Being Mortal: Medicine and What Matters in the End by Atul Gawande Page B

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.
    “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 maître 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.