“I am exclusively her caregiver,” he said. “I am glad to be.” And this role had heightened his sense that he must be attentive to the changes in his own capabilities; he would be no good to her if he wasn’t honest with himself about his own limitations.
One evening, Felix invited me to dinner. The formal dining hall was restaurant-like, with reserved seating, table service, and jackets required. I was wearing my white hospital coat and had to borrow a navy blazer from the ma?tre d’ in order to be seated. Felix, in a brown suit and a stone-colored oxford shirt, gave his arm to Bella, who wore a blue-flowered knee-length dress that he’d picked out for her, and guided her to the table. She was amiable and chatty and had youthful-seeming eyes. But once she’d been seated, she couldn’t find the plate in front of her, let alone the menu. Felix ordered for her: wild-rice soup, an omelette, mashed potatoes, and mashed cauliflower. “No salt,” he instructed the waiter; she had high blood pressure. He ordered salmon and mashed potatoes for himself. I had the soup and a London broil.
When the food arrived, Felix told Bella where she could find the different items on her plate by the hands of a clock. He put a fork in her hand. Then he turned to his own meal.
Both made a point of chewing slowly. She was the first to choke. It was the omelette. Her eyes watered. She began to cough. Felix guided her water glass to her mouth. She took a drink and managed to get the omelette down.
“As you get older, the lordosis of your spine tips your head forward,” he said to me. “So when you look straight ahead it’s like looking up at the ceiling for anyone else. Try to swallow while looking up: you’ll choke once in a while. The problem is common in the elderly. Listen.” I realized that I could hear someone in the dining room choking on his food every minute or so. Felix turned to Bella. “You have to eat looking down, sweetie,” he said.
A couple of bites later, though, he himself was choking. It was the salmon. He began coughing. He turned red. Finally, he was able to cough up the bite. It took a minute for him to catch his breath.
“Didn’t follow my own advice,” he said.
Felix Silverstone was, without question, up against the debilities of his years. Once, it would have been remarkable simply to have lived to see eighty-seven. Now the remarkable thing was the control he’d maintained over his life. When he started in geriatric practice, it was almost inconceivable that an eighty-seven-year-old with his history of health problems could live independently, care for his disabled wife, and continue to contribute to research.
Partly, he had been lucky. His memory, for example, had not deteriorated badly. But he had also managed his old age well. His goal has been modest: to have as decent a life as medical knowledge and the limits of his body would allow. So he saved and did not retire early and was therefore not in financial straits. He kept his social contacts and avoided isolation. He monitored his bones and teeth and weight. And he made sure to find a doctor who had the geriatric skills to help him hold on to an independent life.
*
I ASKED CHAD Boult, the geriatrics professor, what could be done to ensure that there are enough geriatricians for the surging elderly population. “Nothing,” he said. “It’s too late.” Creating geriatric specialists takes time, and we already have far too few. In a year, fewer than three hundred doctors will complete geriatrics training in the United States, not nearly enough to replace the geriatricians going into retirement, let alone meet the needs of the next decade. Geriatric psychiatrists, nurses, and social workers are equally needed, and in no better supply. The situation in countries outside the United States appears to be little different. In many, it is worse.
Yet Boult believes that we still have time for another strategy: he would direct geriatricians toward training all primary care doctors and nurses in caring for the very old, instead of providing the care themselves. Even this is a tall order—97 percent of medical students take no course in geriatrics, and the strategy requires that the nation pay geriatric specialists to teach rather than to provide patient care. But if the will is there, Boult estimates that it would be possible to establish courses in every medical school, nursing school, school of social work, and internal-medicine training program within a decade.
“We’ve got to do something,” he said. “Life for older people can be better than it is today.”
*
“I CAN STILL drive, you know,” Felix Silverstone said to me after our dinner together. “I’m a very good driver.”