Aging can be a constant process of contraction, contracting function, contracting friendships and readjustment to new realities. It can also be a time of renewed interests and exploration. One of the realities to which we must adjust is the prospect of dying. Dying is not so much an event but a process which we experience throughout our lives, but it is much more evident as we age. It is unavoidable, and we must come to terms with it. Most of the time, we go through life as if we had infinite time, waiting for good things to happen and hoping that bad things won’t. If misfortune befalls us we curse our bad luck and hope that it will go away soon. When life pleases us, we hope it will go on forever. But life is constantly changing. Neither the good nor the bad last forever. However, that we will die is a constant.

How can we come to terms with dying, the ending of our existence on earth? Obviously there is no one answer. From different religions and different belief systems there are many different views about what happens when we die, from our “going to a better place” to being resurrected in a new form to simply ceasing to exist. Many of us say we simply don’t know. However I view death, its prospect makes me more serious about life. Suppose you could live forever; there would be no urgency to living, nothing to make us appreciate the wonder of life.   The inevitability of death makes me want to use the time that I have to the fullest and to appreciate the people and the things that are meaningful.

To paraphrase Frank Ostaseski, a Zen master and counsellor to the dying, the only way to prepare for death is to live life to its fullest. “Don’t wait”. Whatever you can do or think you can, begin it. Death will come when it does in whatever form it takes. Rather than worry about how I will die, I want to focus on how I live. Some denial, probably, but it encourages me to make good use of the time that I have.

I find myself much less attached to the accomplishments of the past and interested in how I can contribute to the present, not necessarily through great or notable deeds, but in a more personal way.

For me living life to the fullest looks much more like engaging genuinely with people that I care about. We spend so much of our life living out roles that we created when we were young as ways that we thought would get us the approval and affection of others. We learn from early experiences that certain behaviors will please our parents or teachers, and that a certain persona is necessary literally to survive the circumstances we live in.   At the extreme, a young man growing up in a neighborhood where there are gangs will learn that having a tough exterior is the only way to keep from being abused or even killed.

So as I age the question is how do I want to live, really. I learned as the oldest son of an immigrant father that I had neither a father nor an older sibling to introduce me to the things that seemed so important at the time, sports and fitting in socially. My friends played ball with their fathers, went on camping and fishing trips and seemed confident about their place in the world. I decidedly didn’t. I felt like an outsider, something that has stuck with me all of my life. For a while, I hung out with the dropouts because I wasn’t part of the “in crowd”.   When I tried to participate in sports, I had some notable failures that made me gun shy about trying again. I saw myself as “other”, formal and careful about what I said or did.

At some point, I found a place where I could be successful. By being a good student, I opened a new set of possibilities, particularly as I reached that point in high school where preparing for the future became important. I found that being “smart”, competent, predictable (at least on the surface) and being knowledgeable were traits that others valued, and they developed as my adult persona was formed. These are not bad traits. They contributed to many of the successes in my life, but they didn’t encourage a fuller exploration of what was possible in my life. As most people do, I conformed to a role that was imbedded from my childhood and reduced the opportunity for growth and limited the ways in which I could engage with other people.

I have had a good life. I have been fortunate, and I’ve had a reasonable amount of success. At eighty I’m not going to fundamentally change my stripes, but I hope to get freer from the limiting myths about myself, that I have to be careful and hold myself at a distance from others, that I have fundamental shortcomings, ways in which I feel that I am flawed, places that I don’t go. What I found is that when I strip that away the self-protective armor, what’s left at the bottom is a genuine desire to engage fully with people,  to appreciate who they are and to appreciate the every day beauty that surrounds me. I have lost many of my physical capabilities, which makes what I can do all the sweeter. Rather than waiting anxiously for the end, I would like to engage fully with the present. I don’t know what the final days will bring, but while I have days, I want to use them well, even if it is just in little ways.

It is also important to bring closure to the scars of the past, to put to rest the resentments that I have had and to make amends with those that I have hurt, in other words, while living as fully as I can, to close the books on the past. This isn’t always easy to do. Some of the key people are dead or estranged. For example, I was angry at my father for not participating more in my life and for being an immigrant, not like my friends’ fathers. However, what I’ve come to realize is that he was imperfect like every one else’s father, and that he gave me a great deal of love and encouragement. If I take an inventory of my life, there are many hurts, resentments and regrets that I have. One cannot settle them on one’s death-bed; it is unlikely that there will be time or capacity to do so. “Don’t wait.”

So for me the recognition that I am dying is an impetus to live life more fully and to do things that are new and to explore relationships more fully and settle with the past. That is plenty to keep me busy.

Falling Into Grace Part 2

Falling Into Grace, Part 2

Rehab, Rebuilding Lives: As an acute medicine doctor, I realize that I haven’t had a clue as to what went on at a rehabilitation center. If you had asked me before to describe the role of physiatry, I would’ve been at a loss to do so. Rehabilitation medicine is truly an example of some professionals’ dedication and devotion to helping others reclaim their lives. It is a noble and, I believe, a satisfying, profession. As an acute care physician, I focused on dealing with short-term episodes of care, leaving the patient to manage most things on their own. However, when illnesses are devastating to one’s functioning, that doesn’t suffice. When I entered the hospital, I was unable to do virtually anything. Eating, moving, bodily functions were all things that had to be cared for by other people. I had to be re-taught how to do most things including the simple things that most of us take for granted. The incredible skills of the rehabilitation specialists are what has carried me through. Their kindness, devotion, encouragement and perseverance are an expression of one human being’s love and devotion for others. It requires skill, great patience, optimism and deep caring.

The Invisible People: As skilled as the neurosurgeon and rehabilitation professionals were, the unseen, anonymous nurses aides and technicians were also essential to my recovery. In this facility, many of them are people who grew up in poverty and/or were refugees from other countries who were working to become a part of the national economy. They often do the dirty, unglamorous job of taking care of the basic necessities of people. I’ve met people who grew-up poor in the United States, boat people from Vietnam, people who immigrated from the Philippines, Ethiopia, India, Indonesia – all of them have a similar story. They wanted to start up the economic ladder from  very modest positions, and, almost all of them are working full-time jobs and going to school at night, or on weekends, to better themselves and create more opportunity. Several of them have been on truly heroic journeys. One I recall in particular is a nurse who was born in Vietnam and whose family escaped by setting out to sea in a small open boat, his family trusting that they would find some form of rescue. They were fortunate in finding a barge that picked them up and took them to an America military ship. They were taken first to the Philippines and then to Guam where they lived in a refugee camp for some number of months. They were then transferred to Arkansas and eventually found a placement in St. Louis. The young person then did odd jobs and construction to help earn money for the family. Finally, he managed to attend nursing school part time and eventually get his nursing degree and began to work. His story is just one of many that are similar. Many of them work on the margin with families to support and kids to take care of. I call them invisible people, because most of us hardly register that they are there, but I will tell you that the hospital wouldn’t operate without them.

This is a story that has a long way to go, but I will forever be grateful to the people, professionals, family and friends who have supported me through this odyssey.