Author: richardfleming (Page 6 of 6)

October 2022

By Richard Fleming

Autumn is a cautious time. A period of transformation. Nature presents its most vibrant hues. But it pauses to reflect on what was left behind, and what may lie ahead. It is a season of beautiful uncertainty.

Fall was always my favorite season, but I have taken it for granted for many years. Life was busy. Time in short supply. Autumn came and went, year by year, barely gaining my attention. And before I knew it another fall had disappeared. Year by year.

But now I find myself re-considering the magic of autumn. I am not sure why. Maybe it is because I’m more accepting of my post-work reality. I am fully aware I will no longer be ministering to the sick. The profession I spent so many years preparing for, and so many years practicing, is receding into my past. Or perhaps it is my increasing awareness the autumns ahead are numbered. Their appearances will not be few, I hope, but neither will they be bountiful. As I reflect on years gone by, anticipate the future, and audit my changing sense of self, I feel a need to recapture this precious season.

I am spending more time outside. I see changes unfolding with a different pair of eyes. This fall does not resemble those from the past. Why? Are my memories fraying? Is the way I perceive the world altered? Or is fall itself changing?

In our backyard, a pair of hummingbirds is intently drinking sap from the autumn sage. They are preparing to fly to parts south, hundreds of miles away. Will they make their journey safely? Will this same pair return next year? We have had hummingbirds for years. But this fall, for the first time, one started hovering outside our dinette window for long minutes watching my wife and I drink our morning coffee. Is it saying a final goodbye? Is it asking why we aren’t also preparing for the journey ahead?

The squirrels seem preoccupied this fall. They have long used the top of our back fence as a roadway, ambling from one side of the yard to the other at a leisurely pace. This fall the fence has become their superhighway. They madly dash from one end to the other as though time is short. Do they know something I do not?

The wisteria sheathing the arbor in our side yard is challenging my recall of autumnal transformation. It is continuing to bloom in purple beauty, even as the days grow shorter. This never happened before. Or is my memory leading me astray?

Then there is the honey locust we planted behind our house three decades ago. It is beautiful in the summer, though it starts dropping leaves in late August. By mid-September its branches are typically bare, before the birches and maytens shed a single leaf. This year its leaves began dropping in late August as usual. But two weeks later, the leaf fall ceased. The tree retained half its foliage for weeks before it finally resumed carpeting the patio beneath. Trees resonate with the world around them. Is the honey locust hesitant about what is to come?

California autumns are muted compared to those in Kansas, where I grew up. Fall in Topeka was heralded by thousands of elms and oaks, maples and sycamores, appearing to catch fire. In the Bay Area of the Golden State, the fall colors are less vibrant, but a vivid feeling of change is carried on the wind. The realization that summer’s passion is coming to an end cannot be avoided. And the gray, diminished season ahead is visible on the horizon.

As I enter the early years of my eighth decade, I live in the transformative days of autumn’s time. I look back and see the spring and summer of my life. Many pleasant seasons filled with growth and development. More accomplishments than mistakes, though there were full measures of each. I look around and see much to be thankful for. But there is also a looming sense of closure. When winter will come I do not know.

So I will immerse myself in my personal autumn. I will appreciate beautiful days with family and friends. I look forward to treasured time with my third grandchild, due in December. I will relish some great novels. I will spend more days traveling down the road, observing the trees, marveling at nature, contemplating the trail ahead. I will fondly recall the brilliant autumn colors of my youth and treasure the subdued autumn days of my present.

I am living with the beautiful uncertainty of growing old.

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October 2022

By Richard Fleming

Scientists are gradually unravelling the mysterious biology of human aging. DNA becomes damaged. Cells lose their ability to replicate and repair themselves. Telomeres, the regions at the ends of chromosomes, shorten. But a confounding aspect of the aging process is that different organs and body parts grow old asynchronously. Some age more rapidly. Others more slowly. For each person, the differential aging speed of body parts varies.

According to my birth certificate, I am 71 years old. But I am made up of various components. Each regularly communicates with my brain. Some proclaim their youthful vigor and demand gratitude. Others ask for accommodations because they are older. Juggling these competing claims can be challenging.

Two of the oldest parts of my body are my ears. For all intents and purposes they are pushing 87 years old. They disdain and dismiss the rich world of sound encircling me. And they try to distract me with a constant hissing noise. They insist I lower my expectations for auditory enrichment and demand I provide them hearing enhancement devices.

My eyes, myopic and with increasing floaters, celebrated their 75^th birthday when my birth certificate said I was in my 50s. But thankfully, and for no apparent reason, the premature aging slowed. Their performance level stabilized, neither improving nor diminishing further. They now appear to be biding their time until the rest of my body catches up. What my eyes will choose to do when I officially turn 75 is anyone’s guess.

My right first toe is far older than its nine compatriots, thanks to a 50 pound marble table slab doing a header on that toe many years ago. (Please don’t try to replicate this maneuver at home.) A broken bone and damaged nail bed will definitely accelerate the aging process. For the most part, the other nine toes tolerate the older digit. But some days their patience wears thin, at which point I have no option but to sit down.

On the other side of the ledger, my mouth and tongue remain quite youthful. They relish good food and drink as much now as many decades ago. Truth be told, I sometimes wish they would age a bit more quickly. But they are living life on their own schedule and their enthusiasm requires I spend more time on the elliptical in the garage.

Some organs are reticent about proclaiming their age. My heart, for example, has diligently performed its duties for 71 years with no significant protestations or announcements. My best guess is that it is about 55 years old. But who knows? Tomorrow it may divulge its age is 80. I’ve never been one to object when people or body parts are bashful about revealing their true age. I prefer to let sleeping dogs lie rather than wondering who let them out.

I could offer an inventory of other body components, but doing so would quickly devolve into the swamp of TMI. Suffice it to say my birth certificate does not accurately capture the differential calculus of my aging body.

*    *    *

One arena of variability in bodily aging holds greater importance. It first came to my attention when I was in practice. My older patients often reported their surprise when they looked in the morning mirror. In their brain they felt they were 30 or 40 years old. But the mirror told them they were 70 or 80.

In my early years of practice, I sympathized with these patients. I blithely reassured them this disconnect between mind and body was common to aging. Sympathy was easy to express when my personal experience with the mind-body discrepancy was limited. But as my years in practice accumulated and I traveled further down the road, my approach began to change. I stopped sympathizing with my older patients and began empathizing with them. Empathy more accurately expressed my resonance with my fellow travelers.

Sympathy can be hollow, pro-forma. Empathy is genuine, heartfelt. When it comes to understanding aging, sympathy and empathy are separated by the date engraved on our birth certificate.

In an ideal world, perhaps human aging would be better coordinated. Each organ would grow old in synchrony and harmony with every other. But, as reality clarifies for us on a daily basis, we live in a less-than-ideal world.

If I could choose one organ to age more slowly, it would of course be my brain. I would like to preserve my ability to converse with my grandchildren in a stimulating way for years to come. I would like to listen to great music in the 2040s, wearing hearing aids of course. I want to be able to read poetry, even when my knees will no longer let me stand.

But there are downsides to a 40 year old brain inhabiting a 90 year old body. The brain’s understanding of what lies ahead grows increasingly bittersweet and profound. While opportunities for living remain, the frame of time is visibly shrinking. Some potential persists, but much potential is lost.

As we trudge forward, our powers of clairvoyance improve. We gain the ability to predict our future. We come to know that full synchronization between our brain and our various body parts lies ahead. When that time comes, our birth certificates will gain precision. And the differential calculus of growing old will confound us no more.

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September 2022

By Richard Fleming

Despite my age, or perhaps because of it, my understanding of what it means to grow older is evolving. I will open by deconstructing this phrase. Growing means developing, expanding, increasing in size or substance. Older means more advanced in the years of life.

Growing older is best understood contextually. In my youth, I embraced it enthusiastically. Growing older meant a driver’s license. Voting. College. Marriage and family. An interesting field of work. Travel. For the young, growing older is aspirational.

But youthful exuberance carries an expiration date. At some point in each of our lives, growing older loses its luster.

For me, this transition happened in my 50s. The idea of growing older became daunting. Turning 60 or 70 was less appealing than turning 20 or 30. Further, I failed to understand how people could grow old. Aging seemed the antithesis of growing. People became old. We attained old age. Actually, as we aged, growing ceased, replaced by diminishing. Diminishing height, stamina, cognition and, importantly, skin texture and elasticity. Our bodies may expand and increase in size or substance, true that. But aging seemed more a process of running down than of growth.

I formulated two theories to explain the fallacy of linking the concept of growing to aging. First, perhaps the term growing old arose from an unintentional mistranslation of Old German root words many years ago. Or second, it was intentionally developed as an ironic device to insure senior citizens know we are no longer evolving in a positive and useful way.

Fortunately my ability to learn and adjust persisted. As I reached my 60s, my understanding of aging continued to develop, thanks to lessons from those older and wiser than me. I reflected on the fact this phrase, growing old, has been in widespread use for centuries. Its longevity suggested it rested on a solid foundation. Was there a path that could help me understand that aging is – scientifically speaking of course – a growth process?

*    *    *

During decades of family-building and work, one’s time is constrained. While they are years of growth, they are also years restricted by sturdy fences. The highest level action items are helping one’s family and contributing to the Social Security Trust Fund by remaining gainfully employed. Other activities rank lower on the priority scale.

As people attain higher levels of seniority in the job of life, their energy and fortitude lessens. Multiple well-performed medical studies offer confirmation.

But – assuming their health allows – people also have more freedom. Barriers which delimited family and work responsibilities become weathered and worn. Some of the fencing collapses. And new vistas emerge.

I thought back over my years practicing medicine and recalled many of my elderly patients becoming first-time photographers, book club members, overseas travelers, knitters, exercisers, community volunteers. They became mentors to troubled youth, part-time teachers, learned new cooking skills, got politically involved, took online courses to learn about medieval history or modern art.

Objective scientific assessment could only conclude these elderly people were growing. And, yes, they were growing older.

Unfortunately, not all senior citizens embrace the opportunities which open as the years accumulate. Some are unable to because of physical limitations. But others opt to rest after many decades of hard work. Or they prefer to dwell in the seductive lands unspooling on television and social media. They are getting older but not growing older.

*    *    *

I continue foraging  down the path. Day by day, step by step. As I do so, I have learned what lies ahead is not strictly a process of simple subtraction. The equations of my future years can incorporate the process of simple addition.

And this is already underway. Since retiring, my wife and I travel more. We volunteer for Meals on Wheels. Spend more and better time with our grandchildren. Are active in voter turnout efforts. We gave Covid-19 vaccines at a local community clinic for six months. I teach medical students. Exercise more consistently. Joined a city commission on sustainability. Started a blog.

Of course some growth activities remain off limits. I refuse to sign up for art appreciation classes. Learning to crochet is not on my bucket list. Ballroom dancing is a dicey proposition because I would like to avoid fracturing my wife’s foot bones. The jury is still out on pickleball.

But novel opportunities abound. My challenge is to pick wisely among them.

Thanks to my fellow travelers, I have come to understand that whether to get old is not a choice. Whether to grow old is.

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September 2022

By Richard Fleming

An unusual feature of aging is the rapid acceleration of time. Each year goes by quicker than the preceding one. And much faster than those we lived through 5, 10, and 20 years ago. Astrophysicists advise us that time is not a fixed concept. As an object accelerates and approaches the speed of light, time slows down. And conversely as that object slows down, time moves more quickly. So it should not be surprising that for humans too, as we grow older and our rate of speed slows down, time speeds up. It is just basic astrophysics.

In my early years of practice, older patients often told me about this phenomenon. Most presented it as a complaint, a discriminatory experience. People in their 70s and 80s said how unfair it was that time accelerated as they aged. Time should be prolonged, not abbreviated. I sort of understood what they were reporting, but it did not really hit home until I was around age 50. After I had accumulated a half century’s worth of living, I began to notice this basic principle of astrophysics applied to me also. The interval between major holidays appeared to shorten. The time between birthdays shrunk noticeably.

Seasons began to fly by. In the old days, autumn – my favorite season – would shape the land for three months or even longer. When I was young, I loved to be outside as the temperature gradually cooled and leaves lazily turned to red and gold. Trees slowly shed their ornaments, and birds I had seen throughout the summer flew off and away. My friends and I played touch football in Topeka’s Edgewood Park, a short walk from where we lived, and the games seemed to go on for hours. Dusk gradually came earlier, but each day lingered for hours.

As I grew older, I noticed autumn growing shorter. No sooner did I start enjoying the magical fall transition than it was over. Trees grew bare quickly. The world assumed the gray hues of winter before autumn even matured. Time accelerated before my eyes. In grade school, an autumn weekend day would last forever. Now that I’m in my 70s, these same days vanish before I even take a deep breath.

There are other ways to understand the startling compression of time as we age. For example, when I took American history in high school, the country’s existence seemed to extend back for centuries. Because that was actually true. So much had happened. We studied our country’s major military conflicts, including the Revolution, the Civil War, and two World Wars. These conflicts were meaningful parts of our history, even though they were so ancient.

But aging casts the unspooling of history in a different light. I recently realized I have been alive for 29% of the total time the U.S. has existed. I have been breathing, living, and walking the earth for well over one quarter of the years since the country’s founding. (Am I being optimistic or pessimistic if I round this off to about one third?) I’ve been alive 45% of the time since the Civil War. That is close to half! It turns out the Civil War did not end all that long ago. OK, since I’ve piqued your curiosity, I’ve been alive for 68% of the years since the end of World War One. Don’t even ask about World War Two.

What happened? Where did time go? There are so many things I’ve been intending to do. I need to face the reality I won’t have time for them all. So many books will go unread. Those novels incubating in my brain will go unwritten.

I’m not full of despair, though. Not at all. I have done many things, seen many places, and read many books. I had a rewarding career. I’ve maintained many friendships, including a group of friends from Topeka I’ve been close with for over 60 years. I’ve been a good husband, step-father, and grandfather, and am proud of the family I’ve been part of building.

But there is always more. Always so much more. Why didn’t I manage my time more efficiently? Why didn’t I listen to those wise elders who told me a few decades back to not wait on things I wanted to accomplish. Or did they offer that advice just a few years ago? Time is amorphous, unstable, illusory. Clocks try to fool us. Calendars are deceptive and dishonest. Wristwatches are liars and cheats. Trust me when I say that none of these markers of time can be trusted.

So what lessons can I draw? While I wish my years ahead would be more and longer, I am where I am. Aging is helping my ability to focus. I will concentrate on fewer, more meaningful goals. I have months and years ahead and much life yet to live. I have memories still to create, both for myself and my family. And when my time comes, these memories will be the main legacy I bequeath to my family and loved ones.

Yes, it would be nice if time would slow down as though I was approaching the speed of light. But it can be fulfilling and rewarding to live fully at the speed of life.

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August 2022

By Richard Fleming

It may seem strange, but I feel I missed middle age. What happened? Where did it go?

I’m 71. For most of my life I have felt fairly young. I have been full of energy and confidence. Life was rich with possibilities. Middle age always seemed a nebulous concept, off in the distance. It was the gateway to old age, and I certainly did not feel I was approaching that threshold. Middle aged people lacked energy and mental acuity. This was not how I saw myself. While I didn’t spend a lot of time dwelling on precisely when middle age started, it always seemed to be five or ten years beyond my age at the time.

When I was in my thirties, middle age seemed to apply to those 50 years old and above. In my mid-forties, I still possessed vim and vigor. I assumed middle age would probably hit in my early fifties. But when I reached my early fifties, I certainly did not feel middle aged. It seemed middle age might drop onto my shoulders when I hit 60. You know, the age when folks often start having more aches and pains. When they become less sharp and snappy. But when I made it to 60, I still did not feel middle aged. I was blessed with good health and an active mind. I did not feel I was standing on the threshold of old age, and decided middle age must start around age 65.

It was when I applied for Medicare shortly before turning 65 that the erosion of the brick wall of denial began to accelerate. I looked in the mirror and the marks of a long life, well lived, were etched permanently on my face. My stamina remained reasonably intact but I noticed yard work was more taxing. It was increasingly hard to think of myself as a mature 50 year old. Reality forced me to accept I had finally left the realm of youth. And decisively so. My Medicare card brooked no equivocation. My game of dodge ball was over.

And I began to see increasing instances of newspapers and other media identifying “seniors” and “the elderly” as those 65 and above. Sometimes even 60 and above!

Truth became even harder to avoid when the covid-19 pandemic hit. In discussing risks from covid-19, news sources identified those 60 or 65 and above as being at highest risk of complications. This age group – my age group – was being labelled by physicians and epidemiologists as elderly! Wait, I wanted to shout. How could members of my own profession, physicians, betray me in such cavalier fashion? I was just beginning to accept that I might be entering middle age. Was I expected to suddenly, with no advance warning, accept being viewed as a senior citizen? Something was desperately wrong here.

As I reflect back on why I missed middle age, I think it is because the idea of middle age gets precious little respect. Youth is a valued concept. Young people are full of energy and potential. They enjoy their lives with few limitations. They are the engines of our culture, society, and politics. They are the genesis of our future.

And as far as seniors are concerned, they too are treasured in many respects. They are solid and stable. They serenely carry the weight and responsibility of history. Sometimes they are viewed as wise. And they are exempted from many societal responsibilities, like working, building families, and paying into the Social Security Trust Fund. They even get discounts at movie theaters.

But middle aged people? For too long, I thought they had little value. They had lost the virtues of youth and were yet to acquire the dignity of the elderly. They lingered precariously at the gateway between youth and old age, looking wistfully back at a past which cannot be reclaimed. And yet they were also not eligible to apply for the benefits and respect accorded the golden years. Who would want to claim the mantle of middle age?

But wait. Now that I am an officially-certified senior citizen, I feel much more positive about the virtues of middle age. Those inhabiting this oft-neglected stage of life’s journey survived the impetuosity and risk-taking of youth. And… they are not yet elderly. Though senior citizens are intrinsically virtuous, there are unavoidable downsides to the golden years: mental and physical frailty, financial insecurities, constricting social circles. And a dwindling desire to take advantage of senior discounts at movie theaters.

I have now decided I was wrong to view middle age as the crazy uncle in the attic. Each time of life is precious and should be cherished, even middle age. In fact, I’m beginning to consider claiming the identity of middle age for myself. Just as the entry point into the middle years is poorly defined, the exit point of middle age is also murky. Maybe I’m not too late.

But no, this would not be a viable claim. It’s time – nay, it is past time – to accept my station in life. I am unavoidably, irretrievably, irredeemably, old. I need to come to terms with this reality. Middle age is receding in my rear view mirror.

Who knows, maybe I’ll set a stretch goal. What if I move beyond tolerating being old to actually embracing this stage of life? Many of my elderly patients were able to do so. Why shouldn’t I?

Therein lies my challenge.

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June 1993

By Richard Fleming

Among my tasks as a doctor are helping the elderly come to terms with the limitations of old age, and assisting terminally-ill patients and their families to accept death. Patients and family members tell me I am good at this. I discuss “No Code Blue” designations (orders not to take extreme measures to resuscitate a patient in case of cardiac or respiratory arrest) and make sure affairs are in order with an appropriate mix of compassion and objectivity.

Lately, though, I have begun to feel like a hypocrite. My words of comfort to the aged and dying sound increasingly hollow. Even as I speak them, my reassurances are contradicted by a small voice inside my head saying, “Fool! There is nothing good about growing old. Aging gracefully? Hah! What rubbish! And death. Who would ever be ready to die?”

The days go by, and I continue to carry out my responsibilities as a physician, but a weird role reversal has taken place. Probably no one else sees it, but I am now the one seeking reassurance from my elderly patients that it is OK to grow old and there is nothing to fear from death.

Why, I ask myself, has this issue become a concern for me now? After all, I am only nine months into my 42^nd year and my health is good. So why now? Maybe this is part of the notorious midlife crisis, a phrase I have always despised.

Yet that is where I find myself – halfway through. Though not consciously planned, I find myself reflecting, thinking about the goals I have met, the goals I haven’t met, and those goals I never set. It is a time for taking a personal inventory, to examine the good and the bad. A successful career. But maybe I could have done better. Some good friends, yes, but not as many truly close ones as I would like. No major medical problems, as far as I know, but aches and pains are more persistent.

Time accelerates every more rapidly; each year is shorter than the one before. I fear I will never reach the point where I have lived enough of life that I will be at ease with letting it go. It seems too difficult a challenge. Life is so rich with color and meaning and potential – how can aging and death be anything other than premature?

Anxiety would overcome me if it was not for my daily interactions with the elderly, those time travelers who have reached their 70s, 80s, and 90s. In what appears miraculous fashion, they counter the indignities of old age with dignity. I don’t mean this to be patronizing, but the vast majority of the elderly I work with seem so pleasant, so even-tempered, so calm. Whatever rough edges they may have had in the past – selfishness, insecurity, anger, despair – have often been smoothed away by time.

It is not that the elderly have such easy lives. Many face chronic medical problems, financial insecurity, loneliness, and isolation. And it is not that they look forward to further aging and to death. But they seem to have reached an accord with life and the inevitability of death that is beyond the reach of those who are younger.

“When death comes, it comes,” said a 78-year-old retired carpenter.

“I don’t know, I guess I’ve lived a pretty full life, and I’m ready for whatever comes,” said an 83-year-old with four children, seven grandchildren, and great-grandchildren too many to count.

I am baffled by these sentiments. Don’t these people understand what they are saying?

What accounts for how readily the elderly consent to their terrible predicament? This acceptance encompasses both the healthy and the sick, the religious and the nonreligious, those with strong networks of friends and family and those without. The answer is not to be found among these characteristics. Instead it seems intrinsic, something acquired by virtue of having lived for so many years. It is as though the elderly have crossed into a foreign land, a strange world where the requirements for citizenship include a birth date before 1920 and a quiet understanding of the realities of life and death.

I long to know this mysterious world and, I confess, it is not so that I can be a better doctor, but for reasons very selfish and personal. In my encounters with my elderly patients, I carry on as before, but with a new, hidden agenda, a desire to understand the world they inhabit. My questions to them sound no different than before.

“How are you making out at home with that new walker, Mrs. Peterson?”

“Well, Mr. Sandberg, have you given any more thought to that talk we had last visit about moving into the nursing home?”

But what I strain to hear are not merely the responses to my questions but something more. I seek clues to the puzzle of why the elderly are so accepting of themselves and how this came to pass. In so doing, I am really looking for something inside myself, some aspect of my personality or some experience that will allow me entry into that land of mystery.

I suppose I could be patient and dutifully await my turn. At age 70 or thereabouts, I will somehow acquire a visa providing admission into the nation of the elderly.

But I don’t want to wait! I’m insecure today and want to understand now. I want my own rough edges rounded off. Why can’t I cheat time? Why should I have to wait another 30 years to know my fate?

My next patient awaits. It’s Mrs. McCarthy, an 84-year-old diabetic with a heart condition. Maybe she will have the answer. Maybe she can provide me what I need, reassurance that I too can embrace the coming years of tempered expectations with some degree of peace.

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