Stanley M. Bierman, M.D., F.A.C.P. (C2004)
The choice of aging as the subject for an essay began to percolate through my brain at 4:00 A.M. one cold spring morning. Tiptoeing quietly to the computer so as not to awaken my wife or disturb Coco, my chocolate-colored Labrador, I began to type. I succeeded in writing only a few sentences before stopping the project in frustration, and returning to my warm bed. For the life of me, I could not decide what I wanted to say about aging, but chose to wait another day for the muse to whisper inspiration in my ear. Several weeks passed, and I contemplated dropping the task as being too formidable. But the challenge presented in capturing my thoughts on the subject seemed too beguiling to pass up, so here goes:
I deeply resent it, but am powerless to stop the chronological clock that dictates that I am growing older. This isn't to say that there are not certain advantages to aging. I most enjoy the courtesy and deference shown by young people. This is a simple accomplishment which deed generally comes to most individuals with graying hair. I also appreciate half-price admission paid at most Westwood movie theaters which have determined that at age seventy I truly am a senior citizen. Above and beyond these few privileges, aging, I concluded, wasn't so damned terrific.
Some would contend that with advancing years, we can better enjoy the bountiful blessings that hard work and industry have sown: home, children, and a degree of financial security. It also can be said that with age comes an opportunity to travel, read books, relax on a Sunday afternoon without the relentless demands of professional responsibilities imposing on leisure-time activities. I guess it is a mixed blessing to have the children out of the house, and successfully pursuing their own lives and careers.
What I really don't like about aging is the biologic changes that come with this natural process. My hair grows grayer and is beginning to recede a bit at the temples. The lines around my eyes grow more prominent, and I can't read worth a damn without prescription glasses. The post-coital refractory period takes an additional day or two (or three) to gear up before the passion returns. I complain more bitterly of every minor ailment that assails me, and puff when I walk up a single flight of stairs.
Some people age gracefully, and are attractive and appealing well into their seventies and eighties. My dear mother recently passed, was a beauty at well into her eighties. She retained the charm and good looks of a woman half her age. For others, time is crueler, and the sun-baked skin, pigmentary spots, crow's feet, drooping eyelids, varicose veins, abdominal pouch and other corporeal failings of middle to old-age are downright uncomely.
How wonderful, I thought, to be like Dorian Gray and be forever young and handsome, with only a picture of myself to grow old! Movie stars, in a way, have found a means to be timeless. They are captured on film, and this frozen frame of celluloid brings their chronological clock to a halt. I sometimes watch old-time movies on television and see a debonair Clark Gable, rakish Cary Grant, dapper Fred Astaire, shapely Betty Grable or stunningly glamorous Rita Hayworth. The men appear so suave and sophisticated, and the women so alluring and beautiful on screen. But they are long gone, because their biologic clock could not be stopped.
I thought for a moment, suppose that a time machine could be constructed to return me to a previous era in my life. Hmmmmmmm! Were I to possess that particular travel device, I don't think that I would want to be a teenager again. Life was damned difficult then: I was overly preoccupied thinking about sex, I had a bad case of acne, and was nervous and insecure. College at U.C.L.A. was really tough and exacting, and it was a trial to maintain high grades to get into medical school. My twenties and early thirties were devoted to medical education and residency training in dermatology, and that period of my life was physically and emotionally exhausting. My mid-thirties and forties were given to career building, and the times were both demanding and sometimes frustrating. The fifties saw a sudden and prolific surge in scientific writing and the development of a certain degree of wisdom from my confrontation with life and living. The more I thought of it, the more enticing becomes the idea of finding a means to stop the chronometer right here in my early seventies. Life for me has finally begun to be less stressful and surely more pleasant than in earlier years.
Nevertheless the relentless clock continues to tick. My wife of forty-eight years must visit the beauty salon more frequently to dye the gray from her red hair, and the fine lines around her lips show prominently despite the use of Retin A.
I have often shared the story with patients of an encounter that I had with Vidal Sassoon, the hair stylist. A youthful, dynamic man well into his fifties when he first visited me, we began talking about the subject of aging. "How old would you be," he inquired, "if you didn't know how old you were?" A damned good question I replied. His simple query seemed to be a clever observation on the physical aspects of aging, as well an imaginative insight into the psychology of this natural process. It seemed crystal clear that chronological and biologic aging must be considered as two quite different phenomena. I might be seventy years old but I feel (sometimes) like I am thirty.
Well then, against this particular backdrop, I guess growing old actually does not seem quite such a terrible tragedy. It would be nice, I thought, to grow a little bit older and be, say, seventy-one or maybe seventy-two, or maybe seventy. Even better, perhaps, it might not be altogether terrible to become a healthy and hardy octa - or nonagenarian. That is really the crux of the issue. Since I have no real choice in the matter, I have decided that I should concentrate on being healthy and happy, and forget about that damned clock. I am now attempting to grow old gracefully, and hopefully doing so with some style.
A PIECE OF MY MIND: DEATH AND FANNY'S RED DRESS
Stanley M. Bierman, M.D., F.A.C.P. (C1993)
I guess one reason that I became a dermatologist relates to events that transpired during my internship when I was required to deal with critically ill patients who were dying of advanced cancer. Some individuals succumbed following a lingering course while others died swiftly of their illness. I determined that I was just not emotionally suited for internal medicine. Dermatology seemed to be a specialty where most patients were healthy and rarely died of their skin affliction. I have since concluded that my personal aversion to treating dying patients relates to an unwillingness to acknowledge my own mortality!
Nevertheless, death is inevitable, and I have set aside a small corner of my conscious mind to the event with a blend of realism and personal resignation. Of the many dramas of death and dying that I have witnessed in 45 years as a physician, perhaps the most poignant, if not uplifting, story to be told is that of Fanny and her red dress.
Louis "R" was a 96 year old male whose wife, Fanny, died recently of a stroke. Sitting behind my desk several months after his wife's passing, I expressed my condolence to the surviving widower. Apologizing for taking my "valuable" time, he expressed his wish to tell me a story about his wife's last hours. I listened intently.
Louis and Fanny had been happily and joyfully married for 71 years. At age 95, Fanny was truly a handsome woman with a ready, warm smile. She dressed immaculately, was carefully groomed, and had about her a special grace and charm. She was actively involved in community affairs notwithstanding her age and few infirmities. I was her dermatologist for over 15 years and had inveigled from the pair an invitation to attend their hoped-for 75th wedding anniversary.
One day Fanny sustained a bad fall and injured her wrist. The fracture was slow in healing. After many months of limited activity, she concluded that a simple broken arm would not keep her from returning to her regular activities. A charity affair was scheduled at a Beverly Hills hotel. Dressing herself in her brightest and most alluring red evening gown, Fanny departed with her husband for the evening's festivities.
The two were seated near the dance floor. The band was playing romantic oldies and goodies, and Fanny and Louis danced a careful fox-trot prior to sitting down for dinner. Louis proceeded with his meal, diverting his eyes for a moment to watch other dancers on the floor. When his gaze returned to his wife, she was slumped backward on the chair. Fanny was dead! The emergency team was unable to resuscitate the stricken woman who was brought to the Century City Emergency Room.
I was puzzled by the matter-of-fact manner of the patient's recitation of his wife's death and the apparent lack of anguish, emotional pain or disbelief that characterizes most periods of bereavement. I, personally, had perceived his narrative to be a sad story: a marriage of 71 years had tragically ended with a cerebrovascular accident. Louis, however, had another view of events. While my own eyes were misted with tears, there was a gentle smile on the nonagenarian's lips. He turned to me and said, "You know Doctor Bierman, we had a wonderful life together. I miss her very, very much, but she did not suffer in her last hours. Did you know that when I looked at my lovely wife at that terrible moment, she had a smile on her face? I feel no remorse. Fanny died wearing a bright red dress!