On Old Age and Death III

When all things, including decay, seem to come upon us less gradually and more suddenly, it is because we fail to notice it until it is pronounced. While it is not a disease, per se, old age is a syndrome for which our DNA is wired to avoid gradual things, and they creep into our faces, strength, hearing, sight, and memories, until they seem to appear all at once and threateningly. That constellation of events and scars all of a sudden dim the luster of our surroundings and our very selves. We have gradually become invisible and unheard. We come from the past which is a place far away and where they speak a different language. We meet the people of the present who are youth, health, and vigor; and the contrast is both shocking and discouraging—a harbinger of things to come.

“Age takes hold of us by surprise.”-Goethe

“Society sees old age as a shameful secret that is unseemingly to mention. We do not experience old age from within but from without. Old age is not discovered; it is imposed from the outside.” -Simone de Beauvoir

The counsel a young doctor must obtain is the same as experience should teach the young as they inevitably encounter old people and old age in themselves. The conversation between the elderly professor of gerontology and the intern goes like this:

“Do you ever think about old age,” asked the old professor.

“I think about death, Sir,” replied the young doctor.

“But do you think about old age?” the professor persisted.

“I’m afraid not. It seems too distant to be real.”

“Indeed,” responded the professor, emphasizing by tapping his cane on the floor. “Youth is taught about life, about disease, and even about death, but never about old age. We grow up thinking that old Homo sapiens are almost a different species. In medical school, we should be taught more about aging; so, it will become real to us; and we can better prepare ourselves and our patients to deal with it. Let me ask, what is the first thing you see in very old people?”
“Hmmh… frailty, slowness, loss of physical form, loss of elegance, loss of language, loss of appeal, to be frank.”

“And so, what first emotion occurs when you encounter an old person?”

“Well…  there’s pity, sadness, and even revulsion sometimes, I have to admit.”

“You prove my point, young doctor. Nobody purposely taught you such things. If that were so, you would have better answers than those you have given me; because you would think and feel differently about the aged and would wholly accept them as still being Homo sapiens, just older, and perhaps needier.”

“Practically speaking, in what way would I feel and communicate, should I view the aged?”

“Your eyes need to be trained to see the very old, as when they were young and beautiful instead of old and pitiful. Look at me. Try and see me as an eager young medical student, or as an earnest and involved medical resident. Is it possible for you to picture me differently than your unthinking eyes show me? Can you see me with your mind’s thinking eye? Can you make it a habit to see one such as me as young and vibrant, even healthy and strong, instead of this old relic I have become?”

“We are having a frank and real talk, sir; and I have no thought to offend. But, I have to say that is very hard to do.”

“So, it is my argument that we must train medical students and residents to see the old as they were when young and beautiful, because that is how they see themselves, unless they happen to look in the mirror while contemplating themselves. I suggest you have your old patients bring photographs of themselves in their youth when they won the athletics prize, or the beauty contest, or when they were the family’s pride as they graduated from law school. Look first at those pictures, after that you can study the chart, the lab values, the record of their decay and source of their pain and sorrows. Then, you can see them all the way through for what they really are and not just a chronic back ache, the heart failure, the demented, and the arthritic cripple. Only then, should you address them.

“Allow yourself to realize that the person you see is still a handsome, debonair, active athlete, with a young soul thinking and frolicking on the inside, still ready to take on the world. Realize that the person you are looking at and talking to still sees themselves that way, not as the old body that the elderly person has become and knows it. The old mind and body censures the negative view of the outside which is so evident to an unsympathetic, unempathetic onlooker.”

Taken from-Veteran and Elder Stories


The doctor–especially the geriatrician—needs to be concerned less with the complexities of holding back chronic disease, preventing disease and accidents, and prescribing the correct medications, and pay more heed to prolonging the patient’s relevance and independence than his/her longevity. If you become a doctor for the old, provide the support systems necessary for maintenance of joie d’ vivre, coping with loneliness, and the ability to remain happy at home over the many benefits of assisted living centers. It is incumbent on the doctor to provide care for pain, suffering, anxiety, and acceptance of the status quo as a senior citizen.

Doctors, nurses, families, and individuals, must eventually face the difficult questions:

  1. Are our sincere efforts toward delaying decay, or are they prolonging it?
  2. Is our aging population outpacing its youthful generation and progeny of caregivers?
  3. Are we—by increasing life spans, and seemingly always improving health spans– actually adding to the struggle of the elderly and the economic stress imposed upon the ever-dwindling supply of young people to bear the load?
  4. Should we have the courage to debate the distasteful questions or just have the politicians settle them?


In the next article, let us consider those questions and their answers always remembering that we speak of people, not numbers, of sentient beings, not unfeeling statistics—people who are now what we will become, should we have the good fortune to live to old age, still thinking and moving.

I chose to use a pseudonym for personal reasons. I’m a retired neurosurgeon living in a rural paradise and am at rest from the turbulent life of my profession. I lived in an era when resident trainees worked 120 hours a week–a form of bondage no longer permitted by law. I served as a Navy Seabee general surgeon during the unpleasantness in Viet Nam, and spent the remainder of my ten-year service as a neurosurgeon in a major naval regional medical center. I’ve lived in every section of the country, saw all the inhumanity of man to man, practiced in private settings large and small, the military, academia, and as a medical humanitarian in the Third World.