Four columns ago, I celebrated the life of Cicely Saunders, the British doctor who inspired the modern hospice movement. In response to news of her death, I praised her for her approach to care for the dying, one that takes into account the emotional, spiritual, and familial needs of patients.

Dr. Saunders focused on relief of their pain and suffering, and taught other medical professionals around the world to do the same; this makes her, in my view, deserving of special appreciation.

Nothing in that column was untrue, so far as I can tell. However, further reading and conversation with professionals involved with hospice has revealed the current situation in this country to be more complicated than I realized.

For example, in the New York Times Magazine of August 7th, contributing writer Robin Marantz Henig asserts that the hospice movement has abandoned much of its original approach. Instead, it has conformed to Americans’ desire to keep living at almost all costs, including the acceptance of medical interventions formerly seen as incompatible with the ideals of hospice.

According to Henig, hospice “began in the 1960s as an antiestablishment, largely volunteer movement, advocating a gentle death as an alternative to the medicalized death many people had come to dread.”  But now hospice practices what it calls “open access,” meaning that “terminally ill patients can continue chemotherapy and other treatments and still get hospice benefits through Medicare.”

My longtime friend Art Mazer also sees hospice as having disappointed its original vision. He took part in planning the first hospice in the United States, which opened in New Haven in 1974, and he tells of the struggle to keep the emphasis on home care, rather than institutional services. From the beginning there were pressures to bring dying patients into a newly-built care facility rather than caring for them in their homes. “All this was a distortion in the original plan,” Mazer says.

The hospice pioneers in this country also wanted to educate mainstream doctors about taking care of pain, but that did not happen. Instead, hospice seemed to settle for what my friend calls “its own little niche” in the American medical system.

Part of hospice’s loss of momentum might be attributed to the rise of the palliative care movement. However, Janet Abrahm, a pioneering Boston physician who is involved in both palliative medicine and hospice care defends hospice’s current approach. “I don’t think the hospice programs are giving up their focus,” Dr. Abrahm says. “Hospices are trying to expand to people who say ‘What’s wrong with taking oral chemotherapy to prolong life?’”  “Nationally, Americans don’t want to die,” she adds.

Of one of hospice’s achievements she observes: “I’ve seen that magical work of bringing families together.”  

I have also talked with Dr. Rosemary Ryan, a medical director of hospice programs in the Boston area for over 25 years. She rejects the criticism of hospice for using medical means to help patients. According to her, Cicely Saunders wanted to use whatever would help care for the dying.

It is hard, Dr. Ryan says, to make sweeping rules for those approaching death. What makes a good death varies from person to person, and family to family. “Hospice has adapted to where our population is,” she believes.

If transfusions make people feel better, then hospice can accept them. So, too hospice will take patients who have not given “do not resuscitate” instructions. As for calling 911 when a terminally ill person needs help, it is something hospice does not encourage but does not try to stop.

Dr. Ryan also sees the palliative care movement as not being in conflict with hospice. In fact, she considers hospice as part of palliative care.  

As so frequently with complicated issues, I stand somewhere in the middle. I regret that hospice has made what seem to me compromises with the American refusal to face up to death. It was the special genius of hospice to treat dying people, not by fighting off death but by helping them die as peacefully as possible.

On the other hand, I welcome hospice’s collaboration with the palliative care movement and the latter’s commitment to relieving pain.

However, as Dr. Abrahm points out with regret, many American hospitals and cancer centers lack fully developed palliative care programs. Palliative care has not yet received recognition as a medical specialty, has relatively few doctor practitioners, and is established in only about one-half of America’s hospitals.

In all of this discussion, the most important fact is that altogether too many dying people go without their pain and suffering being relieved. This is an intolerable situation. It calls out for remedy through various approaches, with hospice and palliative care leading the way.

Richard Griffin

“I can hardly think I am entered this day into the seventy-eighth year of my age. By the blessing of God, I am just the same as when I entered the twenty-eighth. This hath God wrought, chiefly by my constant exercise, my rising early, and preaching morning and evening.”

These words, written in 1780 and reprinted in the Oxford Book of Ages, come from the great Methodist preacher John Wesley. They suggest a person of great vigor and a strongly positive outlook on life. No wonder this man of faith had such an impact on 18th century England and on later times and other places

As someone who became authoritative late last month on the subject of entering the 78th year of life, I am a reliable critic of what Wesley wrote in his journal. In that role I dispute the faqmous evangelist’s claim of being the same 50 years previously. Clearly he was indulging in hyperbole to indicate his high spirits on his 77th birthday.

No such claim will come from me. Otherwise, why should I be rapidly approaching Woody Allen’s situation of having a doctor for every part of his body? No, I cannot boast of having the same resiliency that I had in 1955.

Running from first base to third in my long-established Sunday softball games also reminds me of changes. Why else do I arrive at my destination panting? And why is the batter at my heels, approaching the same base?

If Wesley is referring to the continuities in his life, then I am with him. Fortunately, I do recognize in the 27-year-old me some of the same traits that I own now. Skepticism, orneriness, a certain curmudgeonliness, and other such virtues continue to adorn my life as they did five decades ago.

Of course, I agree with Wesley about the value of exercise, and attribute to its daily use whatever vitality I have salvaged from the wear and tear of life. What relish to swim indoors each day, especially when the temperature outside reaches 90-degrees!

As to rising early, I have recently decided it is overrated. I have taken my leave from the abundant ranks of the sleep-deprived in favor of the eight-hour-a-night cohort. Maybe early rising worked for Wesley, but I now suspect that more sleep would have enabled him to live longer.

Preaching I have given up, except when carried away in columns like this one. Wesley probably went on for hours in his sacred harangues, something which I rejoice at neither giving nor receiving.

My source for age anecdotes moves to the 20th century for one about Sir George Sitwell of the celebrated British literary family. Described by his doctor as an “old man of seventy-seven years of age,” Sitwell is introduced fussing about his health.

His son Osbert leaves his bed-ridden father for an errand. On returning, he finds the elder Sitwell still in bed, looking depressed and wondering how long the doctor thinks he will last. About 20 years, the son tells him.

“At this he suddenly jumped out of bed with an agility that would have done credit to a man half his age, and said: ‘I must dress now.’ That night he came down for dinner.”

Throwing off self-pity always strikes me as an ideal for any age. In a funk, George Sitwell hears news good enough to propel him out of bed. Dressing for dinner must have further upped his morale, the exterior making an impact on his inner being.

None of my many doctors tells me how long I’m going to last. Fortunately, they know better, that is they don’t know at all. I am glad to have outlived the infallibility of the medical profession and hope, one day, to be granted the same satisfaction by the ecclesiastical profession.

Sir George’s dinner was at night. It may have been thin British gruel, for all I know, but it was consumed at a gracious hour. I am still afflicted by memories of feeling logy after family dinners at one o’clock in the afternoon. They seem as outmoded as going to the movies at any old time, even in the middle of the film, as we all used to do.

Though 77 does not hold much distinction as a birthday, it does have a kind of alliterative ring to it. In ancient times, a mystical aura would probably have clung to this number. After all, seven was special, so having two of them strung together would presumably have qualified as a mysterious power.

In the modern world, only the numbers ending in zero or five are thought powerful. That’s why people edge close to despair on reaching 30. In a worldly culture like ours, you attach secular meaning to numbers that otherwise seem arbitrary and nonsensical.

For me, 77 feels just fine. I even like the steam-engine sound of it.

Richard Griffin

If you were to seek advice from a doctor about extending life into your nineties, what would you expect to hear?

Most physicians, I suspect, would respond by urging ongoing care of your blood pressure and maintaining strict control of your cholesterol. The most savvy among them would almost emphasize the benefits of physical exercise. And presumably they would want you to have physical check-ups at regular intervals.

Because a friend was in town celebrating the fiftieth anniversary of his graduation from Harvard College, I went to a symposium, this June, in which panelists spoke about various health issues. Most of the speakers were physician classmates reporting on their research. I listened without avid attention until the last presenter took the stand.

He, George Vaillant, is a psychiatrist who serves as a professor at Harvard Medical School. More important, he is director of the university’s long-time study of human development, a role on which he drew for his valuable 2002 book Aging Well.

In his brief remarks Dr. Vaillant shared with members of the class of 1955 his formula for those among them interested in returning for their 75th reunion. His two-fold agenda for longevity must have astonished anyone expecting the conventional wisdom.

What this veteran researcher recommends is, first, taking good vacations. He finds solid therapeutic values in getting away from one’s home ground for extended periods. Pursuing one’s interests and avocations in other places strikes him as an excellent way of adding to a person’s years as well as to the enjoyment of them.

The second piece of advice Vaillant gave to the alums was “take care of your marriage.” He considers the quality of one’s personal relationships to have a strong impact upon longevity. For those who are married, solid harmonious relationships with their spouses have a central place in their lives or─ at least, ought to─if well-being is to be assured.

So the members of the class of 1955 went away from this talk with advice that must have seemed fresh and new. Many of them, I suspect, were amazed to be given such a simple prescription for living longer. “Is that all I have to do?” some must have asked themselves.

On examination, however, the double-barreled advice may not prove all that simple. Many of the people to whom it was addressed have probably become masters at ignoring one or both pieces of this counsel.

The hard-driving, Type A personalities among them may be workaholics who have never developed habits of leisure. Their neglect of taking time off from work may be ingrained by now so deeply that even retirement will not free them of its effects. Powerful cultural forces in American life have enshrined unrelenting work as the supreme value.

These same people and others may have failed to cherish their marriages, and suffered from the fall-out that so often results. Being a caring husband or wife requires priority-setting that goes against conventional notions of success.

Retirement, however, does give many people an opportunity to set out anew toward a life that is more fully human. It can offer the chance for living with a set of values capable of rendering us more relaxed and, perhaps, more loving.

The beauty of this change may be, as Vaillant suggests, the lengthening of one’s years because of a growth in life satisfaction. To me, it also signifies a recognition of the importance that spirit plays in both physical and mental well-being. Ultimately, we prove to be more than our body; the soul, too, needs nurturing.

Vaillant has not pulled this advice about marriage out of thin air. In his book referred to above, he grounds this recommendation in the decades-long research project which he directs. Here is what he writes about one of the findings: “A good marriage at age 50 predicted positive aging at 80. But, surprisingly, low cholesterol levels did not.”

For fear the two pieces of advice seem elitist, meant only for affluent marrieds who graduated from a notoriously privileged college, let me apply this counsel more broadly.

Not everyone can take vacations like those that show up in the travel section of newspapers. By reason of disability some of us cannot endure the rigors of certain forms of transport. And others of us lack the funds necessary for wide-ranging trips.

However, even people not able to travel can adopt the spirit of the first recommendation. This we might accomplish by building change into our lives. By learning something new, for instance, we might discover the moral equivalent of travel.

The advice about taking care of one’s marriage can also apply to those who do not have a spouse. The quality of our human relationships in general surely conduces to our overall well-being. By making sure that our friendships flourish we help to build our own self-worth and find our positive feelings about ourselves reinforced.

Richard Griffin

A friend shared with me recently a hospital happening that you may remember having had yourself. She was sound asleep, only to be awakened by a nurse on her rounds. Why? To give my friend a sleeping pill, of course.

Hospitals make a serious mistake in showing little regard for the benefits of sleep. The worst part of this, of course, is the custom of putting medical interns to work when they are groggy from sleep deprivation. Research has shown that the error rate of such medical staffers is far greater than that of interns who have adequate rest.

This I learned from an enlightening article written by Craig Lambert in the current Harvard Magazine. There he draws on the work of experts, most of them Boston-area  physicians, who have studied sleep and have discovered other disturbing facts about its deprivation. Sleeplessness in this country amounts to an epidemic, with consequences the public has failed to recognize.

“Lack of sleep,” Lambert summarizes, “may be related to obesity, diabetes, immune system dysfunction, and many illnesses, as well as to safety issues such as car accidents and medical errors, plus impaired job performance and productivity in many other activities.”

This bad situation, far from improving, has worsened over the last few years. Sixteen percent of Americans now sleep less than six hours on weekday nights, as contrasted with 12 percent in 1998. And only 26 percent of us get eight or more hours of sleep a night.

Americans may not be the most sleep-deprived people on earth. However, we are right down there fighting for the title. Even worse, going without sleep has come to be regarded as highly virtuous. Adults who do not leave the office until late at night are seen as models. Many college students pride themselves on their “all- nighters” before exams, ignoring evidence that this habit may damage their health and actually harm their performance on exam questions that require critical thinking.

Lambert’s article has convinced me of the dangers of getting too little sleep and the advantages of adding more. I have now resolved to increase my nightly ration by another hour, bringing my total number to eight. My hope is for this experiment to relieve some of the fatigue I experience during the day.

My primary care physician wants me to go further. She urges me to take a sleep test, but thus far I am resisting. The prospect of sleeping overnight in a laboratory setting with electrodes attached to my body intimidates me. But, if my current experiment fails, it may come to that.

The older I get, the more I value a good night’s sleep. Shakespeare’s words in Act II of Macbeth often echo in my mind: “Sleep that knits up the ravell’d sleeve of care / The death of each day’s life, sore labour’s bath, / Balm of hurt minds, great nature’s second course, / Chief nourisher in life’s feast.”

The great Elizabethan expressed poetically something of what modern researchers say scientifically. Sleep is not a waste of time; rather it brings us into a therapeutic process. While we are becoming refreshed, our brain is also at work processing information.    

Many studies suggest the folly of trying to get along without sleep. Lambert quotes a Detroit-based researcher who says: “The percentage of the population who need less than five hours of sleep per night, rounded to a whole number, is zero.”

Yet, our culture and our economy both support habits that research shows to be counterproductive and harmful. No matter what the findings of science, hospitals continue to show little regard for the healing powers of sleep. Why do institutions that profess healing as their main purpose place so little value on the therapeutic effects of a good night’s sleep?

During two short hospitalizations this spring, I rediscovered the setting to be sleep aversive. Despite signs on the walls urging staffers to limit noise in the corridors, there was a constant din of chatter coming from areas near the nursing station. Attendants talk loudly at all hours of the night, making it almost impossible for patients to sleep. And, yes, they do wake people for routine procedures that could be done at other times.

“Sleep deprivation doesn’t have any good side effects,” says another Boston researcher.  By contrast, sleeping well promotes good health and may even extend our life span.

The habit of sleeping well, however, requires discipline. Respecting our daily cycles of light and dark counts as part of it. So does sensitivity toward our established patterns of successful sleep. In later life, especially, the opportunity for sustained sleep must be seized if we are to maintain the habit. Research suggests that such opportunities may become narrower the older we get.

Presuming you are with me at this point, I wish you success with your efforts to sleep well. With the zeal of a recent convert, I have a new vision of the world and the gift of sleep looms large in it.

Richard Griffin

July 14, 2005 marked the death of a woman I consider one of the greatest benefactors of our time. She never became a household name in this country, but Cicely Saunders transformed the way many people around the world are cared for as they die.

I learned about this event belatedly, because American news media have been slow to note Cicely Saunder’s passing.

To my mind, this Englishwoman deserves hall of fame recognition. She was the driving force behind the modern hospice movement that provides the dying with medically enlightened and humanly compassionate support as they approach the end of their life. “We think of her as our patron saint,” says Kristina Snyder, a pioneer who led in founding the first hospice house in Massachusetts.

A decade after having qualified as a physician at age 38, Dr. Saunders in 1967 established St. Christopher’s, the first hospice institution. From this beginning in London, she was the inspiration for the founding of hospice centers and programs in some 95 other countries. In addition, thousands of professionals were to learn hospice care from her.

It undoubtedly helped that, before becoming a physician, Saunders had first been a nurse and a social worker. Seeing the suffering of people from the vantage point of these professions enabled her in time to grasp better than others the meaning of pain and how best to relieve it.

The hospice approach brought skilled medical care together with emotional, social, and spiritual support for those nearing death. The idea was not to attempt to cure people who are obviously dying, but rather to make their last days as comfortable and meaningful as possible.

The United States can now boast of more than 3,000 hospice programs located in virtually every part of the country. Besides the professional staff attached to these programs, an astounding 400,000 people contribute their time as volunteers who help patients and their families.

Not all patients are reached by the hospice movement, however. Fifty percent of all deaths in America take place in hospitals. Unfortunately, many of the patients who die in these institutions do not receive the pain relief they need.

The need to provide this kind of care now seems obvious to many of us, but it took vision and determination for Cicely Saunders to succeed. In England, people have sometimes thought of her as another Florence Nightingale because of her whole-hearted mission to serve the mortally ill. But she was also a medical scientist who did research and published widely the results of her work.

In the first half of her life, Saunders searched for a faith that would fill the vacuum of the agnosticism with which she had grown up. On her graduation from Oxford she found in Christianity a motivation for her life’s work of relieving suffering. She saw the results of her work as a strong refutation of the euthanasia movement that offered a starkly different approach to the end of life.

This creative woman has made it hard to understand why spirituality could ever have been missing from the care of the dying. Similarly, the emotional needs of people in that situation, and that of their family members and friends, have suffered neglect in so much of the medical practice of our era.

Two facts about Cicely Saunders will find a lasting place in my memory. First, she told an interviewer, in recent years, that she would prefer to die from cancer rather than some other cause. This disease, she explained, would give her the time to prepare for death. As it turned out, she got her wish.

Secondly, this courageous woman said there were five statements that people should be prepared to make before they die: “I forgive you. Please forgive me. Thank you. I love you. Good-bye.”

Of course, this beautiful agenda is not accessible to all those approaching death. Many people are denied the opportunity to share these sentiments with those who are close to them.

It also stands, however, as model for living on the part of those whose death is not yet in sight. If you can bring yourself to say these words or, at least, to subscribe to these sentiments, you have surely achieved something important and you might thank Cicely Saunders for the inspiration.

Fortunately, for people in the Boston area, hospice care is widely available. You can find more information about the programs by calling the Hospice & Palliative Care Federation of Massachusetts at (800) 962-2973. End-of-life services can be provided in one’s home, in a hospice facility, or, if necessary, in a hospital. The service teams are one or more physicians, nurses, social workers, home health aides, chaplains, and volunteers.

Hospice seeks neither to hasten death nor to postpone it. The main idea is to make of dying a human experience with freedom from pain and, to the extent possible, anxiety. It is the vision of Cicely Saunders brought to life, and to death also.

Richard Griffin

A friend, Chuck Colbert, has given me his thesis to read. Written as part of his requirements for a graduate degree in theology, his paper argues the case for the Catholic Church to recognize same-sex marriage, both civilly and sacramentally.

Chuck himself entered into such a marriage last fall in a civil ceremony at our city hall. Later in the year, he and his partner celebrated their union in a religious ceremony presided over by a Jewish woman rabbi, an appropriate ritual because Chuck had recently converted from the Catholic faith to Judaism.

I attended both events and rejoiced at the good fortune of two friends finding one another as life partners. Though gay marriage carries some problems for me, I find values in it that deserve to be celebrated. It’s not as if we have so much love in the world that we should fail to treasure it, even when this love finds a setting unfamiliar to us.

In his thesis, Chuck skillfully draws on the tradition crafted by Catholic theologians of the distant past and the present. Similarly, he discusses two papal encyclicals that express views of marriage different from those that had prevailed earlier. And he finds support in some views of the late John Paul II as they apply to personal relationships.

Many Christians, if not most, see the Bible as condemning homosexuality in all of its expressions. My friend, however, uses the work of the late Yale scholar John Boswell to offer a closer analysis of those biblical passages that have been interpreted as condemning same sex activity. The Jewish and Christian scriptures, the thesis writer concludes, present no obstacles to same-gender sexual unions.

Despite the admittedly strong negative elements in the official church’s views of homosexual activity, Chuck is not discouraged. “The Roman Catholic tradition is a robust and dynamic one,” he writes. “I believe the kinds of changes that I suggest will eventually come about.” Thus he considers his study one that breathes hope rather than despair.

My appraisal of the case my friend makes is, in many ways, positive. I believe the Catholic Church, along with other religious communities, ought to recognize spiritual values in the love that gay and lesbian couples have for one another. And discrimination against homosexual people should be held abhorrent by people of all faiths.

However, I have three main difficulties with the suggestion that the Catholic Church could and should embrace same-sex unions as its own.

First, there is the multi-national character of the Catholic Church. This church cannot limit its attention to the United States. It must also respect the many diverse cultures, ideologies, traditions, and attitudes of the people who belong to it in other nations. People in many parts of the world remain far from acceptance of homosexuality.

It would take thoroughgoing changes in mentality on the part of these people before they would support same-gender marriage. I don’t think the church could possibly move toward an embrace of such marriage while large sections of its people opposed it.

Secondly, I am convinced that the Catholic Church would first need to change its official position on sexual activity in general before it can move to a different appraisal of gay and lesbian unions. Currently, all sexual activity on the part of unmarried people of any stripe is regarded as immoral. Though not many would seem to think this position still reasonable, the official church continues to hold to it adamantly  

Thirdly, I consider same-gender and male-female marriages as two different realities. I do not deny their similarities but I continue to regard them as distinct. To me, words are vitally important because they signify reality. The word “marriage” signifies a sexual union between male and female persons that differs from the union of male and male, along with female and female. That is the way a well-established tradition has delivered it to us.

A different word should be found for these latter bondings, though I admit not having found an appropriate one. The word “marriage” might be acceptable for gay and lesbian unions if the word were joined with another to distinguish it from heterosexual marriage.

For me as a man, a sexual relationship with a woman is unique. Women differ from me in their physical being, in their emotional life, and in spiritual life. I am not saying that no elements from these spheres of women’s life are present in males, or in some males, but I still find women unique. I value the difference.

And I believe that, for me as a male, entering into a sexual relationship with a woman inevitably differs from what entering into a sexual relationship with someone of my same gender would be.

The Catholic Church needs to find spiritual and human value in the marital unions of homosexual people, but it cannot accept these unions on the same sacramental footing as heterosexual marriage anytime soon.

Richard Griffin

A man in his later years, riding his bicycle, gets slammed by a car. He is rushed to the hospital where doctors decide he must have his right leg amputated. We learn how he enters upon the long process of dealing with this loss as, after a while, he prepares to return to his apartment.

Thus begins “The Blow,” a short story by J. M. Coetzee in the June 27th issue of the New Yorker. The author, winner of the Nobel Prize for literature, is a South African who writes with uncommon sensitivity about what it is like for an aging man, Paul Rayment, to cope with sudden radical disability.

The man’s first home care attendant proves unsuitable. The second woman, a recent immigrant from the Balkans, turns out to be supportive beyond what he could have imagined. Ultimately, this compatibility brings about surprising changes in him.

For fear of giving too much away, I stop the story here. But, if you want to know what’s it’s like to be in new and unexpected need in later life, I recommend reading it. One of the (many) best things about it is the subtle way that the man’s inner feelings shift as time wears on.

This superb fiction has a basis in real life, of course. That’s what makes it so compelling to read. It puts into imaginative form some of the same approach one of my favorite gurus takes when writing about the meaning of frailty in the lives of old people. This writer, Wendy Lustbader, bases her reflections on the work she has done with a wide variety of such men and women..

Envisioning becoming frail, she poses the question: “How will I let my caregivers know who I am?” That is the issue because, if the provider of my care does not go beyond surfaces, I will be for her only another little old lady or old man. I will simply be one more mouth to be fed or body to be pushed back to the bedroom.

But, if my helper does get to know me and allow herself to be known, perhaps I can preserve my real self. Then I will emerge as a real person capable of being known and even loved.

“Are there ways of becoming more as the body becomes less?” asks Lustbader. Answering her own question, she goes on: “There is a further worth awaiting us in remembering and contemplating, in thinking things over, in letting all that has been said and done assemble itself into something we can grasp.”

Although this looking inward may seem daunting, let me suggest that doing it can change your world. Lustbader would encourage anyone who is attracted by this prospect to “embrace our ultimate fragility” now, before it becomes necessary. Doing so will reveal the beauty of human life and its meaning.

This is where Coetzee’s short story ultimately leads. The man makes discoveries about himself that turn him into a different kind of person. The life that seemed at a dead end as a result of the sudden catastrophe now takes on new meaning.

Thus literary art succeeds in revealing something not commonly perceived or appreciated. It shows what can happen when people are thrown into unfamiliar circumstances that appear only dire. With an effort on both sides, the direness can become transformed into one of the most valuable experiences of one’s whole life.

But the situation is not without challenges. When, as happens most of the time, family members are the ones who care for those who are frail, they may need to improve relationships that have been marred by remoteness or tension. Lustbader tells of a son who was pressed into service lifting his father from bed to wheelchair. They had not been on speaking terms for years, but when he had to embrace his father to make the transfer, the son broke into tears and so did his father, too.

When care comes from professionals outside the family, then the challenge may be different. Hired caregivers often differ in ethic origin or social class in ways that make it necessary for the frail person to adapt to unfamiliar styles of doing things. However, it is vitally important to break through toward respect for personal identity.

Some people, like the man in the story, have frailty thrust upon them suddenly, without warning. They have to adapt sooner than they ever expected.

By contrast, those of us in at least relatively good health have time to prepare ourselves for changes in our status. The best preparation, experience suggests, is to cultivate in ourselves an inner life that enables us to find meaning for what we may be called upon to go through.

Making time, in advance, for assembling within ourselves the various elements of our life can prepare us for diminishment to come. It is the old adventure of finding ourselves in new ways, much to our surprise and, perhaps, relief.

Richard