Portrait of an Old Woman

Portrait of an Old Woman

It is New Year. Another year.

Another year older. I hate getting older.

I joke about it – about forgetting a name here and searching for a word there, about new wrinkles, about an age spot, about the difficulty of getting rid of a flab around the stomach. But it bothers me. It feels as if somehow every day I am getting closer to being a smaller, weaker me with less ‘me’ in it.

Couple of days ago, I stumbled onto a new app on the phone that ages your picture for you. Supposedly, this will make you friendlier towards your future self, so you will take care of it better. Well, ‘it’ being me, really. Obviously. I knew that.

I found a picture of me on the phone I thought looked like ‘me’. The ‘me’ I know. The ‘me’ I like. I hit the “aging” button on the app…


I had come to visit Mrs Beren.

Her face looked small and fragile against the white hospital sheets. Old. Quite a bit older than her fifty-nine years, in fact. With so many chronic diseases, it was no wonder.

She had put on lipstick, I saw. Not a bright garish red I would have expected from someone who was vain enough to bother with makeup while being in the intensive care unit. No, it was a tasteful light pink that did not clash too strongly with her tired and pale face, wrung out from endless nights on a hospital mattress.

She was a strong woman, I knew. Not her body – that was weak – but her mind. I had always been fascinated by it for the years I had known her.

Strictly speaking, I didn’t have a reason to be here, monitoring her progress with the disease that had landed her in the hospital, for the umpteenth time. She had everything wrong with her. She could no longer walk due to neurological damage and depended on her husband to lift her from the chair to bed at night, and back to the chair in the morning. Her kidneys had failed her and her husband brought her to dialysis three times a week. Just this year, she had been in the hospital with pneumonia, urinary tract infection and now again with fever and sepsis that the doctors had not found a reason for yet.

Mrs Beren was not my patient.

Her husband was.

I had no reason to be here.

But her husband had asked me. I had run into him unexpectedly in the hospital hallway, looking out of place and out of sorts. I had been surprised to see him – he was one of my healthier patients, with a minor heart problem, who I saw for routine visits only once a year. He always came with his wife who drove herself into the room in a motorized red wheelchair. I had been confused by it at first – why bother coming to her husband’s appointments when clearly she was so much sicker than he? But after a few visits, I realized that this was their life. The edges of individual lives had blurred. It was a unit, with her being the guiding force. It had always been the two of them, all their lives since they were teenagers. When I asked questions from Mr Beren, the wife answered half of the time. They joked about how the new reliance on a wheelchair for transport no longer allowed them to enjoy traveling that they had been fond of in the earlier days of marriage. When I asked for a report on his exercising, it was the wife who proudly told me how she pushes him to go for a walk each evening – with her driving her motorized wheelchair, right next to him. They told me about the adjustments of their house they had to make, about the new car they had to buy. The life in their little unit had changed to accommodate her increasing disability but at the core they were still the same people.

I had not asked for their life story. It had just naturally flown out of them, piece by piece, over the years’ worth of visits.

So here I was, staring at Mrs Beren’s pink lipstick.

“I ran into Roy in the hallway”, I started. “He told me you could use a visit.”

“Good old Roy”. She looked up, pensive. “How did he seem?”

Confused by the question, I hesitated slightly. “He seemed … well. Worried, of course. About you. I know you have not had it easy lately.”

“No.” I could see she was testing the words before speaking. “I don’t think it will get any better, frankly. And I am pretty tired of being sick. I just don’t know what will happen to Roy when I’m gone. He is not strong.”

Implications were heavy between us. Not strong like her, getting herself to all her husband’s appointments in a wheelchair. Not strong like her, worried about her husband while lying deathly ill in the intensive care. Not strong like her, making herself pretty with lipstick on what she thought may be the last days of her life.


After I first hit the “aging” button, I slammed the phone down. The woman who had looked back at me from the picture was old. Heavily wrinkled, with saggy skin and grey hair.

Also, unmistakably me. It was chilling. Unnerving. A little nauseating.

I picked up the phone again and tried to look past the wrinkles. The confident pose I had liked on the initial picture was still there. The sparkle of enjoyment in the eyes was still there. The smile of general happiness with life was still there. It was me. Old – yes, but still ‘me’.

It made me feel better. The woman on the picture wasn’t smaller or lesser. Just different.

I don’t have a choice in getting older. But as a colleague and friend likes to point out frequently, the alternative is far worse. So, I can choose how I get older. I can choose to be the “me” I like even when old. I can choose to be strong even when sick.

I can choose to put on the lipstick.


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Portrait of an Old Woman, by Guido Reno

How Do We Age Well?


Ella Rose

In preparing for retirement, for aging, we put money away like Smaug The Dragon who knows his coin.  We imagine we will gain freedom, retain vitality, interest, and motivation, perhaps enjoy the affection of those we served through life.  But do we prepare for what is really coming?

I’ve been asked, how do we age well?  And guess who asked.  An aged man.  I tugged on my chin a little to hide my discomfiture.  After all, I would like to sit at his table and listen in on his story of doing what he had inevitably done, grown old.  I’d like to hear what he is pleased with.  And what he regrets.  I’d like to hold up the memories, like picture slides to the light, and see if I recognize anything.  Maybe something I might relate to.  Something I might more deliberately emulate.  I might feel more secure, knowing what he has done before me.  Maybe I’d think I am safe.

Remember that song,

A foolish man built his house upon the sand, A foolish man built his house upon the sand, A foolish man built his house upon the sand and the rains came a tumbling down.  The rains came down and the floods came up, The rains came down and the floods came up, The rains came down and the floods came up and the house upon the sand went splat!

(The hand motions make the song.)

But why ask me about aging?  Do I look so old already?  What the!?  Fine then.  I’d like to say, grow old continent and stock full of Botox.  Nah.  That wasn’t it.  (Mind wandering already you see.)

Or maybe, we who are aging wonder quietly if this person, or that might have a trick of doing it better.  This person wants to hold up my picture slides to the light and gather security to them.  That person wants to do more than hoard coin, and another doubts the vitality and wonders if she’d know what to do with it if it were waiting there for her after all in the end any way.  “How do we age well?”

Start with Me.

Me, where there is freedom to choose, the chance of change, the place where cause begins.  (The 3 C’s done our way at Friend to Yourself :).)

As a psychiatrist, it’s easy for me to think first of the biology of aging of course – brain health over time and to recall that the brain is connected to rest of the body.  I could tell this aged man that he’ll be wanting to get oxygen to his brain at night and use his cpap regularly.  I could speak of motility and exercise, of caloric intake and sleep hygiene.  We might spend some time on medical care for psychiatric illnesses common in again, depression, dementia, anxiety, and so forth.  We might speak of the inevitable process of losing friends and family, aging past a child or losing pets.  But as many so often remind me, psychiatrist’s only have the truth that their perceptions allow.  😉

A dear Obstetrics and Gynecology specialist told me the other day that she has become more convinced than ever that the processes of coming into the world and that of leaving the world are the same.  Having delivered countless souls into life, she has been marked, as if the luminescence of so many branded her.  She carries the knowledge of their entry and of those who have already died.

I remember my niece who died at 9 years and 28 days.  Not so old.  Not so aged.  Some how we think of death when we think of aging, not when we think of nine-year-olds.  However my niece did age well.

I suppose aging is like any system, as strong as its weakest member.  The wonder is that if we believe in aging, we believe our lives run on a line, on Time, which is after all, a human construct, a philosophy and based on Magic. Aging well as implied by my OB-gyn colleague, is looking at it from both ends, looking at what is in between, and looking at what is outside of birth and death.  Aging well includes exploring the essence of Me, what bit of Magic came before Time and before zero and numbers and philosophy turned into math.

How do we age well? Does aging imply disease? Aging is linear. They’re different but definitely paired… Help me on this?

keep on.

Growing Old

Growing old.  When do we stop looking forward to the future?  My husband, who is a Palliative Care specialist, says that even in the end stages of life, we still look forward.

Erikson‘s psychosocial crisis theory of human development says life is a balance between conflicts.  Ambivalence, two opposing forces, is something to embrace and walk with.  I don’t think Erikson ever said it in so many words, but he was largely talking about having a sense of presence in our lives.  He based most of his theory on watching kids grow and then spread the rest over adulthood like the last bit of peanut butter on the knife.  Is that what adulthood is like?

My little girl told me that she’ll never run out of love for me.  (Every now and then, after hours or days of desert-like behaviors, she’ll break open a rock and out will gush something amazingly nice like that.)  Then she looked me over and said, “You’re not old Mommy!”  I showed her my gray and my spots and my wrinkles.  Maybe I was trying to say, “How can you love me in my future?”  Love is evergreen.  I am not.

When I was a kid, my parents loaded us up for a couple weeks every year and hauled us 8 hours in a van to Brian Head ski resort in Utah.  It is where I learned that some things stay green no matter what weather they live in.  The Evergreens, tall, tall, covered in snow except for some undergarments showing through were everywhere.  Even thinking about them, I can taste

Rolo Chocolate Caramel Candies,

feel the weight of booted feet, hear Dad’s bass voice and bits of my favorite ski-story loud to be heard above the chair lift.

Evergreen’s for at least 2 weeks a year, surrounded me and my family.  I’ve heard that Brian Head has materially changed a lot since we stopped going.  I wonder about the trees.  I’m sure there are fewer.

If it is true that every stage of  life has conflicts to resolve, it makes sense to me that in age we must resolve our future with our past.  We can’t just have a past.  If we find ourselves just looking back, than we are turning a blind eye to something we are meant to be present with.  Something that brings balance and fullness to life.  Something that is an evergreen quality.

For me, it is intuitive to look at God to meet this need – future v. past.  I don’t know what it is for others.  Conflict resolution.

When the days on life’s scale are tipping backwards, and we see that there aren’t as many days left on our plate, be present.  It is an illusion.  The past does not outweigh the future.  The opposing directions of time are just fine.

Self Care Tip #71 – Be present with the past by believing in your future.  Be a friend to yourself.

Question:  Agree or Disagree?  What are your thoughts?