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The Art of Aging: A Doctor's Prescription for Well-Being
In his landmark book How We Die, Sherwin B. Nuland profoundly altered our perception of the end of life. Now in The Art of Aging, Dr. Nuland steps back to explore the impact of aging on our minds and bodies, strivings and relationships. Melding a scientist’s passion for truth with a humanist’s understanding of the heart and soul, Nuland has created a wise, frank, and inspiring book about the ultimate stage of life’s journey.The onset of aging can be so gradual that we are often surprised to find that one day it is fully upon us. The changes to the senses, appearance, reflexes, physical endurance, and sexual appetites are undeniable–and rarely welcome–and yet, as Nuland shows, getting older has its surprising blessings. Age concentrates not only the mind, but the body’s energies, leading many to new sources of creativity, perception, and spiritual intensity. Growing old, Nuland teaches us, is not a disease but an art–and for those who practice it well, it can bring extraordinary rewards.“I’m taking the journey even while I describe it,” writes Nuland, now in his mid-seventies and a veteran of nearly four decades of medical practice. Drawing on his own life and work, as well as the lives of friends both famous and not, Nuland portrays the astonishing variability of the aging experience. Faith and inner strength, the deepening of personal relationships, the realization that career does not define identity, the acceptance that some goals will remain unaccomplished–these are among the secrets of those who age well.Will scientists one day fulfill the dream of eternal youth? Nuland examines the latest research into extending life and the scientists who are pursuing it. But ultimately, what compels him most is what happens to the mind and spirit as life reaches its culminating decades. Reflecting the wisdom of a long lifetime, The Art of Aging is a work of luminous insight, unflinching candor, and profound compassion.
270 pages, Kindle Edition
First published January 1, 2007
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534 people want to read
About the author
Sherwin B. Nuland
51 books203 followersSherwin Nuland was an American surgeon and author who taught bioethics and medicine at the Yale University School of Medicine. He was the author of The New York Times bestseller and National Book Award winning How We Die, and has also written for The New Yorker, The New York Times, The New Republic, Time, and the New York Review of Books.
His NYTimes obit: http://nyti.ms/1kxNtQC
His NYTimes obit: http://nyti.ms/1kxNtQC
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Displaying 1 - 30 of 84 reviews
September 15, 2009
I originally picked this book up hoping it would help me get over my dismay at the appalling number of wrinkles beginning to populate my neck and face. While Sherwin Nuland, surgeon and Yale professor, seems sympathetic to the physical perils of aging, he teaches us that "growing old is not a disease but an art - and for those who practice it well, it can bring extraordinary rewards."
Nuland has straightforward advice for keeping an aging body from deteriorating: exercise, don't smoke, eat in moderation, keep active doing things you enjoy. He emphasizes the importance of maintaining social/family relationships. Don't think of setbacks as endings succumbing to despair; rather find pleasure in small things. "In tragedy the unwise see only loss; the wise find meaning." Find something to be enthusiastic about. Continue to make contributions.
His chapter on wisdom was especially engaging to me. His style is somewhat professorial, but still easy to follow.
Nuland has straightforward advice for keeping an aging body from deteriorating: exercise, don't smoke, eat in moderation, keep active doing things you enjoy. He emphasizes the importance of maintaining social/family relationships. Don't think of setbacks as endings succumbing to despair; rather find pleasure in small things. "In tragedy the unwise see only loss; the wise find meaning." Find something to be enthusiastic about. Continue to make contributions.
His chapter on wisdom was especially engaging to me. His style is somewhat professorial, but still easy to follow.
February 12, 2014
Seems like I read this book almost four years ago, didn't write a review and gave it a "meh" three stars. Now I read it again looking for a counterpoint to Nuland's earlier (and I thought pessimistic) How We Die . But it turns out I like the book even less! So let me just copy and paste my current review and move on to some other reading:
I first read this book in 2010 when I thought I had better get some ideas about this aging business since I seemed to be doing it! But I evidently was not very impressed with it since I did not even write a review and gave it a so-so three stars – not a glowing recommendation. But I just read Nuland’s 1993 book How We Die and thought I better come back to this one. Basically Nuland wrote in 1993 that, in his experience of thirty years as a surgeon, death with dignity rarely happened because the process of a body wearing out was almost always a bad experience.
The Art of Aging was published in 2007. I thought maybe in the fourteen or so years since 1993, Nuland had found more hope for death with dignity. It seems that maybe his conclusion those years later was that dignity is found in a life well lived and not likely in a dignified death. Oh, well!
Sherwin Nuland is a bit of a preacher and his good news for mankind is that to lead our best lives, we must take care of our body and mind. Not too astounding to be sure, but he does dress it up in some fancy and flowery words. And then to prove his point, he dwells at length on the long life of Michael DeBakey who was in his mid nineties and a very active man when author Nuland talked with him in 2005. DeBakey was Chancellor of the Baylor College of Medicine until he was 97 and died just short of his 100th birthday in 2008.
Mr. Nuland is a fascinating character to say the least. You can tune in to some of his TED talks online to get some of his story from his own mouth. The twenty-two minute 2001 TED talk I watched is him talking about electroshock therapy and his personal experience receiving this therapy in the 1960s. You can find that talk here: http://www.ted.com/talks/sherwin_nula...
Nuland writes at length – dare I say pontificates? – about the ability of people to do good things for other people. He could not be speaking of himself in this paragraph from the book, could he?
It might be fair to acknowledge “the beam that is in thine own eye”!
This is a book of stories about people whom Nuland considers to be “aging successfully” and often with the help of a higher power. God is not a magnet for me so I find the inclusion of Him to be a negative for me in this book. Clearly God is a player for Nuland and most of the people to whom he introduces us. There is also an aspect in most of these folks that I can only describe as a determination to live to be an old age. In describing the goal of an elderly shot putter to hold the record for hundred year olds, Nuland says, “I am just as determined to be there as he is.” I try to reconcile this man with the one who wrote in 1985 that death with dignity is most elusive and should not be anticipated. Could he have been born again in some sense, I wonder? But, just to confuse me, he drops in the humanist point of view.
So just when I think I have him in an airtight God-box, he squirms a bit and I have to relax my grip. What do you believe, Mr. Nuland? And when I ask that, he slips easily into his verbiage:
Just saying, Nuland goes for the compound complex!
The Art of Aging strangely reminded me of watching Queen for a Day or This Is Your Life in the 1950s; it is a bit syrupy sweet and cloyingly saccharine, definitively glass-half-fullish with the glory overcoming any gloom. If you can’t tell, that is not really my cup of tea! While I am free associating, let me not forget “a spoonful of sugar helps the medicine go down.” We are told that while we do not look forward to aging, here are some amazing stories that will give us hope.
As Hurey Coleman exhorts us,
To quote Anonymous, “Makes me want to puke!”
I am sorry Dr. Nuland, I just seem to have a bad attitude about your book. Can you give a book two stars grudgingly? I want to say irreverently that I did not like this book and go the one star route. But it has enough saving grace and interest for me to say that I am going to pass it on to my 93 year old father with whom I am having a regular conversation about aging. He may find this book inspiring - but that feeling eludes me at the moment. But I want to grant that for some it may have that impact.
I first read this book in 2010 when I thought I had better get some ideas about this aging business since I seemed to be doing it! But I evidently was not very impressed with it since I did not even write a review and gave it a so-so three stars – not a glowing recommendation. But I just read Nuland’s 1993 book How We Die and thought I better come back to this one. Basically Nuland wrote in 1993 that, in his experience of thirty years as a surgeon, death with dignity rarely happened because the process of a body wearing out was almost always a bad experience.
The Art of Aging was published in 2007. I thought maybe in the fourteen or so years since 1993, Nuland had found more hope for death with dignity. It seems that maybe his conclusion those years later was that dignity is found in a life well lived and not likely in a dignified death. Oh, well!
Sherwin Nuland is a bit of a preacher and his good news for mankind is that to lead our best lives, we must take care of our body and mind. Not too astounding to be sure, but he does dress it up in some fancy and flowery words. And then to prove his point, he dwells at length on the long life of Michael DeBakey who was in his mid nineties and a very active man when author Nuland talked with him in 2005. DeBakey was Chancellor of the Baylor College of Medicine until he was 97 and died just short of his 100th birthday in 2008.
Mr. Nuland is a fascinating character to say the least. You can tune in to some of his TED talks online to get some of his story from his own mouth. The twenty-two minute 2001 TED talk I watched is him talking about electroshock therapy and his personal experience receiving this therapy in the 1960s. You can find that talk here: http://www.ted.com/talks/sherwin_nula...
Nuland writes at length – dare I say pontificates? – about the ability of people to do good things for other people. He could not be speaking of himself in this paragraph from the book, could he?
Most of us know these kind of things, though they have been robbed of a great deal of meaning because they have become the stuff of too much ponderous pap delivered from pulpits, the pages of maxim-filled hortatory literature, and the self-satisfied lips of an occasional latter-day Polonius. But in spite of the windy pontifications in which these ideas are sometimes expressed, mindfulness of them is inherent in human perception, though they are often ignored, forgotten, buried, or simply dismissed as the staggeringly banal pronouncements of would-be sages.
It might be fair to acknowledge “the beam that is in thine own eye”!
This is a book of stories about people whom Nuland considers to be “aging successfully” and often with the help of a higher power. God is not a magnet for me so I find the inclusion of Him to be a negative for me in this book. Clearly God is a player for Nuland and most of the people to whom he introduces us. There is also an aspect in most of these folks that I can only describe as a determination to live to be an old age. In describing the goal of an elderly shot putter to hold the record for hundred year olds, Nuland says, “I am just as determined to be there as he is.” I try to reconcile this man with the one who wrote in 1985 that death with dignity is most elusive and should not be anticipated. Could he have been born again in some sense, I wonder? But, just to confuse me, he drops in the humanist point of view.
Somewhere in the middle of it, I play the devil’s advocate by posing the well-worn question of motivation when there is no God looking down with favor. Why does Pete Barker live a moral existence, why does he pay scrupulous attention to playing the game of life fairly and with regard for others, if there is no reward? Indeed, why should any of us? “Because it’s the right thing to do,” he says straightforwardly, as if the answer should be self-evident.
So just when I think I have him in an airtight God-box, he squirms a bit and I have to relax my grip. What do you believe, Mr. Nuland? And when I ask that, he slips easily into his verbiage:
Human nature is far too complex for such simplistic explanations, and there are far too many shades of Eros and Thanatos in each of us – shades, respectively, of the life and death principles, of the optimistic and the morbid, of the need for guilt and self-punishment and the need for joy and the self-expression that leads to fulfilling happiness. As with the amorphous coagulum of influences that form one’s character, there is within us a disordered amalgam of impulses and instincts that are harmful and impulses and instincts that lead only to the good. It is not written in our stars or ourselves that we are compelled without option to respond to either good or bad in any fixed, predetermined, or “inherent” way. We have free will, whether we believe it to have been granted by God or granted by the very nature of the human mind. We are, in fact, capable of choosing how we respond to the circumstances of our lives, and in this way we are capable of changing them for the better – even when our initial impulse is counterproductive.
Just saying, Nuland goes for the compound complex!
The Art of Aging strangely reminded me of watching Queen for a Day or This Is Your Life in the 1950s; it is a bit syrupy sweet and cloyingly saccharine, definitively glass-half-fullish with the glory overcoming any gloom. If you can’t tell, that is not really my cup of tea! While I am free associating, let me not forget “a spoonful of sugar helps the medicine go down.” We are told that while we do not look forward to aging, here are some amazing stories that will give us hope.
As Hurey Coleman exhorts us,
But once that [stroke] has happened, you just have to go on. Have faith in God and take whatever medications the doctor puts you on. A lot of people don’t want to abide by rules, but you have to.
To quote Anonymous, “Makes me want to puke!”
I am sorry Dr. Nuland, I just seem to have a bad attitude about your book. Can you give a book two stars grudgingly? I want to say irreverently that I did not like this book and go the one star route. But it has enough saving grace and interest for me to say that I am going to pass it on to my 93 year old father with whom I am having a regular conversation about aging. He may find this book inspiring - but that feeling eludes me at the moment. But I want to grant that for some it may have that impact.
March 8, 2018
Nuland’s How We Die was an incisive and graphic book. I loved it, and looked forward to The Art of Aging—but what a deception. A better title for this book would be The Art of Pontificating.
Nuland’s mantras are You must, You should, You have to, You’d better. It’s life-coaching at its worst, lumbering and clichéd. There are a few chapters in which Dr. Nuland discusses the physical process of aging, and they are a great relief. There are also several portraits of older men and women who might inspire us—which is why I give the book two stars rather than none.
If Nuland could boil off the fluff, he might have written a decent magazine article. But no, he has to tell us a thousand times about what makes a good and inspiring older person, all in the most abstract prose. I wanted to escort him into a beginner’s writing class where they would explain to him, as repetitively as he writes, how he should show more and tell less.
The next-to-last chapter begins: “In a book on aging, it would seem a worthy undertaking to reflect on wisdom. And so, as a man of now considerable years and therefore some prerogative, I will not hesitate to do just that, accompanied by the hope that I can avoid the great temptation of waxing ponderous.”
Dear reader, he can’t.
Okay, you need an example. Here’s a paragraph from that same chapter:
“Wisdom has a purpose; that purpose is action. This means that action must sometimes be taken with the full understanding that decisions may possibly result in less than perfect consequences. Because taking action in the face of incomplete information is the usual condition in which wisdom needs to be applied, each choice, no matter how wise and with what good outcome, is a choice likely to have some drawbacks of its own, just as even wonder drugs have side effects of which account must be taken in their use. It is in weighing what might be called the cost-benefit ratio of each decision that wisdom faces one of its most difficult tests. Knowing that unwelcome imperfections are the inevitable accompaniments of even the wisest decisions should never paralyze decision-making, or cause hesitancy in a decision’s implementation. The wise take action in the face of imperfect knowledge, and even given the probability of imperfect solutions.”
The paragraphs that come before and after that one are filled with the same mush.
Even so, let me repeat my admiration for Nuland’s How We Die. That was a great book.
Nuland’s mantras are You must, You should, You have to, You’d better. It’s life-coaching at its worst, lumbering and clichéd. There are a few chapters in which Dr. Nuland discusses the physical process of aging, and they are a great relief. There are also several portraits of older men and women who might inspire us—which is why I give the book two stars rather than none.
If Nuland could boil off the fluff, he might have written a decent magazine article. But no, he has to tell us a thousand times about what makes a good and inspiring older person, all in the most abstract prose. I wanted to escort him into a beginner’s writing class where they would explain to him, as repetitively as he writes, how he should show more and tell less.
The next-to-last chapter begins: “In a book on aging, it would seem a worthy undertaking to reflect on wisdom. And so, as a man of now considerable years and therefore some prerogative, I will not hesitate to do just that, accompanied by the hope that I can avoid the great temptation of waxing ponderous.”
Dear reader, he can’t.
Okay, you need an example. Here’s a paragraph from that same chapter:
“Wisdom has a purpose; that purpose is action. This means that action must sometimes be taken with the full understanding that decisions may possibly result in less than perfect consequences. Because taking action in the face of incomplete information is the usual condition in which wisdom needs to be applied, each choice, no matter how wise and with what good outcome, is a choice likely to have some drawbacks of its own, just as even wonder drugs have side effects of which account must be taken in their use. It is in weighing what might be called the cost-benefit ratio of each decision that wisdom faces one of its most difficult tests. Knowing that unwelcome imperfections are the inevitable accompaniments of even the wisest decisions should never paralyze decision-making, or cause hesitancy in a decision’s implementation. The wise take action in the face of imperfect knowledge, and even given the probability of imperfect solutions.”
The paragraphs that come before and after that one are filled with the same mush.
Even so, let me repeat my admiration for Nuland’s How We Die. That was a great book.
May 10, 2021
Well written and easy to follow, from an authority on the subject of how our bodies and minds cope with the ageing process. If you don't fancy working through it, here's the short version:
Care more for your fellow humans and make sure you have regular interactions and feedback from them because it promotes a feeling of well being in you yourself which is enormously beneficial to your health and longevity. Make choices about coping with your life NOW before infirmity and old age force you to make those changes. Be optimistic abut your future: things WILL change even for the healthiest person, but those changes don't have to mean your life will be 'less than' in the future. Accept your limitations and work with them rather than against them, and finally take stock (and advantage) of the opportunities that old age brings - for instance maybe having the financial freedom to not HAVE to do a job which is unfulfilling but pays well ... go and do something which satisfies you but perhaps doesn't pay quite so well.
That said, read the book and draw your own conclusions, I'm sure the text will mean different things to different people.
Care more for your fellow humans and make sure you have regular interactions and feedback from them because it promotes a feeling of well being in you yourself which is enormously beneficial to your health and longevity. Make choices about coping with your life NOW before infirmity and old age force you to make those changes. Be optimistic abut your future: things WILL change even for the healthiest person, but those changes don't have to mean your life will be 'less than' in the future. Accept your limitations and work with them rather than against them, and finally take stock (and advantage) of the opportunities that old age brings - for instance maybe having the financial freedom to not HAVE to do a job which is unfulfilling but pays well ... go and do something which satisfies you but perhaps doesn't pay quite so well.
That said, read the book and draw your own conclusions, I'm sure the text will mean different things to different people.
October 17, 2016
This book is VERY motivating. Written by a physician in his 70s it challenges the reader to take charge of making the best of the last part of life. I highly recommend it.
February 15, 2023
Quite a few years ago I was captured by Sherwin Nuland’s award-winning book, How We Die. Reading it was an eye-opening experience for me. It was fearless and brought to the fore things we in contemporary America do not talk about in company. The Art of Aging is in a way a kind of companion volume, but not nearly the ground-breaking book that the earlier volume was. It feels somewhat scattershot covering a number of topics loosely connected with one another under the big umbrella of oldness. There are mini-biographies here, harangues against proposals for artificial life extension to two or three hundred years or more, and self-help chapters on the the art of aging well if one is so lucky to be healthy in old age. Nuland’s hope and expectation is that progress in medical science will allow many elders to live free of chronic and wasting illness until the end approaches, then experience a short period of morbidity, followed by death. It seems to me that The Art of Aging, subtitled A Doctor's Prescription for Well-Being, does not do justice to its title.
Overall, I preferred his How We Die (1994) and How We Live (1998) to The Art of Aging (2007).
Overall, I preferred his How We Die (1994) and How We Live (1998) to The Art of Aging (2007).
June 7, 2023
The Art of Aging was published by Sherwin Nuland, ~12 years after his award-winning book, How We Die. It marks the author’s literary transition from facing death squarely, to trying to deal with old age up to death. Nuland gives us numerous positive ideas about his view of the aging process:
• Knowing one’s limitations and being able to function within them.
• “Aging is not a disease.” This point is made repeatedly throughout the book.
• Becoming elderly is simply another developmental phase of life.
• Growing old is an art, not a disease.
• Adapting is not merely reconciling.
• Work is love made visible. When our work life is over, it is important to feel that we have contributed something of value.
• “Whatever else aging may represent to us, it is first and foremost a state of mind.”
• To negotiate old age, we must learn to deal with uncertainty and contradictions.
As he did regarding diseases that can lead to death, in How We Die, Nuland begins The Art of Aging by providing a layperson’s summary of the biology of aging. On the one hand, this provides the reader with a map of what kind of things are to be expected and what is ‘normal’. Additionally, he acquaints the reader with data in favor of lifestyle choices that have been shown to be associated with increased quantity and quality of life:
• Regular exercise,
• Balanced diet,
• Not smoking or using illicit drugs,
• Not drinking alcohol excessively,
• Getting adequate rest,
• Maintaining a positive attitude,
• Exercising curiosity and continuing to learn new things, and
• Maintaining positive relationships.
Dr. Nuland goes into the life of surgical icon, Michael DeBakey as a hero of healthy aging. Dr. DeBakey had a long and illustrious career as a surgeon, clinical investigator, teacher, and medical administrator. Dr. DeBakey contributed to the development of the heart-lung bypass machine as a medical student; the development of mobile army surgical hospitals (MASH units) while in the Service; the development of the Research Service while working in the Veterans Affairs (VA) healthcare system; and the development of the Baylor College of Medicine. A pioneer in the surgical treatment of aortic aneurysm disease, DeBakey continued operating until he was 90, and at age 97 underwent the aortic surgery he had pioneered, performed by a team he had trained! Nuland emphasizes Dr. DeBakey’s continued curiosity and pursuit of knowledge, as well as his awareness of having contributed something of value, as critical parts of his longevity. In DeBakey’s own words, “The gratification comes from the feeling that you’ve done something for people.”
Nuland also tells us about Miriam Fox Gabler, a person whose name we are not so likely to recognize. He describes her endurance and resilience through divorce, cancer, remarriage, and the ultimate demise of her ‘second chance’ husband by dementia from Alzheimer’s. In the telling, he reveals that Gabler first reached out to him and thanked him specifically for the chapter he had written about Alzheimer’s in his book, How We Die. In this poignant chapter, Dr. Nuland resonates with Viktor Frankl’s classic, Man’s Search for Meaning. Frankl had written that in response to his tragic triad of 1) pain, 2) guilt, and 3) death; humans can find meaning by either:
• Creating a work or doing a deed,
• Experiencing something or encountering someone or love,
• By facing a fate one cannot change, one may rise above and grow beyond oneself, and change for the better.
Gabler took writing classes and wrote inspiring articles. She celebrated the time she had with her second husband, or in her own words, “Today I made a choice. I could cry and become miserable because my husband is in a nursing home, or I could rejoice that on this day fourteen years ago, I became his wife.” In so doing, she rose above her fate.
In another lengthy chapter, Dr. Nuland attempted to deal with two popular alternatives to his view of healthy aging which purport to guarantee eternal life:
• Religious preoccupation with an afterlife
• Attempts to alter human biology so as to allow humans to live forever.
In his account of Michael DeBakey, Nuland tells us that although he had a strong spiritual perspective, DeBakey did not focus on death but rather on living. Similarly, DeBakey did not worry about church attendance saying instead, “I am in church right here.”
With regard to the efforts to change our biology, Dr. Nuland reviews the work of Aubrey DeGrey and his ‘strategies for engineered negligible senescence. Nuland catalogs many of DeGrey’s theories, primarily as conceptual ‘strawmen’, which he then bowls over. Nuland concludes that man is more likely to destroy his entire species than achieve human immortality.
In his summation, Nuland recommends a triad of wisdom, equanimity, and caring. Wisdom, especially self-knowledge, is for Nuland’s case on aging akin to the place of Beauty in the life of an artist that James Joyce outlines in Portrait of the Artist as a Young Man. Throughout the book, Dr. Nuland has emphasized the necessity of dealing with uncertainty and paradox. His summary of Wisdom involves the attempt to resolve a series of contradictions, such as:
• Consistency with openness to change,
• Reliable or validated knowledge with the awareness that everything should be questioned and there is no ‘absolute truth’,
• Skepticism against cynicism,
• Confidence in one’s own knowledge and judgment while acknowledging imperfection,
• Self-knowledge versus awareness of one’s biases and imperfections,
• Modeling of heroes while recognizing the fallibility of all humans,
• Personal involvement and caring balanced with enough detachment to aid fairness and objectivity,
• Being reflective while committed to action,
• Idealism grounded in realism,
• Equanimity balanced by enough discontent to fuel needed reform,
• Anticipating consequences while conceding uncertainty,
• Accepting change while recognizing all change is ephemeral,
• Thinking timelessly while being of the time,
• Taking account of one’s society and era while not becoming restricted by them,
• Appealing to the best in others without expecting too much of them,
• Maintaining a vision of tomorrow, while living in the reality of today.
Like his earlier work, The Art of Aging is the culmination of efforts by a brilliant physician, thinker, and writer, to write his way through some of the most challenging aspects of our humanity and face our mortality. I recommend reading both books.
• Knowing one’s limitations and being able to function within them.
• “Aging is not a disease.” This point is made repeatedly throughout the book.
• Becoming elderly is simply another developmental phase of life.
• Growing old is an art, not a disease.
• Adapting is not merely reconciling.
• Work is love made visible. When our work life is over, it is important to feel that we have contributed something of value.
• “Whatever else aging may represent to us, it is first and foremost a state of mind.”
• To negotiate old age, we must learn to deal with uncertainty and contradictions.
As he did regarding diseases that can lead to death, in How We Die, Nuland begins The Art of Aging by providing a layperson’s summary of the biology of aging. On the one hand, this provides the reader with a map of what kind of things are to be expected and what is ‘normal’. Additionally, he acquaints the reader with data in favor of lifestyle choices that have been shown to be associated with increased quantity and quality of life:
• Regular exercise,
• Balanced diet,
• Not smoking or using illicit drugs,
• Not drinking alcohol excessively,
• Getting adequate rest,
• Maintaining a positive attitude,
• Exercising curiosity and continuing to learn new things, and
• Maintaining positive relationships.
Dr. Nuland goes into the life of surgical icon, Michael DeBakey as a hero of healthy aging. Dr. DeBakey had a long and illustrious career as a surgeon, clinical investigator, teacher, and medical administrator. Dr. DeBakey contributed to the development of the heart-lung bypass machine as a medical student; the development of mobile army surgical hospitals (MASH units) while in the Service; the development of the Research Service while working in the Veterans Affairs (VA) healthcare system; and the development of the Baylor College of Medicine. A pioneer in the surgical treatment of aortic aneurysm disease, DeBakey continued operating until he was 90, and at age 97 underwent the aortic surgery he had pioneered, performed by a team he had trained! Nuland emphasizes Dr. DeBakey’s continued curiosity and pursuit of knowledge, as well as his awareness of having contributed something of value, as critical parts of his longevity. In DeBakey’s own words, “The gratification comes from the feeling that you’ve done something for people.”
Nuland also tells us about Miriam Fox Gabler, a person whose name we are not so likely to recognize. He describes her endurance and resilience through divorce, cancer, remarriage, and the ultimate demise of her ‘second chance’ husband by dementia from Alzheimer’s. In the telling, he reveals that Gabler first reached out to him and thanked him specifically for the chapter he had written about Alzheimer’s in his book, How We Die. In this poignant chapter, Dr. Nuland resonates with Viktor Frankl’s classic, Man’s Search for Meaning. Frankl had written that in response to his tragic triad of 1) pain, 2) guilt, and 3) death; humans can find meaning by either:
• Creating a work or doing a deed,
• Experiencing something or encountering someone or love,
• By facing a fate one cannot change, one may rise above and grow beyond oneself, and change for the better.
Gabler took writing classes and wrote inspiring articles. She celebrated the time she had with her second husband, or in her own words, “Today I made a choice. I could cry and become miserable because my husband is in a nursing home, or I could rejoice that on this day fourteen years ago, I became his wife.” In so doing, she rose above her fate.
In another lengthy chapter, Dr. Nuland attempted to deal with two popular alternatives to his view of healthy aging which purport to guarantee eternal life:
• Religious preoccupation with an afterlife
• Attempts to alter human biology so as to allow humans to live forever.
In his account of Michael DeBakey, Nuland tells us that although he had a strong spiritual perspective, DeBakey did not focus on death but rather on living. Similarly, DeBakey did not worry about church attendance saying instead, “I am in church right here.”
With regard to the efforts to change our biology, Dr. Nuland reviews the work of Aubrey DeGrey and his ‘strategies for engineered negligible senescence. Nuland catalogs many of DeGrey’s theories, primarily as conceptual ‘strawmen’, which he then bowls over. Nuland concludes that man is more likely to destroy his entire species than achieve human immortality.
In his summation, Nuland recommends a triad of wisdom, equanimity, and caring. Wisdom, especially self-knowledge, is for Nuland’s case on aging akin to the place of Beauty in the life of an artist that James Joyce outlines in Portrait of the Artist as a Young Man. Throughout the book, Dr. Nuland has emphasized the necessity of dealing with uncertainty and paradox. His summary of Wisdom involves the attempt to resolve a series of contradictions, such as:
• Consistency with openness to change,
• Reliable or validated knowledge with the awareness that everything should be questioned and there is no ‘absolute truth’,
• Skepticism against cynicism,
• Confidence in one’s own knowledge and judgment while acknowledging imperfection,
• Self-knowledge versus awareness of one’s biases and imperfections,
• Modeling of heroes while recognizing the fallibility of all humans,
• Personal involvement and caring balanced with enough detachment to aid fairness and objectivity,
• Being reflective while committed to action,
• Idealism grounded in realism,
• Equanimity balanced by enough discontent to fuel needed reform,
• Anticipating consequences while conceding uncertainty,
• Accepting change while recognizing all change is ephemeral,
• Thinking timelessly while being of the time,
• Taking account of one’s society and era while not becoming restricted by them,
• Appealing to the best in others without expecting too much of them,
• Maintaining a vision of tomorrow, while living in the reality of today.
Like his earlier work, The Art of Aging is the culmination of efforts by a brilliant physician, thinker, and writer, to write his way through some of the most challenging aspects of our humanity and face our mortality. I recommend reading both books.
July 7, 2014
A great book for people in their 40's and 50's
I have always felt that we talk too much about how horrible it is to be old and make jokes about it. This provides a great map for a meaningful life span.
I have always felt that we talk too much about how horrible it is to be old and make jokes about it. This provides a great map for a meaningful life span.
July 17, 2010
Rambling, self-serving boring book
July 28, 2025
Boring and long-winded. Not going to waste my time on it. DNF at 50 pages. I tried but ooof, not a well written book.
March 4, 2020
Charles Kingsley-"All we need to make us really happy is something to be enthusiastic about."
Tagore-"When I gaze at the infinity that is you, and lose myself in the beauty and vastness. Death and pain have no meaning, they are insignificant. But when I turn away from you and center on myself, Death looms large and pain overwhelms me."
Robert Louis Stevenson's Lay Morals- "So long as we love we serve; so long as we are loved by others, I would almost say, that we are indispensable; and no man is useless while he has a friend."
We must never allow the luxury of despair.
Religion becomes the paradoxical product of an inherent biological drive. Neither we nor god need ever die.
Destiny is circumvented by faith.
Science 1997- In the oldest old ,loss of muscle strength is the limiting factor for an individual's chance of living an independent life until death.
Wisdom has a purpose; that purpose has action. This means that action must sometimes be taken with full understanding that decisions may possibly result in less than perfect consequences.
I want death to find me planting my cabbages, neither worrying about it nor about the unfinished gardening, Michael de Montaigne
Sense of mutual caring and connectedness with others
Maintenance insofar as we can influence by our own actions, of the physical capabilities of our bodies.
Creativity
William Osler- A Way of Life
Man is not Alone-Rabbi Abraham Joshua Heschel
A great deal can be learned also by meditation on the ways in which person philosophy can take maximal, advantage of constitutional endowment. By meditating on the ways in which some individuals can forge a fusion of mind and body, so remarkable that to be in it's presence is to experience a surpassing awe for the potential of our species.
If you look at a problem long enough, you can see the part you play in it-Miriam Fox Gabler
Grace-Alice Walker
The rug-braiding, the quilting, the cooking-all of these are arts to her, just as they are sources of contentment. "It's not enough to be busy. The busyness must have meaning." Miriam Fox Gabler
Art Galston's thoughts about God. "None. I have very litte patience for organized religion."
Tagore-"When I gaze at the infinity that is you, and lose myself in the beauty and vastness. Death and pain have no meaning, they are insignificant. But when I turn away from you and center on myself, Death looms large and pain overwhelms me."
Robert Louis Stevenson's Lay Morals- "So long as we love we serve; so long as we are loved by others, I would almost say, that we are indispensable; and no man is useless while he has a friend."
We must never allow the luxury of despair.
Religion becomes the paradoxical product of an inherent biological drive. Neither we nor god need ever die.
Destiny is circumvented by faith.
Science 1997- In the oldest old ,loss of muscle strength is the limiting factor for an individual's chance of living an independent life until death.
Wisdom has a purpose; that purpose has action. This means that action must sometimes be taken with full understanding that decisions may possibly result in less than perfect consequences.
I want death to find me planting my cabbages, neither worrying about it nor about the unfinished gardening, Michael de Montaigne
Sense of mutual caring and connectedness with others
Maintenance insofar as we can influence by our own actions, of the physical capabilities of our bodies.
Creativity
William Osler- A Way of Life
Man is not Alone-Rabbi Abraham Joshua Heschel
A great deal can be learned also by meditation on the ways in which person philosophy can take maximal, advantage of constitutional endowment. By meditating on the ways in which some individuals can forge a fusion of mind and body, so remarkable that to be in it's presence is to experience a surpassing awe for the potential of our species.
If you look at a problem long enough, you can see the part you play in it-Miriam Fox Gabler
Grace-Alice Walker
The rug-braiding, the quilting, the cooking-all of these are arts to her, just as they are sources of contentment. "It's not enough to be busy. The busyness must have meaning." Miriam Fox Gabler
Art Galston's thoughts about God. "None. I have very litte patience for organized religion."
January 23, 2018
To use the author's words, this book is not about "eating granola and emulating Okinawans ... this book is about mind and spirit" as we mature. It's about how to age with grace and find joy and contentment in our last decades by establishing a sense of mutual caring and connectedness with others, intelligently caring for our physical bodies, and incorporating creative outlets to keep the mind challenged. Aging is not a disease, but rather an art to be honed and nurtured, ideally starting well before most of us are ready to admit our years. Every stage of life is preparation for the one ahead.
I especially enjoyed the stories he shared of several people he felt were aging successfully. In each in depth interview he asked the important question (to me) about how/if faith played a role in their lives. He lost me in the chapter on adding centuries to our years through the search for the "master aging gene". I skimmed the topic because I simply have no interest there.
The writing is good and I have another of his bestsellers on my shelf, How We Die: Reflections on Life's Final Chapter.
I especially enjoyed the stories he shared of several people he felt were aging successfully. In each in depth interview he asked the important question (to me) about how/if faith played a role in their lives. He lost me in the chapter on adding centuries to our years through the search for the "master aging gene". I skimmed the topic because I simply have no interest there.
The writing is good and I have another of his bestsellers on my shelf, How We Die: Reflections on Life's Final Chapter.
March 28, 2018
The author, a former professor of surgery at Yale University, write with clarity and candor about growing old and the eventual process of death. One of the most moving parts of the book is his series of letters with an aging woman who thought she should take her own life. He reminds her that her life is of great value, especially to those she loves.
Dr Nuland writes about aging intentionally. He explains: "Why not also prepare ourselves [for aging] emotionally by putting away spiritual and intellectual capital? Why not prepare ourselves physically, by becoming accustomed to regular vigorous exercise and proper diet long before they become crucial to avoiding frailty? Why not prepare ourselves with a cultivation of the caritas that can ring untold rewards to every stage of our lives? Like a well-run pension fund, what we put in is proportional to what we get out, and the interest keeps growing."
I wish the book had contained a bit more research although I did really love the stories and the interviews he includes.
Dr Nuland writes about aging intentionally. He explains: "Why not also prepare ourselves [for aging] emotionally by putting away spiritual and intellectual capital? Why not prepare ourselves physically, by becoming accustomed to regular vigorous exercise and proper diet long before they become crucial to avoiding frailty? Why not prepare ourselves with a cultivation of the caritas that can ring untold rewards to every stage of our lives? Like a well-run pension fund, what we put in is proportional to what we get out, and the interest keeps growing."
I wish the book had contained a bit more research although I did really love the stories and the interviews he includes.
November 4, 2018
I was disappointed in this book. Compared to other science/medical books I've read recently, this was pretty dry. There isn't a lot of anecdotes, and it seems overly philosophical. A lot of fancy language and vocabulary, but largely just wordiness. I didn't even get through the whole book, but so far, he's talked a lot about two people he interviewed who, in his opinion, aged amazingly well. One is a Catholic who tells him that her faith plays a huge role in how she's accepted the challenges of getting older/health problems. The second is an atheist. The author explicitly says that, despite the woman's claim that her relationship with God has helped her age gracefully, she really owes everything to her ability to make good choices. As a woman of faith myself, I can't help but think that one's relationship with God and understanding of what truly matters in life is what really makes the difference as we grow older. The author is quick to point out that relationships and serving others is important, but again, denies that real source of that.
September 17, 2021
Found much valuable here but also thought chapters were of uneven interest with some covering ground that is very familiar to anyone reading in this area. The standouts are Chapter 2: How We Age Body and Mind, and Chapter 7: Adding Centuries to Our Years. Chapter 2 is very useful and very unusual in that it actually describes the physical processes underlying aging. So often in these kinds of books, this is glossed over, perhaps because it's not necessarily cheerful reading, but I find it helpful to understand what is going on and what we can expect. In this sense this book very clearly mirrors Nuland's "How We Die," which defies convention in providing very specific and detailed information about the physical process of dying and preceding events. Chapter 7 is quite interesting also in that Nuland takes on the argument that life can and should be extended indefinitely as a moral imperativ e and argues instead using resources for improving the quality of life in one's later years.
September 30, 2021
I discovered Dr. Nuland’s book through a lecture series I listened to featuring Dr Nuland on the Great Courses, Doctors: The History of Scientific Medicine Revealed through Biography. He is an engaging and thoughtful speaker. I loved the course. His book did not disappoint. The art of aging is really that—an art. This is how Nuland describes it towards the end of the book. He doesn’t discount however the science behind aging—how our bodies deteriorate over time, how disease can accelerate the process that much more, yet Nuland describes (very well) how aging successfully within our (aging) bodies requires a strategy, a plan and much thought.
In the book Nuland shares stories of people he encounters in his life, and his personal and professional reflections on aging from a medical doctor’s perspective as well as from his viewpoint as a man in his seventies. At times the book is philosophical, and long-winded. This is a criticism I read in some Goodreads reviews. But I didn’t take it that way. I found it insightful, helpful and inspirational. I highly recommend this book to anyone in their fifties or older.
In the book Nuland shares stories of people he encounters in his life, and his personal and professional reflections on aging from a medical doctor’s perspective as well as from his viewpoint as a man in his seventies. At times the book is philosophical, and long-winded. This is a criticism I read in some Goodreads reviews. But I didn’t take it that way. I found it insightful, helpful and inspirational. I highly recommend this book to anyone in their fifties or older.
December 6, 2022
Dr. Nuland was a world class surgeon, a patient-focused writer/teacher who had the rare ability to understand both how the human body "works" down to the cellular level, AND the ability to simplify and distill that knowledge into intelligent essays for those of us unable to understand the overcomplicated medicine-speak of today...
He was a voice in the wilderness asking his profession to become more patient-centric, more compassionate, more willing to be emotionally present when confronted with a patient having a life threatening diagnosis or life ending illness. He asked that doctors simply tell the truth when confronted with that reality, to help the patient prepare for their end point, instead of staying silent and only offering false hope and unnecessary procedures as a plan of treatment. The original "don't ask, don't tell"... I wish more doctors thought like him! I blame the medical schools!
He was a voice in the wilderness asking his profession to become more patient-centric, more compassionate, more willing to be emotionally present when confronted with a patient having a life threatening diagnosis or life ending illness. He asked that doctors simply tell the truth when confronted with that reality, to help the patient prepare for their end point, instead of staying silent and only offering false hope and unnecessary procedures as a plan of treatment. The original "don't ask, don't tell"... I wish more doctors thought like him! I blame the medical schools!
This entire review has been hidden because of spoilers.
September 13, 2022
How We Die author mellowing with years to tell us about a satisfactory life or not only living but
enjoying it with good friendships and good experiences and, even, health.
All we need to make us really happy is something to be enthusiastic about. [Chas. Kingsley.] p. 158
Belief in God is belief in the supernatural (superstition). p. 182
"Who is wise?" answer "He who learns from all men." p. 256
Marcel Proust: We do not receive wisdom; we must discover it for ourselves after a long journey that no one can take for us or spare us." p. 271
The better we have used our years, the greater will be the rewards of individuality and accrued wisdom. As Leonardo da Vinci wrote in the Codex Atlanticus, : If you are mindful that old age has wisdom for its food, you will so exert yourself in youth, that your old age will not lack sustenance. " p. 286
enjoying it with good friendships and good experiences and, even, health.
All we need to make us really happy is something to be enthusiastic about. [Chas. Kingsley.] p. 158
Belief in God is belief in the supernatural (superstition). p. 182
"Who is wise?" answer "He who learns from all men." p. 256
Marcel Proust: We do not receive wisdom; we must discover it for ourselves after a long journey that no one can take for us or spare us." p. 271
The better we have used our years, the greater will be the rewards of individuality and accrued wisdom. As Leonardo da Vinci wrote in the Codex Atlanticus, : If you are mindful that old age has wisdom for its food, you will so exert yourself in youth, that your old age will not lack sustenance. " p. 286
December 23, 2020
I have repeatedly had the notion that I should inform myself about the aging process. My original thought was to read memoirs or accounts of healthy octogenarians. The author is a doctor in his seventies, fits the bill. Most of the book seems to reflect common beliefs, scientific and medically proven tactics for aging well; Good diet, exercise, mental challenges, social interaction and having a purpose in life. Nulands approach is a bit anecdotal to emphasize these traits, either through interviews or accounts of persons he's known in his own life. He is refreshingly hopeful while being clearly realistic about the process of dying. I wish him a long and healthy life, and trust that some of his advice reaches my subconscious to direct my own.
March 27, 2024
The author, a cardiologist, gives us biographies of people who have lived to old age and their accomplishments even while being aged. I believe it is meant to be inspiring and to give us elderly the idea that there is not much to do just because we've reached our 70s or 80s.
While Dr Nuland does speak to physical health - exercise and eating well - I was expecting more advice about the practical application of the physical, social and mental health of growing older and not so much of the relating of what miraculous living was done by the special people he talks about.
He is a good writer and sprinkles just enough new-to-me terms into his writing to keep me looking things up on Google.
While Dr Nuland does speak to physical health - exercise and eating well - I was expecting more advice about the practical application of the physical, social and mental health of growing older and not so much of the relating of what miraculous living was done by the special people he talks about.
He is a good writer and sprinkles just enough new-to-me terms into his writing to keep me looking things up on Google.
October 8, 2018
very good book on aging from the author of 'How we die'
Dr. Nuland steps back to explore the impact of aging on our minds and bodies, strivings and relationships. Melding a scientist’s passion for truth with a humanist’s understanding of the heart and soul, Nuland has created a wise, frank, and inspiring book about the ultimate stage of life’s journey.
The onset of aging can be so gradual that we are often surprised to find that one day it is fully upon us. The changes to the senses, appearance, reflexes, physical endurance, and sexual appetites are undeniable–and rarely welcome–and yet, as Nuland shows, getting older has its surprising blessings.
Dr. Nuland steps back to explore the impact of aging on our minds and bodies, strivings and relationships. Melding a scientist’s passion for truth with a humanist’s understanding of the heart and soul, Nuland has created a wise, frank, and inspiring book about the ultimate stage of life’s journey.
The onset of aging can be so gradual that we are often surprised to find that one day it is fully upon us. The changes to the senses, appearance, reflexes, physical endurance, and sexual appetites are undeniable–and rarely welcome–and yet, as Nuland shows, getting older has its surprising blessings.
Read
January 11, 2021Nuland was a surgeon in his early seventies when he wrote this book about what aging is and how he thinks we should confront it. As an MD who can write well, who has "skin in the game", he has the qualifications to address the issue. The book is not a detailed instruction manual as much as a contemplation of some of the central questions: what are the problems we face, what are the strengths we can bring to it, what should be our aim, broadly, how should we go about it, what mental attitudes will help us in the process?
Well worth reading.
Well worth reading.
Read
February 24, 2024DNF. Rambling anecdotes and Plato quotes. Not my cup of antioxidant tea.
Alternatively:
Keep Moving: And Other Truths About Living Well Longer
Alternatively:
Keep Moving: And Other Truths About Living Well Longer
October 14, 2019
An excellent follow-up to the classic 'How we die', Dr. Sherwin Nuland gives an excellent perspective of aging and old age from many perspectives - from the aging person, for people with aging parents or loved ones, from that of a doctor, a scientist and his own journey and wisdom gained post retirement. A very important read for anyone curious to understand the journey through wisdom, gratitude and creativity, also called as aging.
Read
May 19, 2020Don't let the description of the subway encounter at the start of the book through you off. It makes the discussion of the topics that follow a personal journey with the author. For those of us entering our later years or who are providing support to older loved ones, Dr. Nuland offers informed opinions and evidence-based information for navigating the later stages of development of the human body, mind, and spirit.
February 27, 2025
I think just about everyone would get something out of reading this book. I wish I had first read it decades ago and then committed to reading it with the entrance to every new decade. Nonetheless, I enjoyed reading it now, look forward to utilizing the wisdom gifted and re-reading it at a later date.
September 2, 2017
This book has some interesting info but is a ponderous read. I expected mostly advice, but the book is mostly made up of the overly-detailed stories of people who've aged well. I wanted the advice. Oh, well.
July 2, 2019
I'm glad I read this. There was a lot of good information and interesting anecdotal stories of people who are aging gracefully. Of course there is no magic bullet but we certainly have plenty of choices to ease the process. No real epiphanies just a lot of good common sense.
March 7, 2020
Age concentrates not only the mind the body’s energies leading to new bursts of creativity as well as new perspective and spiritual intensity. Aging is not a disease but an art form. Aging is an opportunity for greater growth and compassion as well as abundant creativity.
December 20, 2023
It would have benefited from more stories about people’s lives and less quoting of sages. However, the stories of people’s lives that he chose were well-chosen. So were the sages.
This was a good book for me to be reading as I enter my last year of work.
This was a good book for me to be reading as I enter my last year of work.
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