By Dr. Jim Ferguson
I’m a pretty good internist and even have secondary board certification in geriatrics. But, I have no experience in growing old or as I like to say growing “older.”

In medicine there is a wisdom axiom which goes, “Watch one, do one, teach one.” I first encountered this philosophy when I was in training and learning to do various procedures such as venipuncture for blood samples, starting an IV and even more complicated procedures such as spinal taps and delivering babies. Since it was obvious to my superiors that I wasn’t very interested in the surgical disciplines, I never graduated beyond holding retractors in surgery. These surgical instruments help the surgeon visualize the operative field. For contemplative internists they are dubbed “idiot sticks.”

People often ask this aging doctor how I’m doing. My centenarian mother-in-law responds to this question by quipping, “I don’t how I’m doing; I’ve never been this old before.” Actually, most of the time I feel pretty well for a 66-year-old guy.

I have a number of aphorisms which my former partners referred to as “Fergisms.” One of these is that you often imagine yourself as one generation less than your actual age. Another Fergism derives from the famous jazz musician, Count Basie who said, “If it sounds good, it is.” In other words, if you like a certain piece of music or artwork, don’t let someone else tell you what you should like. And my corollary to Basie’s observation is, “If it looks good, it is.” So, I often turn the question around and ask, “Well, how do I look?”

Last week I mentioned a book I noticed in a patient’s home while making a housecall. I was intrigued by the title “How To Grow Old” written c. 50 BC by the famous Roman statesman, Cicero. Luminaries like St. Augustine and Thomas Jefferson admired this book and John Adams read the work over and over as he aged. I think there are nuggets of wisdom in this book which I consider worthy.

Philosophically, Cicero was a stoic who admired personal virtue and  order of the Roman republic. He also believed in destiny and divine providence. These stoic attributes are depicted by Russell Crowe in the movie The Gladiator. I was struck by Cicero’s common sense and readable prose as translated from Latin by Philip Freeman. I encourage you to read the book and Cicero’s own words, but I want to summarize the patrician’s advice and then offer a few comments from the perspective of a geriatrician/internist.

Cicero’s advice for the latter half of life is:

  1. Cultivate the qualities of wisdom, moderation, rational thought and enjoying all aspects of life.
  2. Realize that old age is enjoyable if one’s character is good.
  3. There are seasons to life and we can’t fight nature.
  4. Aging does not preclude an active life, but assigns some limitations.
  5. Imparting your acquired wisdom to youth is pleasurable and a worthy endeavor.
  6. Like a muscle, the mind must be exercised.
  7. Older people should stand up against discrimination (ageism).
  8. A reduction in sensual appetites allows room for other more satisfying and lasting activities.
  9. Find things which interest you and do the things which give you enjoyment.
  10. Death should not be feared.

I sometimes wonder why I am so blessed. I know I am where I’m supposed to be. As a Christian I hold that Grace is at the heart of things, but recognize that this perspective may conflict with the reason espoused by Cicero. However, reason is only one lens to acquire wisdom which I believe is a higher order of function. John Wesley, the founder of Methodism, recognized that the church is built on reason, experience, tradition and scripture.

I’ve come to terms that I can’t know everything and I’ll never shoot par golf. The Proverbist observed that “[respect] of the Lord is the beginning of wisdom” (Proverbs 9:10). There are seasons to life and only a fool ignores nature. And more important than self-actualization is supporting family and community, and imparting the wisdom you’ve acquired to young people (teaching). I’ve told many patients that they shouldn’t retire without a plan. In retirement you need to stay active and exercise your mind and muscles. It is a great irony that “resting” makes you weaker. You need to find a way to use the things you love in the service of others; mine is writing and concierge medicine.

We moderns see ageism as a form of discrimination which should be resisted. The term ageism was unknown to Cicero or the poet Dylan Thomas, but Thomas urged his father:


Do not go gentle into that good night,

Old age should burn and rave at close of day;

Rage, rage against the dying of the light.

Cicero advises us not to fear death, but is that realistic? Humans naturally fear the unknown, and death is a journey into the unknown which we all will take.

Ferguson’s aphorism #11 holds that “Most thoughts have been thought before.” Several years ago I concluded that when I close my eyes for the last time I will either blink into oblivion or awaken in paradise. And since I’m a Christian I hold to the latter. I was pleased with my reasoned conclusion, but then I came upon Socrates’ speech during his trial for treason in 400 BC. Apparently, Socrates came to the same conclusion 2500 years before me, and Socrates even looked forward to meeting Homer, his hero who wrote the Iliad. Recently, I was not surprised to learn that Cicero had likewise come to the same logical perspective, though he somewhat fatalistically said an actor needs to know “when it’s time to leave the stage.”

Hopefully, I will not soon go quickly or quietly “into that good night.” I hope to “burn like a candle in the wind” as Elton John sang, instead of dwindling into nothingness on this side of the great divide.

So, I’ll close this exegesis of growing older with my favorite poet Emily Dickinson’s vision of “distant shores,” and celestial seas:

As if the Sea should part

And show a further Sea –

And that – a further – and the Three

But a presumption be –

Of Periods of Seas –

Unvisited of Shores –

Themselves the Verge of Seas to be –

Eternity – is [these] –