“I didn’t think I would survive the change,” Felix said. He’d observed in his patients how difficult the transitions of age were. Examining his last patient, packing up his home, he felt that he was about to die. “I was taking apart my life as well as the house,” he recalled. “It was terrible.”
We were sitting in a library off Orchard Cove’s main lobby. There was light streaming through a picture window, tasteful art on the walls, white upholstered Federal-style armchairs. It was like a nice hotel, only with no one under seventy-five walking around. Felix and Bella had a two-bedroom apartment with forest views and plenty of space. In the living room, Felix had a grand piano and, at his desk, piles of medical journals that he still subscribed to—“for my soul,” he said. Theirs was an independent-living unit. It came with housekeeping, linen changes, and dinner each evening. When they needed to, they could upgrade to assisted living, which provides three prepared meals and up to an hour with a personal-care assistant each day.
This was not the average retirement community, but even in an average one rent runs $32,000 a year. Entry fees are typically $60,000 to $120,000 on top of that. Meanwhile, the median income of people eighty and older is only about $15,000. More than half of the elderly living in long-term-care facilities run through their entire savings and have to go on government assistance—welfare—in order to afford it. Ultimately, the average American spends a year or more of old age disabled and living in a nursing home (at more than five times the yearly cost of independent living), which is a destination Felix was desperately hoping to avoid.
He was trying to note the changes he experienced objectively, like the geriatrician he is. He noticed that his skin had dried out. His sense of smell was diminished. His night vision had become poor, and he tired easily. He had begun to lose teeth. But he took what measures he could. He used lotion to avoid skin cracks; he protected himself from the heat; he got on an exercise bike three times a week; he saw a dentist twice a year.
He was most concerned about the changes in his brain. “I can’t think as clearly as I used to,” he said. “I used to be able to read the New York Times in half an hour. Now it takes me an hour and a half.” Even then, he wasn’t sure that he understood as much as he did before, and his memory gave him trouble. “If I go back and look at what I’ve read, I recognize that I went through it, but sometimes I don’t really remember it,” he said. “It’s a matter of short-term registration. It’s hard to get the signal in and have it stay put.”
He made use of methods that he once taught his patients. “I try to deliberately focus on what I’m doing, rather than do it automatically,” he told me. “I haven’t lost the automaticity of action, but I can’t rely on it the way I used to. For example, I can’t think about something else and get dressed and be sure I’ve gotten all the way dressed.” He recognized that the strategy of trying to be more deliberate didn’t always work, and he sometimes told me the same story twice in a conversation. The lines of thought in his mind would fall into well-worn grooves and, however hard he tried to put them onto a new path, sometimes they resisted. Felix’s knowledge as a geriatrician forced him to recognize his decline, but it didn’t make it easier to accept.
“I get blue occasionally,” he said. “I think I have recurring episodes of depression. They are not enough to disable me, but they are…” He paused to find the right word. “They are uncomfortable.”
What buoyed him, despite his limitations, was having a purpose. It was the same purpose, he said, that sustained him in medicine: to be of service, in some way, to those around him. He had been in Orchard Cove for only a few months before he was helping to steer a committee to improve the health care services there. He formed a journal-reading club for retired physicians. He even guided a young geriatrician through her first independent research study—a survey of the residents’ attitudes toward Do Not Resuscitate orders.
More important was the responsibility that he felt for his children and grandchildren—and most of all for Bella. Her blindness and memory troubles had made her deeply dependent. Without him, she would have been in a nursing home. He helped her dress and administered her medicines. He made her breakfast and lunch. He took her on walks and to doctor’s appointments. “She is my purpose now,” he said.
Bella didn’t always like his way of doing things.
“We argue constantly—we’re at each other about a lot of things,” Felix said. “But we’re also very forgiving.”
He did not feel this responsibility to be a burden. With the narrowing of his own life, his ability to look after Bella had become his main source of self-worth.