Thoughts About Aging and Wisdom on Mother's Day (with just a dash of science)
The development of intranasal vaccines is (slowly) making progress
This week I have decided to do something a little different. In honor of Mother’s Day, this Briefing concerns itself more with love than with science.
Mother’s Day 2022
I. Tim
The late Art Buchwald, spinning off of a quote from James Thurber, once famously remarked regarding martinis, that one is never enough, two is too many, and three is just right. Such wit – a cocktail of irony and sophistication, gently stirred. One of the last extant members of a vanishing class of intellectuals: urbane but with a hint of optimism that was uniquely American.
Vanishing greatness (and finding one’s own greatness) are recurring subjects of conversation with Tim Carpenter, my best friend, who runs a non-profit that builds senior housing on the concept of an arts-based college campus. At EngAGE properties, older adults without means can live in safe and sometimes rather beautiful homes while participating in lifelong learning in the visual and performing arts.
The courses are taught by university-level instructors but instead of final exams, the student-residents finish each semester’s coursework with something called a culminating event, which essentially amounts to some kind of public performance. Painters have a showing at an art gallery in town; singers perform live on stage; filmmakers debut their work at a local movie theater, etc.
Thousands of seniors who once found themselves circling the drain have not just been rescued from that fate but reborn at his facilities, which span from coast to coast. Retired clerks and machinists, upon the discovery of their inner musician or sculptor, now stride the lawns and hallways of EngAGE properties not with a renewed sense of confidence but a newfound one. Their voices have grown deeper, more relaxed. Laughter tinkles in the common areas like wind chimes.
(Tim in Dublin a few years ago)
Tim is the kind of person who could have done almost anything. He was poised to become a player in Hollywood but walked away when his seemingly biological inability to tolerate easy lies made that world unbearable to him. He was, at times, a journalist, a playwright, and a screenwriter. For a brief period, he worked in healthcare. He was almost good enough to play in the NBA. Eventually, he retreated about as far from the limelight as he could get, setting up shop in the world’s least sexy industry (aging) where he felt he could make a difference without being noticed.
But the world can’t help finding people like him, and if you have anything to do with aging, affordable housing, arts-based programming, or senior living, chances are you’ve heard of him. Because what he has created is on the side of God – an unequivocal good amidst a progressively murky culture of self-centeredness and moral relativism.
II. From Clarity Comes Truth and From the Truth, Wisdom
In Sydney Pollack’s 1975 cold-war spy masterpiece, Three Days of the Condor, a senior CIA ‘company man,’ played by the great John Houseman, briefly reminisces about his entry into the intelligence field after WWII, “I go even further back than that. Ten years after The Great War, as we used to call it. Before we knew enough to number them.” “You miss that kind of action, sir?” he is asked. “No,” Houseman’s character replies, “I miss that kind of clarity.”
Clarity, to me, is a kind of sacrament, a means to the truth which is the bedrock of wisdom (the holy grail). At no time in my life has clarity been more under attack than during the last few years. The CDC has not helped. Wading into politics, they have found themselves a fish out of water, crafting public messaging that is both confusing and seemingly out of step with the most current science. Political operatives have exploited the state of confusion this has created to promote disinformation narratives engineered for the specific purpose of eroding already diminished public trust in government, science, and expert consensus opinions of all kinds.
These Briefings began as an exercise in making sense of an avalanche of COVID-19 data. I had support from some excellent physicians, microbiologists/virologists, and research scientists. Despite this, I often found myself forced to make policies and decisions for my medical office that would have benefitted from more clarity. More than once, I found myself compelled to go against the public-facing advice of the country’s premier public health agencies. Given what was at stake, that was often quite terrifying.
My proximity to Tim gives me access to my own personal ‘Art Buchwald.’ As he continues to transform his vision of elevating the lives of the most vulnerable adults into a reality of joyful empowerment (EngAGE now has more than 50 properties in the US), I get to discuss the concept of wisdom with someone who has accumulated more than his fair share. Our ongoing conversation which frames aging not as a tragedy unfolding in slow motion but as a kind of clarifying tonic has moved my perspective across the spectrum of hope from bleak to guardedly optimistic.
III. Carole
Not long ago, during a phone visit, the subject turned toward politics and my mother said to me, “You know, all my conservative friends think that I’m a radical liberal and all my liberal friends think I’m crazy conservative. So, I guess I must be doing something right.”
It was a throwaway comment. A routinely perfect dry martini poured by a veteran bartender. I caught it before it had a chance to evaporate into the ether, tucking it safely away into my memory basket of mom-isms. She regularly scatters precious gems these days — some ornamental, others fundamental — and I have grown to be alert when I speak with her, like a hound with the scent for pearls of wisdom.
My mother has always been in love with beauty and elegance. Ours was the family that traveled to Rome and Paris to stand in museums until our collective feet ached. My brother and I were tasked with hauling around heavy sight-seeing equipment deemed necessary by my father who believed that boys should be taught at an early age to endure discomfort silently as a preparation for manhood. Children were not allowed to have meltdowns in the 1960s and ‘70s, and I can still feel the sense memory of the inflamed point where the skinny strap of a clunky camera or hefty binoculars once burrowed into my 6-year-old shoulder as I repeatedly swallowed the urge to whine.
I have a memory from one family trip of my mother asking my father to take a photo. We were in Interlaken, Switzerland and I remember bonding with her over the intoxicating blue-green of those silent lakes framed by snow-frosted mountains. “You heard your mother,” my father barked, indicating the brick wall behind the restaurant that we had just left, “go stand over there.” “Dick,” my mother offered, indicating a space between two soaring pine trees through which the majesty of the lakes and mountains were in full view, “let’s do it over there so we can have the Alps in the background.” My father considered this, his face taking on the same shape it did when my mother would entreat him to not pick up bagels wearing white tennis shorts and black dress socks. “Okay, you heard your mother, go get in front of the Alps.”
(Carole and me in Naples, Florida at the beginning of the pandemic)
My mother is herself rather beautiful. Now in her 80s, one can still observe her effect on older men. But in that context, her relationship with beauty was always a more nuanced affair. Like Tim, there is a side of her that enjoys shining but a bigger part that has always instinctively fled from too much attention. She has a natural distrust for gossip and an allergy to superficiality. And yet, she also struggles with the way a vulgar youth culture has pitilessly downregulated her stock. “To be a woman in her 70’s,” she once confided to me, “is to be invisible.”
While being stared at less, I think, has been mostly a relief to her, she would have liked to have somehow achieved invisibility on her own terms rather than had her visibility confiscated. We have often discussed how in America today, the notion of elder female beauty is tragically restricted to the doctrine of trying to look younger than one’s age. There is not even a cultural conception of a woman in her 70s both looking her age and also looking beautiful, stylish, and cool. (What that says about us is something that deserves its own discussion.)
Physical attractiveness, in Carole’s era (the 1950s and ‘60s), was the principal source of power available to most women. And although she had been gifted an abundance of it, my mother always had an uneasy relationship with her own beauty, and for us, her true authority always derived from hidden qualities that did not cause doors at restaurants to fling open before her or bring men to attention when she entered a room – her keen intelligence and artistic sensitivity.
Strong and confident outwardly, the real Carole is shy, fragile, someone who suffers from interminable heartache caused by seeing things too clearly and feeling things too deeply to be carefree in a world that cannot seem to fight off the chronic infections of injustice and brutality. You have to know her a long time before she will allow you a glimpse of just how profound is her compassion and empathy for children, animals, and all beings vulnerable, oppressed, or marginalized. And if you hang in there long enough, you may also meet the woman capable of shape-shifting into a ferocious guard dog willing to go all the way in their defense.
These were the qualities that made her so good at everything she did. They also made her susceptible to the peril of excessive attention which seemed inevitable each time she took on some new project. She became a dietician, helping sick and overweight patients at my father’s chiropractic office move toward a plant-based diet (in the 1970s!). She painted in oil on canvas and a portrait she did of my sister still entrances me — not so much for its photographic fidelity but for the deeper likeness evidenced in those heavy brushstrokes that somehow managed to capture exactly Amy’s truest nature. She started a women’s fashion design company that within a year was selling its merchandise in major high-end department stores in New York. She became an interior designer and created some of the most spectacular (even iconic) interior residential spaces in NYC.
She did these and so many other things the way that an incurably curious and brilliant college freshman might sample courses. She would feel a spark of interest, put herself into it, get an A, then either get bored or attract too much attention and hustle away to the next thing. She dabbled, creatively and intellectually, with the energy left over from raising three children, becoming a masterful cook, and keeping a spotless home. I sometimes imagine my mother as a movie star climbing out of a limousine, waving to the cameras with one hand while hiding her eyes with the other.
There is just one thing my mother seems never to have grown tired of. The thing that I now understand to be the through-line of Carole: her family. It is what she is still fighting for on Mother’s Day, 2022. It gets her out of bed in the morning. Motherhood, as Gurdjieff might have said, is her chief feature. And it is something she passed to my equally brilliant and talented sister, under whose maternal gaze none of us will ever have to face the unmitigated disaster of circling the drain. In my family, I often say to my wife, it is the girls who get things done.
III. With age (sometimes) comes wisdom
A few years back, after working out together, my nephew, with characteristic youthful cruelty, quipped, “So unc, what’s it like knowing that every day you’re just a little less good than the day before?” At 17, he was on the upswing of life’s pendulum, gaining strength and intelligence effortlessly by the day. “Well boy,” I explained, “I’m not entirely getting worse. Physically, maybe, but in some ways, I’m getting better.” “Really?” he asked, a little incredulously. I explained to him how wisdom and courage can accumulate with age and experience. And that wisdom (the ability to see big truths with clarity) and courage (the willingness to act on those truths even though it scares you to do so) are essential ingredients for happiness.
I have spoken at length with Carole and Tim about how much freer we feel as competitiveness and striving have begun to fade in the rearview mirror. How aphorisms that once seemed ridiculous, like don’t sweat the small stuff, now redound with shrewd pragmatism. How the breadth of people whom we truly enjoy keeps narrowing but the degree to which we enjoy those remaining few is growing deeper. How saying ‘no’ has become so much easier — especially regarding those whose currency is gossip. How the idea of disappointing others has attenuated from a catastrophe to a manageable nuisance (and sometimes, strangely, a form of relief). How the secret to living well is to value and enjoy the process (the journey) over the outcomes (the destination).
Carole has a peculiar talent for summarizing complex ideas in simple phrases. “Save yourselves” she advised my wife and me recently after we vented our frustration about certain friends who, in our estimation, had gone off the deep end politically. “There’s no medicine that cures a mind virus.” In the presence of aggressive anti-vaxxers, her technique is to smile and stand mute until they finally look away. Caste ye not thy pearls before swine are the watchwords of my mother’s elder years, the winters of which she now spends in Florida.
In truth, my mother has never been more interesting or powerful. Unlike me, she has not made goals of becoming wise or courageous. She has managed to accrue both in the course of embracing the calling of motherhood. She picks her words and battles like a museum curator. Beauty still matters to her, as always, but its domain has shifted toward the beauty of lives well lived. The concept of there being a kind of sweet spot for everything we say and do (too little is deficient, too much is toxic) informs when she gives, when she receives, and when she stops giving and receiving. Those who have been following my health and science Briefings these last two years will have noticed this to be a theme.
IV. Happy Mother’s Day
Today is Mother’s Day. It’s not my mother’s favorite holiday (Christmas is), in part because it turns the spotlight on her but also because honoring the people you love, to Carole’s way of thinking, should not be reserved for special events carved away from everyday life but something that reverberates in the day-to-day acts that call no attention to themselves. Allowing someone the time and space to express themselves fully without being talked over; the choice to trust someone; the preparation of a beautiful meal; recalling the details of a life well-lived with satisfaction... “Listen to what people say but watch their feet more,” is one of her axioms.
I agree. And yet, this Mother’s Day, I feel a particularly keen welling up of love and community with my mother that I wanted to share. Maybe it’s because our family is going through a difficult moment. Or perhaps, at 60, the clarifying tonic of aging informs me of how extraordinarily lucky I am to be able to warm myself in the reflected light of so many remarkable people, including my wife Tricia, my best friend Tim, my sister Amy, and my mother Carole who show me daily what aging well looks like.
I don’t know if my mother will read this Briefing. She texts but otherwise has little tolerance for screens. I called her earlier this morning to let her know, as I do a couple of times each week, that she’s on my mind and in my heart. I also spoke with Amy and Tim. I meant to tell Carole what it means to me that she managed to somehow find on her own what Tim’s EngAGE properties help so many older adults to find: their inner artist and the hope and confidence that flows from that. Instead, Tricia and I were treated to a synopsis of the recent Supreme Court opinion regarding Roe v. Wade. “I’m from another era,” she explained, “and I’m not for abortion myself. But how can anyone think they can make that decision for somebody else? Okay, you’re a Christian or a Jew, whatever. That’s fine, base your decision on your religious conviction if that feels right for you and you find yourself with an unwanted pregnancy. But not everyone shares your religious convictions. Am I missing something here?”
Listen to what people say but watch their feet more. We teach our children more by who we are than by who we tell them to be. I’ve been watching my mother’s feet for 60 years; they walk a path that is truthful and wise, courageous and beautiful.
Covid Corner
For more than a year, I have been writing about how we might find our way (actually) out of the pandemic. One important measure is effective antiviral medicines which we now have. Paxlovid is becoming more readily available but the current supply is still being restricted only to patients at high risk for developing severe acute disease.
Another critical piece to the strategy is using wastewater surveillance to inform public health measures. The daily case rate, which is a tally of the positive laboratory PCR tests reported to public health departments, is no longer an accurate metric since so few people are seeking out PCR tests now when they get sick or have a potential exposure. The amount of virus in sewage has been used effectively to predict rises and falls in community cases and employing stricter public health mitigation strategies when the community prevalence is on the rise will help stem the tide of surges.
And yet another critical piece of the strategy involves a pan-coronavirus vaccine that is sprayed into the nose. As the SARS-CoV-2 virus continues to shape-shift to evade immunity induced by vaccines that target the virus’ spike protein, new vaccines that target parts of the virus that do not change much over time and are common to all human coronaviruses make sense. Directing these vaccines into the nose engages the part of the immune system that polices the airways. That immune compartment, called the MALT (mucosal associated lymphoid tissues), produces a special kind of antibody called IgA that patrols the nose, throat, lungs, and intestines–all the places with mucous membranes–looking to attack the virus. One shot of a pancoronavirus vaccine put into the arm to stimulate the systemic immune system and one dose sprayed into the nose to stimulate the MALT would likely provide much better immunity against the current and future variants, protecting us not just against severe disease but infections.
Several such vaccines are currently in development and a new study on one such vaccine that combined parts of the original SARS-CoV-1 coronavirus from 2003 with the current SARS-CoV-2 virus demonstrated a stronger, broader immune response that offered better protection compared to the current intramuscular-only vaccines in an animal model. Human trials are next.
Bravo to both wonderful humans, Tim and Carole!