My work gives me some insight into the lives of others. Not being able to travel these days (and who knows for how long), having different kinds of people come to the clinic is another horizon-broadener. In a fundamental way, I believe we are all more similar than different, but my podiatry chair sits me in a privileged perspective to witness a wide spectrum of human life. Life, that is to say, as the cards one is dealt, in addition to Life - with another capital ‘L’ - as the game one brings to the table.
Burdens to Bear
Just as I see the same foot problems over and over, I am afforded glimpses of general life problems. The problems of the various demographics; they do come in classic sets. Teenage problems, problems at work, money problems...marriage problems, single person problems, problems with health. Problems that the same demographics have had (to some degree) in every previous generation. Problems swapped one for the other through life.
Some problems are sought out voluntarily. Other problems are sheer black hole problems that have been fallen into. To try to retrospectively untangle the proportions of ‘voluntary’ from ‘falleness’ is problematic itself. Trying to attribute what percentage was ‘you’ versus ‘what happened to you’: it’s a waste of your grey matter.
Twenty-twenty hindsight might now wince at the ‘decision’ to ‘choose’ the mortgage and 2.7 kids - it must have seemed like a good idea at the time - but on the face of it, this was your idea. At least this boulder on your shoulder will be easier to make meaning from than a burden unexpectedly loaded on you. And while there will be unexpected burdens to bear, the relatively chosen problem - if you have been lucky enough to choose it - will not be as notorious to emerge from as are black hole problems that you are unconsciously sucked into.
“The truth is, everyone is going to hurt you. You just got to find the ones worth suffering for.”
- Bob Marley
And leaving choice aside, there is inevitable old age; the twin assault of gravity and time will sag your face and bend your spine. In my clinic room, I get to see how the elderly - reliably called ‘the oldies’ here - cope in their dotage. Sometimes - if they’ve received a terminal diagnosis - I see how they approach the last challenge and chapter of life.
In the first few minutes of my thirty minute sessions, my elderly patients will sigh in resignation about their specific foot problem. This is what they came for in earnest, but they’re not entirely hopeful. “It’s just old age I suppose”. More age-associated struggles are soon revealed further up the body; Bad backs, botched hip replacements, fading eyesight, faulty hearing aids.. “Bit of advice”, my patients will conclude while sitting in my chair; “never get old”.
“Have you tried orthotics?”, I venture, trying to veer them back to the issue at hand while checking their familiarity with shoe inserts.
“Oh yes dear, I wear them all the time”.
Oh right. And how do you find them?”
Oh fine. Obviously, they come out with my teeth, but that’s only when I’m eating”.
Darkness into Light
I will try to diagnose and manage their specific foot problem as they talk. Usually they talk more than me. Shiny happy people are more of a pleasure to interact with, but those who have won the lottery bestowing that level of happiness are rare.
In many cases, the limit of my intervention will be toenail-cutting. Sometimes, in attending to their feet, my attentive listening will be the most appreciated thing. In quieter moments, away from the conveyor belt of patients, I realise there is a privilege too in listening to people who aren’t doing so well; those who are speaking vulnerably with you, and who otherwise don’t get heard. The quality of your attention here goes a long way. In sitting with someone, just as in painting their portrait, the sitter’s darkest parts respond most strikingly to the added contrast of the lightest light.
Progression to Childhood
I also enjoy those contented old patients who have long ceased caring what people think of them. They have thrown off the shackles of self-consciousness, and like a child’s un-self-consciousness, their directness can be a breath of fresh air. I'm thinking of the sprightly ninety-something great-grandfather who I recently asked what his secret was. With his sixty-something designated-driver son in the room, the old man didn’t miss a beat: “Loads of great sex”.
Perhaps because sex is finally off the table (but perhaps still on the bed), it seems to take centre stage in the humour of extreme old age. It is usually the butt of my eighty-six-year-old patient “Mary’s” jokes. The same singular joke, that is to say; forgotten about between visits and reliably re-told just before leaving my clinic room: “What” she asks me then, “do sex and bank accounts have in common?” I chuckle, knowing the punchline, but grateful for Mary’s determination to bring back her sense of humour into the room.
“I don’t know Mary. What do they have in common?”
“When you withdraw, you lose interest”.
And all the old folks would agree that they must not lose interest in life itself. Vitality is a key ingredient; an antidote against disinterestedness and inevitable deterioration. It is why the ninety-seven year old inspiration, “Michael” still works out at the gym every day. It is why so many others who still live a life of quality, exercise a positive attitude. Coming to each day with the right attitude remains a necessary buffer against the never-ending vicissitudes. To lose the positive attitude is to lose interest. To lose the interest is to give up. The giving up - at any age - is death.
“At the moment of life is death; at the moment of death is life”.
- Zhuang Zi (Taoist thinker)
The Luck of the Draw
There is always the unforgiving lottery of circumstance. Grace is not equally easy for everyone. While my most unfortunate patients still emphasise the importance of mustering a positive attitude, lady luck can erode the most resilient heart.
Take one of my patients in severe chronic pain. “Joanne” arrived in tears from the sleep-depriving pain of abdominal plaques (caused by psoriatic arthritis). I soon learned that she was, in a former life, a former world-top-ten tennis player, and coached tennis for literally as long as she could stand. Now seventy, not only does she have to stomach her treatment-resistant pain, she must somehow cope with her rheumatic joints attacking themselves, life in a wheelchair, and having someone like me cut her toenails.
The occasional patient has been dealt such blows that have left them ‘old’ before their time. Take one of my 57-year-old patients, a deaf woman from birth, with a long history of ill-health and a still-cancerous liver. Last month, her husband’s psychotic break led to her being beaten black and blue, with broken ribs and damaged spinal nerves and waking up the following afternoon in the garage. Her husband was institutionalised.
Many philosophers balk at the idea of eternal life. Sooner or later, they say, a never-ending life would become hell. In this hell, they emphasise that you must remain a regular witness to the death of every mortal loved one around you. And so it is in my very real encounters with elderly mortals; they have already suffered multiple major losses.
In the rarer cases where wives depart first, a widower will often reminisce on the time they spent with their wife. Their nostalgic tales amplify their current feelings of disconnection. A few of the widowers speak candidly of their loneliness. “A loneliness” one of them remarked, “that I wouldn’t wish on my worst enemy”.
The Lost Minds
When it comes to end-of-life problems, perhaps a worse set of problems than those of the lonely widowers, are those of the old carer-spouse. These unfortunate souls must watch helplessly as the better parts of their loved one waste away, slowly but surely, from dementia. Though only the third most prolific cause of death, dementia (with all its subtypes) is, for good reason, the number one most feared disease. Neurological research investigating dementia is finding that the functional abilities of dementia patients tend to deteriorate in a similar way as young children acquire these abilities. Below is a description of this ‘retrogenesis’ (meaning backward-beginning) in practice:
“At the age of 12 and above, children have the ability to hold a job, as working people at the very early stage of Alzheimer’s would insist on doing. At the age of eight to 12, children can be trusted to handle simple finances, as people with mild Alzheimer’s also do. At the age of five to seven, children can be counted on to select proper clothing for themselves, and people with moderate Alzheimer’s likewise determine their own fashion preferences. Around the age of four, children start to brave the toilet independently; people with moderately severe Alzheimer’s often retain that ability, too. At the age of 15 months, children can speak five to six words, and people with severe Alzheimer’s are equally fluent. Younger than 15 months, infants exhibit reflexes important for survival, for example, turning their faces toward a gentle stroking hand or sucking whatever touches the roofs of their mouths. These reflexes are lost in adulthood but regained in severe Alzheimer’s”.
Every week, I help elderly carer-spouses to lift their daydreaming spouse from the treatment chair back into their wheelchair. By the wheel-chair-bound stage, their mind has deteriorated beyond recognition. Once I hold open the final door out of the clinic for the carer spouse, they will continue to lift their loved one into the car seat, and from one chair to the next, that day and every proceeding day, caring for them whether it’s a privilege or a pain, despite their own bad back, and all the while seeing less and less flickers of remembrance in their spouse's glazed eyes.
The age-old struggles of old age are not news. They are in store for you and I at The Supermarket of Life Which Offers No Choice. My podiatry clinic chair is simply a front row seat on these natural evolutions of life. The inevitability of it all is, like my patient's feet, in my face.
Each man's death diminishes me, for I am involved in mankind. Therefore, send not to know for whom the bell tolls, It tolls for thee.
- John Donne
And while you’re not supposed to have favourites, my favourite podiatry clients are those rare old-timers that seem to be able to grow old gracefully. These oldies still face the changeable aspects of life with courage, but have somehow learned to let the unchangeables slide with serenity.
And while growing old gracefully is definitely not as easy for everyone, there are lessons to learn from those who do it well. They have grasped that the real lessons of dying are about making the most of life. Much better to have begun practicing this fuller life fifty years earlier, but the next best time, they realise, is now.
“Only boldness can deliver from fear. And if the risk is not taken, the meaning of life is somehow violated, and the whole future is condemned to hopeless staleness.”
- Carl Jung
Those who grow old gracefully have tried. They have taken more meaningful risks; have less regrets. They are not interested in growing older merely for the quantity of life. On their self-created map of meaning for navigating the world, they have orientated themselves toward their own true north of quality. In this way, their small everyday steps create everyday meaning in this existential game of life and death.