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MELISSA BLOCK, host:

This is ALL THINGS CONSIDERED from NPR News. I'm Melissa Block.

ROBERT SIEGEL, host:

And I'm Robert Siegel.

Dr. Sherwin Nuland, the surgeon who wrote "How We Die," says his latest book is a project that he's been working on for more than 76 years - in other words, his whole life. It's called "The Art of Aging." His topics range from the adjustments everyone faces with age - physical, sexual, psychological - and some stories of people who have aged with remarkable grace and vigor. One of them is the heart surgeon Dr. Michael DeBakey. Nuland begins the book with a story about something that happened to him a few years ago.

Dr. SHERWIN NULAND (Author, "The Art of Ageing): There I was. I was 72 at that time and I had gotten on the subway. And as I did so, a man's hand came from behind me; his whole arm encircled me, missing my waist by about six inches as it reached for the buttocks of my then 19-year-old daughter. And I did what any good father would. I stepped backward and moved him just six inches. That got his hand away. But a moment later, I realized that hand was in my pocket.

And without even stopping to think, I reached into my pocket, actually enraged at this double insult, wrapped my fingers around his knuckles, although his knuckles were much wider than my palm, and I crushed them. When I turned around and faced him and realized he was three or four inches taller than I, and 40 years younger, and I - luckily for me, the car doors is opened at that point, and he rushed out.

My wife and daughter were incredulous at the foolishness they had just witnessed on my part, and that set me to thinking, of course, oh my God, what have I just done? I'm 72 years old. And it brought up the whole notion of what Michael DeBakey refers to as pulling in one's horizons, recognizing that one must not look only up at the possibilities that life brings, but one must look down at one's feet and see where one can really sensibly and reasonably travel.

SIEGEL: Of course, one implication of that story is that, as you say, without thinking, you did this. If you had thought about it, you might not have done that. But somewhere in our being, our bodies and our brains don't say you're 72, don't take that physical defensive action. They say, do what you would do at any age right now in defense of your 19-year-old daughter and yourself.

Dr. NULAND: Well, most of us have an image of our self at a much younger age than we really are. I'm quite fixated at 19, and have been since I was 20.

(Soundbite of laughter)

Dr. NULAND: And it was that 19-year-old sub-brain that pushed my hand over his hand and carried out that really silly maneuver.

SIEGEL: You write at the end of the book that you have concluded after all this time that there is a triad of factors, essentially ingredients that help us age better. And those are a sense of mutual caring and connectedness, to the extent that we can; maintaining our physical capabilities of our bodies; and the third one is - I think this is the hardest one to understand - creativity.

Dr. NULAND: Yes.

SIEGEL: How do you think creativity enables us to age better?

Dr. NULAND: I think when one is creative, one produces something, even if it's an emotional or mental something that makes one feel just a little bit better after it's been completed, or is late in the process of completion, than one felt before, better about ourselves, feeling we're a more whole human being, a human being who's contributed just a little bit, whether it's to our own welfare or the welfare of others.

So it really takes in a wide spectrum of activities. It might be something as straightforward as taking a course in flower arranging, or it might be the writing of a book or the invention of a new machine.

SIEGEL: There's a wonderful line that you attribute to your - is it your colleague, Dr. Cooney, I'm thinking off, who is from Yale Medical School?

Dr. NULAND: Yes. Leo Cooney.

SIEGEL: And it's the issue of how important connectedness and caring for members of one's family can be. You remember what the choice is, as he describes it.

Dr. NULAND: Oh, of course. It was a hallmark moment in my many discussions with Leo Cooney. I was going on about the importance of musculoskeletal strength and exercise. And he said, yeah, but you know, Shep, it's not the Holy Grail. The Holy Grail is something else. And what is it? It's relationships. And then he uttered that memorable line. Look, if you have the choice between going to the gym and playing with your grandchildren, you should choose your grandchildren every single time.

(Soundbite of laughter)

SIEGEL: And not only as a sign of virtue, but as a sign of remaining vital and alive.

Dr. NULAND: Well, that's right. It's a glorious kind of feeling.

SIEGEL: You mentioned Dr. Michael DeBakey, who is one of the people you profiled in the book, who is extraordinary and who was productive and vital throughout his 90s, in a way that, well, when I was a kid you just assumed people stop being this way sometime around the age of 62 or 63.

Dr. NULAND: Well, he's been gifted of course by nature. He has two sisters in their 90s who are still working. But there's got to be something more than that. And that was why I spent two days with him to try to find out what that something was. And there were several somethings. The most important of them was the anticipation of pleasure - I think that's the best way to put it - that notion that there is something exciting that's going to happen today. As he put it, I often wake up in the morning, I can't wait to get to the work that I didn't complete yesterday. And he also talks about drawing in his horizons, recognizing what is really important to him, and what he's really good at, and what will give him the most pleasure, and focusing on that.

SIEGEL: In the case of, say, Dr. DeBakey, one can't simply create a life in which there's something wonderful to do tomorrow if there hasn't been something wonderful to do for the past 30 years.

Dr. NULAND: Well, that's really the ultimate lesson of my book, that these last decades are nothing more or less than a stage of life. We reach that stage as a continuation of everything we have been before. This book is largely aimed at people in their 50s and 60s, to help them with the trajectory that they would like to follow into their 70s and 80s.

SIEGEL: People in their 50s and 60s constitute what is known as the Baby Boom.

Dr. NULAND: The Boomers, yes.

SIEGEL: There are a lot of us.

Dr. NULAND: There are a lot of you. Yes. And you are to a great extent obsessed with yourselves, aren't you?

SIEGEL: The Me Generation will be the - still the same on Me Generation.

Dr. NULAND: Well, precisely. And preaching to the Me Generation I think is a very productive thing to do, because I expect that the Me Generation will be much more aware of the possibilities and probabilities for a very productive and very rewarding last few decades.

SIEGEL: Dr. Sherwin Nuland's book is "The Art of Aging." There's an excerpt at npr.org.

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