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Summary
Author Notes
Dr. Sherwin B. Nuland was born Shepsel Ber Nudelman on December 8, 1930 in the Bronx, New York. He received a bachelor's degree from New York University in 1951 and a medical degree from Yale University in 1955. He decided to specialize in surgery and in 1958, became the chief surgical resident at Yale-New Haven Hospital. From 1962 to 1991, he was a clinical professor of surgery at Yale University, where he also taught bioethics and medical history. Before retiring to write full-time, he was a surgeon at Yale-New Haven Hospital from 1962 to 1992.
His books include Doctors: The Biography of Medicine, The Wisdom of the Body, The Doctors' Plague, The Uncertain Art, and the memoir Lost in America. His book, How We Die, won the National Book Award for nonfiction in 1994. He was also a contributing editor to The American Scholar and The New Republic. He died of prostate cancer on March 3, 2014 at the age of 83.
(Bowker Author Biography)
Reviews (4)
Publisher's Weekly Review
The septuagenarian surgeon whose brutally honest demythologization of death in How We Die garnered a National Book Award offers a mushier, platitude-filled treatise on aging, calling it a "gift" that establishes boundaries in our lives, making everything within those boundaries all the more precious. Brief, frank descriptions of droopy penises, declining hormone levels and loss of hearing and bone density are accompanied by reminders that stroke is not a normal consequence of aging and that our bodies are like cars and taking good care of parts extends their usefulness. A gushing tribute to pioneering cardiac surgeon Michael DeBakey, now aged 98, teaches the importance of knowing one's limitations and learning to function within them, while now-80-year-old actress Patricia Neal recalls how sheer stubbornness and a browbeating husband enabled her recovery from a debilitating stroke at 39. Nuland learned life lessons from two fans, a cancer survivor who understands that it's her response to adversity, and not the adversity itself, that shapes her future, and a formerly depressed octogenarian who now doesn't allow herself the "luxury" of despair. Although some of Nuland's devotees will be comforted by his hopeful if familiar advice, others seeking more of the bracing, defiant insights that made him famous will be disappointed. (Mar. 6) (c) Copyright PWxyz, LLC. All rights reserved
Booklist Review
In the penultimate chapter, on wisdom, Nuland says he hopes to avoid the great temptation of waxing ponderous. Too late. All too many of the preceding chapters are eye-rollingly boring in spots or, when they consist largely of medical and physiological data, almost throughout. At least there are no graphs; better yet, despite the subtitle, this is not a self-help tome. But Nuland is far too good a writer to give us a thoroughly dull book, and as we know from his previous best-sellers and prize winners, beginning with How We Die (1994), when he writes about his own experiences and particular people, his is as good as narrative nonfiction gets. Two chapters are outstanding; each of them is primarily a profile of an extraordinary person. One focuses on the greatest living cardiologist, Michael DeBakey, who remains professionally and otherwise active at 98. The other profiles the brilliant English eccentric Aubrey de Grey, who has made himself a one-man explanatory and promotional army for the notion that human life is vastly extendable and that maximum longevity is every person's most important right. A couple of other chapters containing portraits of vigorous survivors of severe disease incidents (stroke, heart attack, etc.) are pretty absorbing, and all the advice on aging is sound and unfaddish, despite being tedious. --Ray Olson Copyright 2007 Booklist
New York Review of Books Review
IS there an art of aging? Or is there merely aging, a condition over which one hasn't all that much control and in which one is hostage to one's genetic inheritance and financial resources, and dependent on friends and family members to help ease the way into old age and thence as gently as possible into that blasted good night? Sherwin B. Nuland, a professor of surgery at Yale, is committed to the view that there is an art to aging, that there are things most of us can do to make our later years better through maintaining good health, mental activity and important relationships. "The Art of Aging" is a curiously upbeat and optimistic book. I say "curiously" because until now Nuland has been a writer with a strong propensity for facing unpleasant facts and passing them along to his readers without trimmings. His book "How We Die" (1994) is a physiological description of death in several of its unattractive possibilities: through heart failure, old age, Alzheimer's, cancer, AIDS, murder and more. In its pages lungs fill up with water, oxygen is cut off, arteries collapse, livers enlarge, kidneys are poisoned, tumors grow, cancers spread, intestines do things you really do not want to know about. I read 150 or so of its gruesome pages before squeamishness prevented my finishing. I did read all of Nuland's "Lost in America" (2003), a memoir of his upbringing in an immigrant Jewish family in the Bronx. "Illness, death, financial struggle - these had been the accompaniments of their American journey," Nuland writes of the father, grandmother and an aunt with whom he grew up near Jerome Avenue. The book, which begins with the author in a mental institution with depression so severe that a lobotomy has been strongly recommended, is about Nuland's life with a difficult father who never came near assimilating to America, was an endless embarrassment to his children and, unbeknownst to him and his family, suffered for decades the debilitating effects of syphilis. The family name was Nudelman, changed to Nuland by the author and his older brother when they entered early manhood. The memoir is handsomely written, heartbreakingly sad and not likely to be forgotten by anyone who has read it. The unflinchingly lucid man who wrote "Lost in America" and "How We Die" puts in only a part-time appearance in Nuland's new book. "The Art of Aging" feels as if it has been written by two different people: one a no-nonsense medical scientist and the other a Polonius-like figure who delivers a series of sermonettes in the psychobabble of the day and whom, as I read, I preferred to think of as Nudelman. The gerontologists, Nuland reports, now speak of the "compression of morbidity," by which they mean holding off serious debility until as late in life as possible - not necessarily to increase life span but to make the last years of living as enjoyable as possible. On the physical side, the best method of doing this, set out in the pages of "The Art of Aging," will hardly surprise: avoid cigarettes and heavy boozing, exercise more, be circumspect in what one eats, keep mentally active. All this is reminiscent of George Santayana, in his early 80s, reporting his doctor's request that he lose 15 pounds so that he might be perfectly healthy, Santayana said, just in time for death. Yet of course, even after taking the most scrupulous possible care, one can still be stabbed by one of the many hovering cancers, struck down with terrifying diseases of the nerves (Parkinson's, multiple sclerosis, Lou Gehrig's) or rendered nugatory by one or another form of dementia. All this is quite unreasonable, but then apparently whoever's in charge - God, perhaps? - loves a joke. Owing to medical advances, public health measures, better diet and greater affluence, the average life expectancy in America has gone from 47.3 years in 1900 to 77.9 years in 2004. The number of people living to 100 or beyond rose from 37,000 to 50,000 in the brief period between 1990 and 2000. Nuland suggests it is even possible one day to imagine the age of 120 as a normal biological life span. People 65 and older, according to a report by the Department of Health and Human Services and the Department of Commerce quoted by Nuland, are "on the threshold of a boom" in health. A chapter of "The Art of Aging" is given over to a Cambridge University biogerontologist named Aubrey de Grey, who believes that, through manipulations at the cellular and molecular levels, death itself can before too long be all but eliminated. In measured prose, Nuland states his own belief that eternal life is a bad idea. "For reasons that are pragmatic, scientific, demographic, economic, political, social, emotional and secularly spiritual," he writes, "I am committed to the notion that both individual fulfillment and the ecological balance of life on this planet are best served by dying when our inherent biology decrees that we do." Not nice, in other words, to fool with Mother Nature. A SENSIBLE man, Dr. Nuland, but I wish he had held his co-author, Nudelman, in firmer check. This Nudelman is a preacher, an amateur psychologist, a nudnik not above quoting Kahlil Gibran on the importance of love and work to enjoying the later years of life. This Nudelman writes gushing profiles of the actress Patricia Neal (who is thriving more than 40 years after suffering a severe stroke at 39) and the pioneering cardiac surgeon Michael DeBakey (who kept up a dizzying medical career until he himself at the age of 97 underwent surgery based on his own innovations), idealizing both doubtless interesting people beyond reality, as well as mushily sentimental portraits of more obscure older people who have managed to enjoy life despite having been smashed by serious illness. Full of advice on how to be creative and caring and sharing, on growing and nurturing and finding "wellsprings" and "pathways" on our "journey" through life, this Nudelman frequently lapses into unconscious self-congratulation; and he certainly doesn't mind letting one know how sensitive he is. His interest in longevity has, alas, rendered him short on levity. He can write passages so purple that one feels one hears violins in the background and awaits slides showing sunsets out of the Barbizon School. Take, for example, this passage from one of his profiles in old-age courage, concerning a woman he met after she wrote him a fan letter: "Everything about that room and the feeling it invoked in me, I soon came to realize, was the reflection of Miriam herself, and of the contentedness she has found in the everyday richness of her life." I prefer to believe it's Nudelman, and not Dr. Nuland, who thinks there is nothing really all that wrong with wearing a toupee or acquiring a penile implant; Nudelman who quotes Browning ("Grow old along with me! / The best is yet to be") and Longfellow; Nudelman who uses such words as "toileting" (see what happens as a result of our letting "parenting" get through?); Nudelman who announces that he is now going to reflect on wisdom "accompanied by the hope that I can avoid the great temptation of waxing ponderous," and then becomes entirely ponderous, beginning with the word "waxing"; Nudelman whose sugary acknowledgments might be dangerous if read by anyone with diabetes. This Nudelman must be captured and as soon as possible silenced, if not placed under house arrest in a nursing home. How to account for the stern and penetrating Dr. Nuland letting loose the soppy and vaporous Nudelman, this perfect "Oprah" guest. (Dr. Jekyll at least struggled against the emergence of Mr. Hyde.) Could it be that he sat down to write "The Art of Aging" after returning each day from the gym high on endorphins? Or, what I fear may be the case, is "The Art of Aging" itself an example of what aging can do to make a once unsparingly unsentimental writer so intellectually squishy? Nuland isn't above quoting Kahlil Gibran on the importance of love and work to a happy old age. Joseph Epstein's most recent book is "Alexis de Tocqueville: Democracy's Guide."
Library Journal Review
Americans are living longer but not necessarily better lives. Late life is often filled with pain as well as physical and mental disability, much of which, argues National Book Award winner Nuland (surgery, Yale Univ.; How We Die), is a result of the "current biomedical campaign against the natural process of aging." Aging itself is not a disease but an important risk factor for many debilitating disorders of old age, he asserts. In an informal study of older adults, the author, now 77, observed individuals (himself included) who live active, fulfilling lives often despite serious health challenges or extreme age. He identifies three key practices for a rewarding late life (which he applies to his own life): developing satisfying personal relationships, maintaining physical abilities, and being creative. The book also casts a critical eye on life-extension research, suggesting that work on preserving physical and mental function as long as possible is far more valuable. "We must study how to be old," Nuland writes. This literate, thoughtful book-an excellent "textbook" for successful aging-is highly recommended. [See Prepub Alert, LJ 10/15/06.]-Karen McNally Bensing, Benjamin Rose Inst. Lib., Cleveland (c) Copyright 2010. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
Excerpts
Excerpts
CHAPTER ONE AN INCIDENT IN THE SUBWAY About five years ago, I had a brief experience that since then has helped me to tell the difference between nurturing a sense of vibrant good health and nurturing the delusion of being still young. Put somewhat differently, I learned that a man of advanced years who has never felt himself hemmed in by chronology should nevertheless not allow himself to forget his chronology entirely. The event took place late on a September afternoon when I, along with my wife and younger daughter, had just entered a New York subway car at the Times Square station. Pushed forward by the advancing throng of rush hour passengers, we were crammed together single file, with nineteen-year-old Molly in the middle and me packed in behind her. Between my back and the doors stood someone whom my peripheral vision had recognized only as a tall, broad-shouldered man, perhaps in his late thirties. No sooner had the train gotten under way than the fellow's bare right arm reached around past me, its hand extending forward in an obvious attempt to make contact with Molly's buttocks. As taken aback as I was by the man's brazenness, I did have the presence of mind to do what any father might: I pressed my body rearward just firmly enough to push him up against the car's door, putting Molly beyond the reach of his outstretched fingers. As though by some form of unspoken New York agreement, both he and I acted as though nothing had happened, and the train continued on its clattering way over the subterranean tracks. But I was wrong to think that the episode was over. Scarcely half a minute had passed before I became aware of a barely perceptible creeping thing, surreptitiously entering the right-hand pocket of my khaki trousers. Any thought that imagination was playing tricks on me was dispelled a moment later when I was able to feel an unmistakable sensation through the fabric, of fingertips moving around inside the empty pocket. In the flashing eyeblink of time that followed, it never occurred to me that I should consider the consequences of what I instantaneously decided must be done. In fact, "decided" is hardly the word--my next actions were virtually automatic. I plunged my hand into the pocket, transversely surrounded the bony knuckles of a palm wider than my own, and squeezed down with every bit of force I could muster. Aware that I was gritting my teeth with the effort, I did not let go until I felt more than heard the sickening sensation of bone grating on bone and then something giving way under the straining pressure of my encircling fingers. A baritone roar of pain brought me back to my seventy-one-year-old self, and made me realize that I had gone too far. What had I let myself in for? Would not the simple act of removing the intruding extremity have sufficed? Or perhaps I should have done nothing--the pocket was, after all, as empty as it always is when I anticipate being in a crowded, chancy place. Made overconfident by hundreds of hours spent pumping iron in a local gym, I had succumbed to an unthinking impulse dictating that I crush the felonious hand. As the first flush of instinct faded, I all at once became certain that my victim's revenge would now swiftly follow. Alarmed by that thought, I relaxed my grip and felt the mauled appendage whip out of my pocket. But who could have predicted that the response would take the form that it did? With his torso still pressed up between my back and the train's doors, my antagonist inexplicably shouted out a garbled accusation for all to hear, about my having ". . . TRIED TO STEAL MY BAG!" Being certain that I had misheard and anticipating a powerful assault, I awkwardly turned my body around in those compressed quarters, in order to confront the expected assault as effectively as my acute attack of nervous remorse might allow. Having managed that, I found myself looking up into the anguished but nevertheless infuriated face of a thuggish-looking unshaven tough three inches taller than I, and quite a bit broader. I noted with some relief that the injured right hand hung limply alongside his thick-chested body. Tucked up into his left armpit was a bulging deep-green plastic portfolio, its top barely held closed by a tightly stretched zipper. This, no doubt, was the pouch in which was held the loot of a day's pocket pilfering. Seeing the flaccid, useless hand dangling from the muscular but now inactivated forearm momentarily revived my unthinking and foolhardy courage. Looking directly into the bloodshot eyes glowering at me (and now able to smell liquor on the thick breath blowing down into my face), I roared back as though I were Samson, "YOU HAD YOUR HAND IN MY POCKET!" Something stopped me before I added "you son of a bitch," which was a lucky thing because as soon as the first words were out of my mouth, I regretted them. Fearful once more, I prepared for the violent response that would surely follow. But the fates were with me: Just at that moment, the train pulled into the next station and my foeman charged out through the doors as they slid open, clumping off toward an exit staircase as fast as he could, until his forward motion was slowed by a bunched-up throng of passengers tumbling out of the next car. He was swallowed up among them until only the top of his bobbing head could be seen. In a moment he was gone, leaving me standing there--thinking of how close I had come to my own annihilation. I turned toward Molly and my wife, who later told me that my face was pale and bloodless. I felt as though rescued from certain death by a last-second reprieve. My hands were shaking and my knees seemed just a bit uncertain about whether they intended to continue holding me up. It was several minutes and another station's traveling before they steadied themselves. But everything finally stabilized and I was then faced with the embarrassment of having to withstand the two women's justifiably withering comments about how foolish I had been. During the short period of Sturm und Drang, they later told me, not a single person in that overcrowded subway car had so much as glanced in my direction or otherwise acknowledged that anything unusual was taking place. I present this story as an example of a conflict within myself, a conflict that I suspect exists in the minds of many men and women beyond the age of perhaps their middle fifties. On the one hand, we recognize that age is ever increasing its effects on us and now requires not only acceptance but a gradually changing way of thinking about ourselves and the years to come; on the other, some narcissistic genie within us cannot give up clinging to bits of the fantasy that we can still call on vast wellsprings of that selfsame undiminished youth to whose ebbing our better selves are trying to become reconciled. The same formula that enhances our later years--continued mental stimulation, strenuous physical exercise, and unlessened engagement in life's challenges and rewards--sometimes fosters an unrealistic confidence that the vitality thus maintained means that we are virtually the same as we were decades earlier, even in appearance, ready to challenge youth in its own arenas. In outbursts of denial and bad judgment that are virtually instinctual, we at such times discard an equanimity that has taken years to develop, and indulge ourselves in behavior foolhardy and foolish, as though using it as an amulet to stave off the very process to which we have so successfully been accommodating by consciously sustaining our bodies and minds. The tension between the two is very likely stronger in the case of men, but nonetheless common in women as well, though manifesting itself in somewhat different forms. This rivalry within ourselves reflects a rivalry with youth, and it serves neither youth nor age at all well. Self-images from an earlier time are not easy to give up, even when giving them up is in our own best interest. Those whose calling is to work with an older population know that the ability to adapt, to learn and then accept one's limitations, is a determinant of what the professional literature of geriatrics calls "successful aging." Adapting is not mere reconciling. Adapting brings with it the opportunity for far greater benisons and for brightening the later decades with a light not yet visible to the young. Even the word itself is insufficiently specific to convey what is required. In the subtle but nevertheless enormously significant shades of meaning that characterize the English language, "attune" may, in fact, better describe the process than "adapt": "attune," in the sense of being newly receptive to signals welcome and unwelcome, and to a variety of experiences not previously within range, while achieving a kind of harmony with the real circumstances of our lives. This book is about attuning to the passage of years, and finding a new receptiveness to the possibilities that may present themselves in times yet to come--possibilities conveyed in wavelengths perceptible only to those no longer young. And the book is also about traps for the unwary, into which all of us fall from time to time and from which we must teach ourselves to emerge with a refreshed sense of purpose. The very word--"attune"-- sounds like another word to which it has a not coincidental connection: "atone," originally a contraction of "at one," meaning "to be in harmony," most cogently with oneself. To become attuned to an evolving perspective on a life is to be at one with the reality of the present and of the future years. Achieving such attunement can bring a form of serenity previously unknown, and perhaps unsuspected. The process begins with an acknowledgment that the evening of life is approaching. But with that approach come foreseeable possibilities. We have only to take advantage of all that those coming decades have in their power to offer. It is incumbent on each of us to cultivate his or her own wisdom. So gradual a progression is the onset of our aging that we one day find it to be fully upon us. In its own unhurried way, age soundlessly and with persistence treads ever closer behind us on slippered feet, catches up, and finally blends itself into us--all while we are still denying its nearness. It enters at last into the depths of one's being, not only to occupy them but to become their very essence. In time, we not only acknowledge aging's presence within us, but come to know it as well as we knew--and still covet--the exuberant youth that once dwelt there. And then, finally, we try to reconcile ourselves to the inescapable certainty that we are now included among the elderly. Realizing how much of our dreams we must concede to that unalterable truth, we should not only watch our horizons come closer but allow them to do precisely that. If we are wise, we draw them in until their limits can be seen; we confine them to the possible. And so, the coming closer can be good, if by means of that closeness--that limiting of expectations--we begin to see those vistas more clearly, more realistically, and as more finite than ever before. For aging can be the gift that establishes the boundaries of our lives, which previously knew far fewer confines and brooked far fewer restrictions. Everything within those boundaries becomes thus more precious than it was before: love, learning, family, work, health, and even the lessened time itself. We cherish them more, as the urgency increases to use them well. Many are the uses of the newly recognized limits. Among their advantages is that our welcoming acceptance of them adds to the value, adds to our appreciation, adds to our ability to savor-- adds to every pleasure that falls within them. The good is easier now to see; it is closer to the touch and the taking, if we are only willing to look truthfully at it there and gather it up from amid the cares that may surround it. There is much to savor during this time, magnified and given more meaning and intensity by the very finitude within which it is granted to us. Aging has the power to concentrate not only our minds but our energies, too, because it tells us that all is no longer possible, and the richness must be more fully extracted from the lessened but nevertheless still-abundant store that remains. From here on, we must play only to our strengths. Some of the more meaningful of those strengths may be not at all less than they once were. The later decades of a life become the time for our capabilities to find an unscattered focus, and in this way increase the force of their concentrated worth. Even as age licks our joints and lessens our acuities, it brings with it the promise that there can in fact be something more, something good, if we are but willing to reach out and take hold of it. It is in the willingness and the will that the secret lies, not the secret to lengthening a life but to rewarding it for having been well used. For aging is an art. The years between its first intimations and the time of the ultimate letting go of all earthly things can--if the readiness and resolve are there--be the real harvest of our lives. It is the purpose of this book to tell of human aging and its rewards-- and also of its discontents. And the book has as its purpose as well to tell of how best to prepare for the changes that inevitably demand accommodation, demand a shift in focus, and demand a realistic assessment of goals and directions, which may be new or may be a rearrangement of the trajectory of a lifetime. We do this at every stage of life without noticing the new pattern to which we are becoming attuned, whether it be in adolescence, the twenties, or middle age. Though the changes may be more obvious as we approach our sixties and seventies, they are, in fact, only a continuation of everything that has come before. For becoming what is known as elderly is simply entering another developmental phase of life. Like all others, it has its bodily changes, its deep concerns, and its good reasons for hope and optimism. In other words, it has its gains and it has its losses. The key word here is "developmental." Unlike other animals, the human species lives long beyond its reproductive years, and continues to develop during its entire time of existence. We know this to be true of our middle age, a period of life that we consider a gift. We should recognize and also consider as a gift that we continue to develop in those decades that follow middle age. Living longer allows us to continue the process of our development. From the Hardcover edition. Excerpted from The Art of Aging: A Doctor's Prescription for Well-Being by Sherwin B. Nuland All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.