Monday, June 06, 2005

The Benefits of Age

“At sixty, a man has passed most of the reefs and whirlpools. Excepting only death, he has no enemies left to meet....That man has awakened to a new youth...Ergo, he is young.”

George Benjamin Luks, American painter

There are many wonderful benefits of middle age. It has taken me many years to come to this conclusion. In my younger days, I raged. I fumed I ranted. I rebelled. I have pictures of me in my youth, when I had more hair, fewer wrinkles, and seemed to always have a serious expression on my face. I was attuned to every slight, every ill-mannered comment, every question of my knowledge or judgement. Even the slightest sense of a challenge to my omniscience - a lowly pharmacist questioning my dosage instructions on a prescription - would be enough coal to keep the fires of indignant outrage burning for the rest of the day.

I remember the daily annoyances that used to drive me absolutely berserk. Just the drive to and from work would push me buttons just the wrong way for the full 24 hours, usually every day. People parking their oversized SUVs too close to my car. Drivers pulling out in front of me, quickly and just in time to cut me off, and then slowing to a crawl. Or, as I approached a red light, pulling up on the side street, tripping the traffic light and forcing me to stop for their entrance onto the throughway. One lousy car and I have to stop for them! Or some politician giving a speech on television and saying all the wrong things. That would give me enough righteous outrage for days. A teenager with his car radio booming with those horrendous bass acoustics rattling his and, more importantly, my car windows.

But for the past few years, I have become aware of quite a change. Driving home has become an almost welcomed comic ending to the day. I like to drive without the radio and in the peace and solitude of my little car because the entertainment lies outside these comfortable confines. Watching the helter-skelter drivers, forever jockeying for position and all ending up together at the next red light with hardly a change in their starting position brings a wide smile to my face. The young pharmacists, fresh out of school and equipped with the knowledge - or at least their computers are - of every known side-effects of every drug on the market, still question me about prescriptions. They call to tell me that my recently prescribed Drug X has been shown to cause diarrhea in 2 per cent of patients when used with Drug Y the patient is already on. They ask, with their best professional phone voice, if I really want to use this combination? As I suppress a laugh, I switch to my deepest, professorial voice and reply "Yes" and thank them for their well-researched, current information on the subject of these possible drug interactions. I assure the well-intentioned, young graduate that I think the patient will be fine. I thank the pharmacist again and hang up with a whimsical smile on my face. I think, briefly, of the pharmacist making a note in his log that they warned the prescribing doctor of the possible interaction and the physician accepted the risk. "CYA" and all that, at its very best.

I come to my empty home - I am divorced and my children are grown - and I, maybe to some, selfishly, revel in the tranquility. I have probably always been a bit of a loner but, like so many things, I fought against it. I married and stayed married for almost 25 years. I had three great kids. I grew up, for all practical purposes (a much too long a story), as an only child, but I thought it would be a good thing to have kids. I served 12 years as an Army doctor - this, after growing my hair long and vehemently protesting against the military and Viet Nam, Kent State, and the assorted missteps of the 1960s. Now, after all the rage and the indignation, I have finally had a soulful, spiritual exhale.

But, lest you think I am some bitter, complacent, aged shell of a man, resigned to living on the edge of society, for my remaining few years on this planet, I assure you nothing could be further from the truth. In my heartfelt solitude I have found an immense sense of peace and comfort. It is a oasis in my heart where resides a calm. There is a sensation that one must feel when, after fighting upstream against the rapids of a raging river, you reach a tranquil pool. Here, at the top of the headwaters, the current no longer pulls downward at you. There is no struggle and only minimal effort keeps you afloat. After the long swim, banging against rocks and scrapping against the shallows of the raging torrents called life, there is a respite.

I have a recurring mental picture of the salmon swimming upstream from the ocean in the northwest rivers. They fight against the river's torrent to spawn. Then, from starvation, trauma and exhaustion. We spend most of our lives in the same sort of struggle. Fighting and clawing against the currents of daily life is our youth. And, as we age - doesn't "maturing" sound better? - we realize that, despite all our fighting, kicking and screaming, we ultimately reach the same tortuous end. Some sooner (like my son, Danny, 1980-2002) than later.

After over a half a century of fighting the good fight, I have, reached a sense of contentment. I have achieved far more than was rightfully mine to achieve. The only son of a mail carrier in a family that never went farther than high school, I was the first in our modest history to go to college, much less medical school. My family could never afford medical school so I accepted a free-ride from my old nemesis, the good old U.S. Army. I have published 3 books, spoken to the American Medical Association and the American College of Physicians. I have published medical research papers. The whole nine yards. I am proud of what I have accomplished. More importantly to me now, is that it has made my parents proud. Now as they slide onward toward octogenarian-hood, they can still talk to their neighbors about their son, the doctor.

Truth be told,. there have been many (many, many, many) failures and regrets along the way. I was never much of a father and an even worse husband. But I have made peace with these glaring imperfection and defects. Now, instead of regret and discontent for the errors and missteps, I am unabashedly happy. I have taken the conscious and innermost decision to rest in the backwaters of whatever remains of my life. Lest you get the idea I have given away all my worldly possessions and have gone to live in an Oregon commune, you couldn't be more wrong. I have all intentions to live life to it's fullest and enjoy whatever time I am given on this earth. It's just that I am, at long last, happy and contented. I am, in the trite old (is it?) phrase, "in a good place." Surely, it is not the absolute cloudless calm that I know death will be, but a conscious, deep sense of the sudden lack of conflict. It is a fine place to be.

I can speak, with some degree of experience, about the sensations of death. I recall, with great clarity, the "time I almost died." I venture that many have had similar claims to the almost-afterlife, but mine remains quite vivid with me. During a heart catheterization prior my quadruple coronary bypass (it sounds more dramatic to say "quadruple" than simply a 4-vessel bypass), I had what pop culture would call a "near-death experience." During the procedure, shortly after I threw up from the nausea induced by the dye injection, I remember what can best be described as simply falling asleep. But, unlike the sleep of fatigue or after a day's work, it was a memorable drifting off into unconsciousness. I don't remember the "feeling" of dozing off in any of the many thousands of naps and nocturnal rests in my life. I remember laying down and, then, waking up. But this sensation was exquisitely unique.

Before you roll your eyes, it really was a sensation I had never felt before and I have not since. There was no "light at the end of a long tunnel," no voices calling for me in the distance, no angels, none of the things I have heard from near-death survivors. This feeling was something entirely different. It was an overwhelming sense of calm, of peace, of solace. It was a deep inner sense of tranquility.

I noticed later, in the cardiac care unit, that I had some very painful circular burns on my chest. When I asked the nurse what they were, she nervously informed me that my heart had "stopped" (specifically, I went into asystole) during the procedure and I had to "defibrillated" 6 times to resume an effective heart rhythm. The burns, I was informed, were from the haste of the cardiologist to apply the paddles to my chest with inadequate conductant gel and the increasingly higher voltages used in the attempt to get my heart back into an effective pulse. When I discussed the episodes with my cardiologist, a friend who I had actually trained during his Internal Medicine residency, he told me he "was scared to death" he was about to lose his former Chief Resident. His exact words were I was "dead for about 60 seconds."

Since that little heart stopper, when I was the ripe old age of 42, I have lost all fear of death. Death, in my heart, mind and in the innermost depths of my soul, is nothing to be feared. It is an almost orgasmic peace. Perhaps not in the circumstances in which one dies - car wreck, gunshot, heart attack - but, when that heart beats its last beat, I am convinced we will all have this peace. When those last few red blood cells deliver their last molecules of oxygen to the last living brain cells and we have an "irreversible end of consciousness," we will experience a final, ultimate, overwhelming sense of placidity.

With apologies for the diversion, I return now to the point of this rambling: whatever lies ahead, it's all OK. Through all the aches and pain of waking up each morning, all the alopecia, all the wrinkles and blemishes, the daily loss of neurons, it's all going to be just fine. And when people question my judgement, drivers cut me off on the freeway, the power goes off in a storm, and I forget to record my favorite TV show, I will try to remember that lesson. I wish, as we all do, that I could go back and visit myself when I was 18 and scared to death of starting college, or when I was 24 and marrying for all the wrong reasons, or when I was 39 and leaving the Army for the alien and increasingly competitive world of private practice, or even just 3 years ago when my son died. I would smile, knowingly, and whisper "you will get through this, too." Age does have some unique advantages and I find that I like them very much.