bones, that life has end and that the end may be near — and the end, itself, either in death or a descent into dementia.  The moment may be brief or lengthy.  It may begin in your 60’s or 70’s but might begin earlier or later .  The timeline is indefinite; but the time is dramatic because it is lived in the shadow of death.

Our culture paints these years in shades of gray.  It is most aware of the diminishment and the humiliation of old age.  The poet Yeats describes it aptly:

What shall I do with this absurdity—

O heart, O troubled heart—this caricature,

Decrepit age that has been tied to me

As to a dog’s tail?

I differ.  Most of the time, I think the nearness of death makes each day more vivid, more engaging.  And Penelope Lively agrees:  “And if it sounds — to anyone — a pretty pallid sort of place, I can refute that.  It is not.  Certain desires and drives have gone.  But what remains is response.  I am as alive to the world as I have ever been — alive to everything I see and hear and feel.” P 47.  (Ammonites and Leaping Fish)

The experience of impermanence lends a poignancy, a melancholy that departs from the primary colors of youth and bathes our lives, instead, in deeper hues.   Here’s how a friend of mine, Pat Brandes, put it:

“I distinctly remember when I was in my mid-20s and my children were around 4 and 2 years old.  They were as fresh and lovely as the morning dew. I felt the desire to freeze the frame and hold onto it.  I also knew that I couldn’t.  Instead I said to myself ‘be with this as deeply as you can because this precious time will never come again.’  There have been many times since then when the same thing has happened but I notice that I am having many more of them now that I am older.   When I was younger it had to be something extraordinary or amazing that made me super aware and able to stretch out my presence.  Now just ordinary events bring on the inner voice saying, “This is it!”   I am increasingly aware of the poignancy of impermanence.”

I hadn’t expected it but old age has surprised me with how fresh things feel.  Far from the cultural narrative — continual, inevitable decline or frantic efforts to reverse the decline and the fall from youthful grace — my experience is better characterized by discovery, uncertainty, ambiguity, and mystery.

For older people, freedom and discovery come almost unbidden when many of the ties that bind us to activities, relationships, and communities take flight.  There is the freshness of each, unscheduled day.  I can ask: What shall I do?  What do I want to do?  At last, the weather plays a role as it hasn’t since childhood.  If it’s sunny, I’ll take that walk.  If rainy, I may read more, or call a friend.  Or a friend might call me, and I can usually say: “Sure.  What time do you want to meet?”  Spontaneity is my friend again.

There seems to be more uncertainty in old age.  It’s not just your schedule that’s flexible.  You can’t count on your health as much.  Friends, too.  They get ill, become infirm, die, move away.  I mean this not so much in a sad or depressing way but as a fact of life, one that changes almost as much and as rapidly as during any time since early childhood.  It can make you anxious and unsure of yourself.  There’s a temptation to draw inward and to limit yourself in an effort to ward off bad consequences.  But, in the purest sense, this is also an invitation to turn up your capacity to adapt. This, in turn, can awaken you to a life painted in brighter colors.

For a long time, I had imagined that old age meant playing out a relatively prescribed script.  The sad part of the script — of course not the whole of it — included physical decline, nostalgia for my lost youth and vitality, and a narrowing of my social circle.  Now that I’m 76, I see that I was wrong in so many ways.  Like others, for instance, my ideas and images about old age have continued to shift.  As a young man, 60 seemed old.  By the time I was 45, it was 70.  At 60, it was 75.  Now, at 76, I feel so much more alive than I imagined I would. The ground of expectations keeps shifting and the shifting keeps me on my toes.

One of the most surprising experiences of old age is the way that history keeps changing.  Here I mean your personal history, our life story.  By this point it has been extraordinarily well-rehearsed.  You’ve told it countless times to new acquaintances, among others; and you’ve mused about it inwardly for decades.  Now I find the narrative shifting, once again.

Here’s an example.  For the first few decades of my life, my father appeared to me like a rock, but now, he comes into focus as a troubled man.  My mother, who felt more like a peer, a friend, now seems like an inspiration.  I’d like to tell you that, with the perspective of years, I see them more clearly, but it may be truer to say I see them differently.  I see them now in light of my current life.  They are younger people, more vulnerable, and more complex too. I see their lives more in terms of the choices and drives and challenges they faced, and less in relation to me, their child.  Truth be told, this makes for a more interesting story.

As my image of them changes, so does my self-imagery.  For example, I was said to be my father’s child.  Supposedly, I looked and acted like him.  I was his heir, meant to carry on his dreams.  With each passing decade, though, I discover how much I have taken on my mother’s restless energy, her defiance, her wish to explore new territory.  One day last month, I looked into the mirror and saw, not a reflection of my aging father, but a dead ringer of my mother and her side of the family.  I keep “discovering” things about my childhood, my family, my neighborhood — not because they have actually changed, but because I keep seeing them anew.

You can say that these aren’t such major discoveries, but to me they are, because they shake everything up.  If I’m really more like my mother — or even equally like her — then that “realization” changes how I view the rest of my family.  It changes how I feel about gender, about my purpose in life, my destiny.  I put the word realization into quotes because I can’t be sure if my new insight is, strictly speaking, true, or if it’s just another view of the same phenomenon.  But it feels new.  And when you jostle your sense of reality, it stimulates a scramble to reorganize everything.  That’s what has happened to me.  I am scrambling.

Historian that I am, I have begun to reimagine the flow of events and relationships in my life.  Since I’m pretty comfortable with myself at this point, the project is more a source of fascination than anxiety.  I have begun to give up on the idea of a coherent narrative, with a clear beginning, middle, and end.  Like others, I have a great desire to pin down the definitive story of my life.  But there is nothing of the sort.  Rather, it is a story that has been invented and reinvented many times throughout my life.

There is freedom in this realization.  A long time ago, Carlos Castaneda’s Don Juan taught me about this.  The more others think they know about your past, he said, the more they think they can predict your behavior in the present and future.  These predictions become expectations that limit your possibilities.

When we slip off the straight jacket of cultural narratives and family expectations, of social prescriptions and proscriptions, even for a while, we enter a world of radical possibilities.  In that world, we can experience the sunshine on our faces and the scent of the forest, the smiles of friendship and the embrace of lovers as if for the first time.  That is the possibility born of multiple freedoms in old age.

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This is a transition of the first order, requiring or just yielding to the “chaos of a new freedom,” the realization that you are entering a new stage of life.  A time of terror and opportunity, a vivid time, a time that requires the best of our senses and our capacity to solve problems, to see clearly and accept what you see, a time to mourn, and a time to affirm.  This is the most extraordinary moment of our lives.

I’ve not chosen this phrase—a chaos of a new freedom—randomly.  It’s the title of my doctoral dissertation, whose first draft I completed in 1967.  I had been exploring a generation of philosophers and poets who had thrown off the received truths of the past—monotheism, tradition, and the like—and found themselves both thrilled at the freedom that rebellion yielded but also confused and frightened.  Back then, I sensed what my characters—William Carlos Williams, Walter Lippmann, and William James, among others—I sensed what they felt, but only a bit.  But I’ve continued to ruminate on the experience of freedom and now, in old age, I think I finally understand.

I want to shine a bright light on this next-to-last period.  In Mary Catherine Bateson’s terms, I want to compose or re-compose this period for my elderly sisters and brothers.  What that means, among other things, is letting in the new, no matter how terrifying, and letting the energy of terror animate our lives.  It means acknowledging the chaos.  And to balance both, it means finding and honoring the threads of continuity, the themes and values and, where possible, the people who have meant the most to us over our long lives.

The existential realities of human existence take on unique importance in old age.  The physical decline of the body, the increased awareness of limitations, major life transitions, and the continual experience of losses all require the aging individual to confront with greater frequency the transitory nature of life.  Insufficiently dealing with these issues by denial, suppression, or the inability to accept them, frequently causes suffering in the forms of depression, anxiety, illness, and suicide.

As it turns out, old age is such a strange, almost mysterious time. A time of loss and pain, humiliations, anguish, and uncertainty..  But peeking out from within that dark cauldron are discovery, creativity and imagination – a childhood borne not of innocence but of experience.  That’s what this book is about.

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What you’ve just read is the Prologue to a book that I’m writing.  Throughout it, I’ll be giving equal emphasis to ruminations and stories, the combination that people tell me they like best in my blog.

The book will cover a lot of ground.  I’ll be looking at the transition into retirement and what you need to clear out and let go in order to be fully alive to the opportunities in old age.  I’ll be talking about couple relationships, relationships with adult children and grandchildren, and friendships.  Regrets and roads not taken will be among the themes.  I will come back to the melancholy, the sweet poignancy, and the vibrancy of the final years.  And, towards the end, I’ll be ruminating about death and dying.  Throughout, I’ll be in search of ways to cope well and even to affirm the hard times, while savoring the good.

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Throughout the book, which is currently in search of a title, I’ll be trying to keep both the pain and the opportunities of old age in plain view.  At the least, old age is humbling.  It demands a certain honesty.  At our best, we let go of ideas about how life should or could be—or might have been.  It simply is as it is.  With that realization, we free ourselves to engage our lives with greater immediacy, and that is the key to being as alive as we can possibly be.  I would be grateful to learn that these chapters urge you onto that path.