Age: Old, Elderly, Senile?

There is a time for everything. More importantly than coming in, there is a time to go, to shed illusions and delusions of grandeur and invincibility…

‘You’re sure it’s not la gangrin?’

‘Yes,’ I replied, I’m quite sure that there’s no gangrene in your big toe, it’s something serious and treatable but not dangerous.’ That’s what I told the 90-year old in front of me.

As it happens, he has been a regular at Trou-O-Cerfs for longer than anyone around, and it took me couple of seconds to recognize him because he wasn’t wearing his telltale hat. As a layman he obviously would not know what gangrene truly is in technical medical terms, but clearly he was sufficiently aware of the condition to have a fear of it.

‘Ok, now I am reassured. So can I wear shoes and resume my walks?’ How could I restrain this raring-to-go spirit of a nonagenarian! And so, ‘yes of course!’ I confirmed to him, ‘quite so,’ spelling out the precautions he should take. He was otherwise a picture of fitness: elderly but not quite old I reflected, as I watched him walking out of the consultation room with a spring in his gait, ahead of his daughter. If anything, she had an ‘old’ look, with wrinkles showing on her face, whereas the father barely had any. Threw me back to several years ago when I had seen an 85-year old whose son had brought him for some minor ailment, and what with his abdominal obesity and rotund figure he did look rather unhealthier and older than his tall, slim pater.

At what age does one actually become old? Is there a cut-off age – the tradititonal 60? Or 65? ‘Hey, I’m gonna be forty! L’âge pe rentrer!’ – don’t we hear? And the same refrain at 50, sounds a bit more like it, but 60 yes, definitely, there is some justification to have that perception. Or is it?

Well, as the saying goes, it’s all in the mind – but also in the heart: you are as old as you think and you feel you are, no doubt about that. On second thoughts – here goes the mind again! — it’s mostly how you feel. But it is also true that physical ageing is a fact, in terms of diminished capacities because of weaker muscles, slower response times (reflexes), poorer eyesight and hearing, forgetfulness and so on – in varying degrees in each person. We may be comforted, flattered even, on being told when meeting friends or acquaintances years down the line, ‘you look the same, you don’t seem to have changed!’ Big deal! But no, you have changed, and it is best to take the compliment with a pinch of salt and not mistake it for gospel truth, which can lead to trouble. Forewarned is forearmed, and I received the lesson one morning quite abruptly, almost twenty years ago.

‘DOCTOR!’ I heard. I turned my face towards the voice that had called out – and from where I was saw my neighbour Mr Ah Fan in his yard. ‘Come down,’ he said imperiously, ‘I have to talk to you!’

I had no choice but to obey as I climbed down the ladder and walked to the gate to meet him. As it is, he himself has residual paralysis after a stroke he suffered when he was relatively young, and he uses a walking stick; nevertheless, he is a very good table-tennis player.

‘Sorry I had to shout at you, doctor, but I am older to you and I can allow myself to do so, particularly under the circumstances.’

I had to agree, and I accepted his admonition. ‘Do you realise that you were taking an undue risk at your age (I was nearing 50 then) by standing on that ledge and, to boot, trying to reach out to that window by tiptoeing on one foot? You are a doctor, and your job is to treat people, not to clean windows, especially the way you were going at it. Leave that to younger people, you can easily get one to do that, no need to do so yourself.’

I have never cleaned a window since — well, at least not one on the first floor from the outside. Mr Ah Fan was absolutely right: I was about to do a very silly thing. ‘Imagine if you fell down what could have happened to you! Did you think of that? You are a doctor, and it is not for me to tell you about these things.’ Wise words, from an older and elderly looking gentleman, which I took in the spirit they were meant to convey.

I have since come across a few cases of retired people who forgot that their bodies were no longer in a position to fulfil all their wishes. And did similar silly things as I had tried – but unfortunately there was no kindly neighbour to caution them in time. Two teachers landed with their femurs fractured. The first one was on a ladder, doing some cleaning. The other one had placed the ladder against a tree trunk, and came down with the branch he was cutting as he tried to pull it.

Another friend got off with, fortunately, a lesser injury (to the back). He had also used a ladder to reach the stem of a regine banane which, after he had cut it, he thought he would lift it and come down the ladder holding that heavy bundle. He lost his balance – not, I am afraid, unsurprisingly – and fell on his back.

The common factor in all these circumstances was that all these guys (including me) were on their own, with no help around, and had used ladders. I am sure there must be many like us still out there, and I do not think I need to repeat what my goodly Mr Ah Fan had told me.

Come a certain age, say past 50 especially when one has been in a profession that does not involve skilled or semi-skilled physical activity, there are some things that one can do, others that one cannot and should perforce avoid. But of course that does not mean one must not be physically active, in occupations and leisure activities that do not put one at risk. In fact, quite the opposite is advisable, to keep the body and the mind fit: mens sana in corpore sano is the norm for the common mortals that we are.

There are some rare exceptions of course, the most famous one being the famed physicist Stephen Hawking whose mind is still razor sharp despite the fact that he is paralysed from the neck down because of a severe and untreatable (so far) neurological disorder which started in his early twenties.

In parallel with the bodily changes, there are also changes in the brain which are both positive and negative. One of the positive ones is what is known as the plasticity of the brain, which is its capacity to repair after injury through the formation of not only new brains cells (neurons) which was thought impossible earlier, but also because of the new connections among themselves and with the other neurons that they establish. These connections are practically the warp and the woof of the brain’s functioning, and such plasticity has implications and future potential for the management of mental disorders such as dementia and its extreme form, Alzheimer’s disease.

On the other hand, the negative fallouts of the ageing brain come about as stealthily but as surely, and impair our intellect and judgement. To put it plainly: creeping senility sets in. And it can not only affect us adversely as individuals, but worse still, it can have disastrous effects on others generally if we persist in believing that we are supermen and superwomen, unbeatable and irreplaceable. This failure to recognize our senility leads to delusions of grandeur, a syndrome which some politicians and bureaucrats are particularly prone to. I don’t think that I need to give examples, save to note that our little country may be on the way to having local Mugabes. The bureaucrats tend to become, in the words which one of them uttered not too long ago, ‘hardworking donkeys.’ I would add ‘braying’ to complete the picture. Sure sign of senility.

Probably that is why we recognize that there is, in contrast, something called to ‘age gracefully.’ Like Nelson Mandela, for one. Or Jimmy Carter. Or the 105-year old man who was being interviewed on the Bhojpuri channel a couple of weeks ago. And the 100-year old lady whom I had the good fortune to meet about ten years ago, who looked at least twenty years younger than her age, and refused the offer of my helping hand to climb the few steps to a dais. I learned that she lived alone, and did her own cooking and washing. The 105-year old gentleman was so clearly a fulfilled person, happy and serene as he recited a few verses from the Ramayana, sitting in his chair with a bed of arthuriums in the background.

All these people had a certain composure and a certain look of kindness on their faces, exhibiting what one can qualify as a wise look. They are old and elderly, but not senile, unlike the others I have mentioned earlier. Whatever his political record, for me Jimmy Carter deserves admiration for his remarkable achievement after he left the American Presidency: that of the quasi-eradication of a disease known as ‘River blindness’ which used to affect millions in Africa, and which is now reduced to mere hundreds with the definite prospect of coming down to zero in a foreseeable future.

There is a time for everything. More importantly than coming in, there is a time to go, to shed illusions and delusions of grandeur and invincibility. To allow grace and wisdom to take over from senility. This, perhaps, is the most important lesson to learn and to apply as age starts overcoming us. Amen, for my island.

* Published in print edition on 11 April 2014