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Plea for Better Care

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Losing weight needs application. So does learning French. But not wrinkles. They appear by themselves, no effort required.

As they arrive, so does receding hair, an expanding waist line in men, thighs in women, spotty hands, arthritis and other aches, plus forgetting the name of the movie you saw just last week. The whole basket is free of charge.

And it all falls under the heading of aging, the subject of an important new book, by Atul Gawande, a writer and surgeon at Brigham and Women's Hospital in Boston. The book is called "Being Mortal" (from Metropolitan Books), and it begins with, "I learned a lot of things in medical school, but mortality wasn't one of them." Starting to tackle that subject as physician, Dr. Gawande notes how life span has changed over the centuries. "Subjects of the Roman Empire had an average life expectancy of twenty-eight years," he writes. "The natural course was to die before old age."

Not today. We age... and age. My Texas uncle died two years ago at 103, lucid and keeping up with baseball until nearly the end. He wasn't so unique, the old old being a fast growing segment of the population. All the same, Dr. Gawande writes, "When we study aging, what we are trying to understand is not so much a natural process as an unnatural one."

What does that mean for a physician? When the author asked whether gerontologists have discerned a particular pathway to aging, a geriatrician said, "No, we just fall apart." I suppose that even with good medical care and loving support of neighbors, that is what happened to my uncle, finally. He missed out on another baseball season,

Dr. Gawande relates many stories of people aging, including in his own family, often with a gradual decline, and how a physician deals with them. Handling a specific ailment is one thing; when the person has gone through the decline and approaches end of life status, the challenge is different. The easy out, often the temptation, is for a doctor to assure the patient of relief, even cure, when he knows there isn't one. At times this happens in answer to what the patient or his family yearns to hear.

To help a patient approach the end of life in a comforting and caring but not pointlessly optimistic way, is what Dr. Gawande advocates and what not many doctors are trained to do. Compounding the problem, the number of certified geriatricians, doctors specializing in the care of the elderly, has actually fallen in the United States. Until the time all physicians are trained differently, we can look forward to a shrinking supply of doctors to care for us in a loving way as we age further. I believe it means that we need to take responsibility for aging on our own shoulders.

How do we care for ourselves better, before reaching the moment when we beseech a doctor to give us hope? First is to work as best we can on staying healthy, with diet, exercise, perhaps meditation. Quit smoking if we haven't. And if we haven't done so already, learn techniques to gain pleasure in being solitary, as we may end up: reading, writing, walking, gardening, even doing needlepoint. (I went through that phase until there were no more people to give things to!)

We might attend a senior center for companionship and activities and mutual support with others our age, something it won't be hard to find. (The Romans probably had no need for them.) An unmistakable source of satisfaction is to do volunteer work with other seniors or young people, an antidote to loneliness as well.

And we ought to plan what our next step will be if we are unable to continue living as we do today.

Those aches and wrinkles plainly evident in the mirror give evidence that we've lived a good while and probably overcome roadblocks along the way. If we're on our own two feet (or even using a walker or wheel chair), feel the achy joints and be grateful to have been born well past Roman times. And take a good look at Dr. Gawanda's book

Stanley Ely writes about aging in his new book, "Life Up Close," in paperback and ebook.