Photo by Ksenia Yakovleva on Unsplash

Your doctor writes you a prescription for a name-brand drug. Your pharmacist fills the prescription with a generic drug instead. You don’t think twice about it, because you have been assured for years that generic drugs work just as well as their name-brand counterparts.

But what if those assurances are not quite true?

Evidence is starting to paint a picture of the generic drug industry that suggests caution might be a better attitude than blind faith.

Share The EndGame

If all generic drugs on the U.S. market were made in America and carefully regulated by the Food and Drug Administration (FDA), perhaps trust would be more appropriate. The FDA is well respected internationally as the most thorough and effective agency when it comes to the safety of drug products.

Imported Ingredients

But in fact, about 80% of generic drugs and their ingredients are imported from other countries, primarily India and China. The FDA does inspect drug manufacturing facilities overseas, but rigorous oversight is difficult.

Last year a study by a team of Ohio State University and Indiana University researchers found that generic drugs manufactured in India were linked to significantly more “severe adverse events” for patients than U.S. produced drugs.

“The FDA assures the public that all generics patterned after the same original drug should be equivalently safe and effective,” says Indiana University associate professor George Ball, a study co-author. “However, that is not necessarily the case when it comes to generic drugs made in India.”

India produces about 40% of all generic drugs on the U.S. market, according to Bottle of Lies: The Inside Story of the Generic Drug Boom, a 2019 book by investigative journalist Katherine Eban. She found that some foreign companies encourage fraudulent data. And many FDA staff members told Eban that FDA inspections overseas are announced in advance, giving companies time to hide unsafe practices.

This is old news to Gina Pera, author of Is It You, Me, or Adult A.D.D.? and a respected expert on adult ADHD. Since 2009 she has been warning readers on her blog, ADHD Roller Coaster, that generic drugs for ADHD symptoms sometimes work differently than the brand-name drugs they replace. While the generic may be identical in its active ingredients, strength, and dosage form, it may have different inactive ingredients, tablet construction, or a different drug-delivery technology. It may even vary in the amount of active ingredient: the FDA standard for “bioequivalence” is between 80% and 125% of the original (although in practice, the variations tend to be 3.5-4%).

Delivery method is especially important for extended-release drugs such as Vyvanse and Concerta. People taking generics that used a different delivery system from the brand-name drug have reported variations in how quickly the medicine began working, how evenly it controlled symptoms, and how long it remained effective.

Unfortunately, says Pera, patients and physicians rarely consider that the manufacturer or the generic drug could be an issue in how well the drug works. Yes, a poor response to a drug could be because the dosage is wrong or the medication is not a good fit for that patient. But it could also be that the generic is not really “bioequivalent” (i.e., works exactly the same) as the name brand. It may only be “biosimilar.”

Surprise Substitutions

One other factor makes it harder for patients to understand their medications. Pharmacy Benefit Managers (PBM), which act as intermediaries between health insurers, drug manufacturers, and pharmacies, can change which generics, by which manufacturers, are covered from month to month. Some pharmacies, but not all, inform you of substitutions.

But how do you know where your medicine comes from?

Short answer: You don’t.

You can find a limited amount of information on the labels from the pharmacy. Below the name of the drug (printed in bold, all capital letters) will be “Generic for” and the name of the name-brand drug (in eye-strain-size type). You will also find the name of the manufacturer. Looking them up may tell you if they are domestic or international.

Or not. I checked the labels on the seven prescriptions I take daily. All seven are generics. When I looked up the manufacturers, each of them was a U.S.-based company – but at least five of the seven have manufacturing facilities in India, China, or Argentina. Some are U.S. affiliates of Indian or Chinese corporations. You can consult the ProPublica database to look up your specific generic and its manufacturer and see if there is a record of recalls or FDA violations.

Not Scared but Aware

Does this mean you should be afraid of all generics?

No, says Pera. But be aware that despite constant assurances that generics are safe, tested, and equivalent to name-brand drugs, generics do not always work the same way as the drugs they substitute for. And if the medication you take seems to be less effective than it was, consider that the reason might be your generic drug.

If you do experience adverse effects, an unexpected loss of effectiveness, uncontrolled crying or irritability, or a suspected change in quality after a product change, Pera recommends filing a report through FDA MedWatch. Although quality problems are hard to prove, the FDA does issue warnings to manufacturers who violate guidelines (if and when they catch them.)

Just one more thing to be aware of as we navigate our bodies, ourselves, and our meds in this stage of life.

Leave a comment

Photo by Alexey Sabulevskiy on Unsplash

First, a personal announcement: I’ll be co-leading a workshop, along with retirement coach Ivory Brown, on “Finding Meaning and Purpose in Your Next Act,” at the Re/Imagining Retirement Summit at Towson University, Sept. 25. The one-day event features longevity and retirement expert Simon Chan as keynote speaker and a number of workshops, including mine. You can register here. I’d love to see you there!

Maybe you remember the dire warnings in our younger days about Big Brother. The name comes from George Orwell’s novel 1984, where it refers to the supreme leader of a totalitarian surveillance state. Big Brother was watching every move you made and listening to everything you said. Concerned patriotic Americans were quick to warn us that Big Brother was precisely what surrendering to Communism would mean for us.

Clearly, somebody must not have been paying attention, because the surveillance state has arrived in the U.S., without the Communists. Cameras watch from our front doors, from office buildings, and from satellites, all to protect us from criminals and terrorists.

Share The EndGame

I seldom bother debating what is. What worries me is that surveillance has become so normalized that when we enter our later years, it will seem business-as-usual for our lives to be continuously monitored – when we lie down, when we rise up, and every moment in between. And it won’t be because of Big Brother. More likely, it will be because of our own children.

In 20 states it is legal to place cameras in nursing homes, and some states also permit them in assisted living facilities. The rationale remains the same: It is for our own protection. Should we fall, surveillance alerts our loved ones (and the institution). If caregivers abuse us, our loved ones will have proof. And of course, it goes without saying, it offers peace of mind to the children who can’t be with us 24/7 to make sure we are taking our meds and eating our meals and thriving to the greatest possible extent.

Privacy and Dignity

And all we have to sacrifice is our privacy. Also our dignity. Because being assisted to the shower or the toilet, or having our undergarments changed, will not show us at our best.

Is that an acceptable tradeoff for protection?

It’s really an ethical question, and not a black and white one. It’s a question we should be asking ourselves and our families now.

The first dilemma is consent. The laws generally insist that the subject of surveillance – the patient in institutional care (or at home, for that matter) – give their consent to being monitored. As long as we patients have all our marbles, it’s a simple yes or no. But it gets complicated if we are suffering from dementia or other debilitating conditions that make us unable to give our consent. In that case, who gets to decide?

Sometimes a family member can give consent on the basis of “precedent autonomy,” which means they are acting as we would have wanted them to when we were fully capable of deciding. (This is a point you may want to address in your medical power of attorney papers, the better to to leave less room for doubt.)

Altering Relationships

A thornier issue is how cameras alter the relationship between caregivers and patients. As a patient, you want caregivers who treat you with respect and bring a human touch to your care. But caregivers might well interpret the presence of cameras as a sign of distrust – positioning them as potential suspects rather than partners in care. The likely results: care strictly by the book, no more nor less, and a less than friendly patient-caregiver relationship.

Whether cameras actually deter bad behavior or improve quality of care is an unknown. “There’s zero research cited to back up these [state] bills,” a University of Washington gerontologist told the New York Times.

While you are wrestling with the legal and ethical questions, here are some other thoughts to consider.

• Other medical alert devices can monitor patients less invasively than cameras.

• For care at home, don’t just install a device, says Dr. Jane Barratt, an international advisor on aging and social policy. Make devices part of a care plan that establishes what is being monitored, what data is kept, who can access it, what triggers an alert, how to pause the system, and how consent will be reviewed as circumstances change.

• “Cameras are a symptom, not a solution,” say gerontologist Dr. Clara Berridge. As a society, we need to address the systemic problems with the health care system that make cameras seem necessary.

Give some thought – and discuss with your family members – where you want to draw the line between surveillance for your protection and Too Much Information. As always, the best time for discussion is before it becomes necessary.

Leave a comment

No. 113/August 19, 2026

NewScan is a biweekly briefing on news relevant to readers of The EndGame. NewScan is a premium feature exclusively for paid subscribers.

Expect Part D Medicare Premiums to Rise

A subsidy designed to keep drug prices lower for Medicare recipients will end on January 1, a year before it was due to expire, and higher premiums are a li…

Read more

Photo by Curated Lifestyle for Unsplash+

You would think there are some things you just can’t laugh about. Things like a brain cancer diagnosis.

Don’t tell that to Joyce Wadler, a former New York Times columnist in her 70s who learned that an aggressive sinus cancer had entered her brain. Wadler can find the funny in anything. Chronicling her adventures in chemo and radiation, she recently wrote about losing her sense of taste in a piece entitled “Talk Dirty to Me About Bagels” (illustrated with a mock cover of a racy romantic paperback). She realizes something is afoot when she tastes a favorite chicken and avocado sandwich and realizes “the chicken tastes…off. Worse than off, it tastes like it had suffered a long illness, lain miserable in the chicken coop, and died an excruciating death….”

Wadler admits that she is terrified of brain surgery and radiation. Finding the funny is her defense against her terror.

What is Ageist?

Wadler’s fearlessly funny approach to life has me thinking about the difficulty of being humorous about aging. Being an older adult certainly has its ridiculous moments that can look funny from a certain angle. At the same time, though, there is a strong current of thought that making jokes about older people reeks of ageism and poor taste. To see examples, just browse the greeting cards on display at your local drug store.

Or consider this tidbit from Reader’s Digest: An article titled “60 Old-People Jokes That Make Aging So Much Funnier.” I suspect few of them will seem funny to you if you were born after 1945. Examples: “What’s the secret to having a smoking hot body in old age? Cremation.” “Which underwear brand do seniors love best? It Depends.”

Anti-ageism advocates slam this type of humor for dealing in harmful stereotypes about old age that cast older adults as feeble, if not feeble-minded. Cathy Goodwin, who writes the blog “Aging in Sneakers,” typifies this line of thinking. Jokes about nursing homes, she says, are “supposedly lighthearted, but for many of us, the idea of living in one is closer to a nightmare than a punchline.” There is lots of abuse in nursing homes, she adds. “That’s not funny. It’s terrifying. We need more outrage, not more jokes.”

And what are we to make of Andy Huggins, a comedian for 40-plus years who gained “overnight success” in his mid-70s when his routines about old age went viral on the internet? Huggins walks on stage with a cane and delivers his stand-up sitting down. He claims to have looked for love on an online dating site: “Carbon Dating.” Another one-liner: “As far as social media goes, you can follow me on the bulletin board at Kroger’s. Or on Mychart.”

And What’s Just Good Fun?

Is that ageism or just good clean fun? Is it okay to laugh at ourselves sometimes, or is all humor about old age harmful negative stereotyping?

My interest in this topic is not strictly academic, but professional. I am someone who has used humor all my life to lubricate social situations. In the beginning it was just to deflect the hatred and disgust of my classmates for being a smart kid, a defensive maneuver in the hopes of surviving junior high school in one piece. Later, in the working world, I cracked jokes to reduce tension and to encourage people to lighten up.

Sometimes it worked. Sometimes I got fired. You never know.

So from a professional standpoint, I would like to write what’s funny about aging, without crossing the line into negative stereotypes and blatant ageism.

My initial instinct is to fall back on a distinction my parents told me as a kid: the difference between people laughing at you and people laughing with you. The former can be cruel, the latter can be affirming.

From that perspective, first-person accounts like Wadler’s are the good kind of humor, because readers are laughing with her. Greeting cards and Reader’s Digest? Bad humor and bad taste.

The good humor, like Wadler’s, may be a psychologically healthy way to deal with what we fear most. We laugh because we recognize the writer’s fears mirroring our own, and laughing is a healthier response than worry, anxiety, or depression.

Besides, laughter is actually good for you physically. Scientists have shown that laughter boosts dopamine and other stress-relieving hormones and chemicals, helping to lower anxiety and depression. Studies also conclude that laughter’s social benefit is among its most effective properties – laughing in the company of others helps support social relationships.

I’ll continue trying to walk that line between affirming laughter and harmful ageism, because I can’t imagine abstaining from humor altogether.

As tropical philosopher Jimmy Buffett once opined, “If we couldn’t laugh, we would all go insane.”

Photo by Alba Calbetó on Unsplash

Where would you prefer to age: in your home or a nursing home?

You don’t need a Gallup Poll to know how older adults answer that question! By a commanding margin, aging in our own homes, or “aging in place” as it’s usually called, is the people’s choice.

This despite the fact that a significant share of us do not own our own homes and, as renters, do not enjoy the blessings of stable housing. This also despite the fact that many of us will be unable to maintain our first choice of residence forever. The house may be unsuitable because of stairs at the entrance or lack of a first-floor bedroom and bathroom, or lack of safety features such as grab bars, or a location far from groceries, pharmacies, and transportation options. And obtaining all the in-home services necessary to ensure medical care, day-to-day needs, and comfort adds up to an expensive proposition – before we consider how realistic it is to expect the necessary caregivers and aides, given that the current supply is well below the current demand.

But maybe we’re thinking about “aging in place” too narrowly.

Share The EndGame

A recent article in Shelterforce, a magazine about community development, suggests that the focus should shift from “keeping older people in their homes at all costs” to “supporting them to remain in – and part of – their communities.”

Housing, disability, and community development advocates have argued for years that a person’s health and well-being are more than a matter of good medical care. They also depend on having safe and stable housing, reliable transportation, walkable communities, and access to social amenities.

Community Alternatives

What would thinking about community solutions to aging in place look like?

Perhaps you’re fortunate to live in a “Naturally Occurring Retirement Community (NORC), a neighborhood or building that wasn’t designed to be for older adults but has evolved to be one over time.

Or perhaps you have chosen to live in an “age-friendly community.” AARP’s Livable Communities Program encourages local leaders, elected officials, and parent organizations to design communities that improve quality of life for all ages. Localities that earn the Livable Communities designation go through a process of assessment, planning, implementation and evaluation. (You can find out if your community is part of the AARP network through an online lookup feature.)

The Village Movement offers another alternative. Villages are community-based, nonprofit, grassroots groups that neighbors organize to help older adults remain in their homes and communities for as long as possible. Though the well-established villages have paid staff, most of the services are provided to members by volunteers.

Generally, villages coordinate members’ access to transportation, health and wellness programs, tech support, home repairs, and social and educational activities. They may keep a directory of trusted and vetted plumbers, electricians, and other service providers.

The Village to Village Network is a national nonprofit that provides guidance and models for setting up local villages. The model for the village is Boston Village (formerly Beacon Hill Village), which started 25 years ago. Boston Village offers grocery and transportation services and home help referrals. It encourages members with similar interests to organize groups, and it also offers classes and social engagement activities based on members’ interests. Members pay an annual fee, with reduced fees for low-income households.

Finally, if you can afford it, a senior living facility can function as a community that offers medical services, recreation, and transportation.

In the U.S., it seems, the myths of individual liberty and self-reliance have conditioned us to think about many social problems as issues for an individual to solve on their own. That has definitely been the case with aging in place.

But humans are social animals. All people, old and young, need connections to other humans to thrive. It is time to think more broadly about aging in place and recognize that the “place” for “aging in place” can and should be within a supportive community.

Leave a comment

No. 112/August 5, 2026

NewScan is a biweekly briefing on news relevant to readers of The EndGame. NewScan is a premium feature exclusively for paid subscribers.

Older Workers’ Careers Cut Short by AI

Since the launch of ChatGPT is 2022, many older white-collar knowledge workers in the jobs most vulnerable to AI are finding themselves unemployed in growing …

Read more

Photo by Curated Lifestyle for Unsplash+

Two lines on a graph are going in opposite directions. One, heading upward, represents the number of older adults in the U.S. Not coincidentally, the leading edge of the baby boom turns 80 this year. The other line, heading sharply south, is the size of the workforce available to care for this burgeoning population. The decline reflects low pay, difficult working conditions, and the impact of the federal war on immigrants, who comprise a significant share of the healthcare workforce.

Together, these two lines mark a crisis point. As the baby boom generation and those who follow reach the age where care becomes imperative, fewer paid caregivers will be available to deliver it.

Share The EndGame

Today the burden of closing the gap between care needs and paid caregivers is unpaid family caregiving. The Caregiving in the U.S. 2025 report finds that 24% of all adults in the U.S. are family caregivers. That means one in four adults must balance caregiving duties with holding jobs, maintaining relationships, saving for retirement, and the other exigencies of daily living. That number of adults engaged in family caregiving has grown 45% over the past decade.

The burden is heavier still for the 45% of adults under 50 who are in the “sandwich generation” – caring both for children under 18 and an older adult. (One young mother I know, with both a mother and grandmother to look after, declared herself a member of the “club sandwich generation.”)

The two opposing trend lines are slowly shifting the traditional narrative – that caring for elders is a personal, individual obligation – to seeing the caregiving crisis as a larger social problem requiring collective action of some kind.

Most of the discussion to date has centered on what government can do. Many countries provide universal coverage for elder care, with or without copayments or means-testing. The U.S. offers only limited coverage through Medicare and Medicaid.

There has been less attention on the role corporate American can play. But as the crisis continues to worsen, some business experts are making the case that employers have much to gain by adopting caregiver-friendly policies for their workforces. (And we, the ones who will need the care, will benefit if our children are less stressed about losing their jobs.)

This is an unconventional idea. The dominant thinking in business circles today is that employees with caregiving responsibilities are a cost item. These employees are absent more often, which lowers productivity. Often the burdens of caregiving cause them to leave the workforce altogether.

From Liability to Asset

But Joe Fuller, a Harvard Business School professor, argues that viewing employee benefits only as a cost is no longer valid. He says companies need to invest in employee benefits that ease the pressure on family caregivers. His research finds that companies that offer innovative care benefits can make better hires, mitigate turnover, and increase productivity and morale. “Investing in new benefits models that address the needs of caregivers is no longer a nice-to-have fringe activity,” says a report, Healthy Outcomes, written by Fuller and Harvard Business School colleagues. “It is an essential investment in building a more stable and competitive workforce for the 21st century – one that guarantees a high return.”

Fuller warns that “if you’re not taking into account systems effects like reduced turnover and improved productivity in your analysis of benefits, you’re doing the math wrong.”

Business policies that would help relieve the stress on caregiver-employees include:

• Flexible or predictable scheduling

• Remote or hybrid work options

• Caregiver-friendly leave policies

• Caregiver resources such as care navigation services, financial wellness resources, and counseling.

• Managers and supervisors trained to respond with empathy to caregiver-employees and ready to connect employees with resources.

Cynthia Hutchins, director of financial gerontology at Bank of America, says there is a compelling business case for supporting employees who are caregivers. Companies with caregiver-friendly policies are better able to retain experienced employees, reduce turnover, preserve institutional knowledge, and minimize absenteeism. They are “also better-positioned to attract talent in an increasingly competitive labor market….”

Going a step further, researchers at Rutgers University’s Center for Women in Business contend that “caregiving cultivates the very abilities many employers say they need most right now: empathy, problem-solving, adaptability, and leadership under pressure.” Based on their research, they write, “caregiving isn’t a career detour; it’s a form of leadership training. In an era of AI and automation, caregiving builds the human capabilities machines can’t replicate.” In short, “retaining your caregiver employees isn’t just good for equity and morale; it’s advantageous to your organization.”

Businesses looking for ways to reexamine their employee policies can turn to Caregiver-Ready Workplaces, a national initiative from Caregiver Action Network that promises to help companies institute caregiver-friendly policies by bringing “lived experience and practical solutions directly into the workplace.”

Caregiving has gone from an individual responsibility to a national problem. Government has a role to play in finding solutions – but so does business.

Leave a comment

Photo by Mohamed Nohassi on Unsplash+

Surely no sector of the American economy is more eager to deploy robots than the eldercare industry. Faced with rising costs and a chronic shortage of workers – made even worse by the Administration’s vigorous enforcement of immigration policies – robots seem to offer a way to get more done with fewer employees.

Investors have been enthusiastic about the prospects. The market for automated assistance in eldercare was $3.14 billion in 2025 and it continues to grow by more than 12% annually.

Share The EndGame

But before cheering the passing bandwagon, a few nagging questions have yet to be resolved:

• Is there credible evidence of robots’ effectiveness?

• Are they worth the cost?

• How do elderly patients and care workers feel about them?

A Long Way from Chatty Cathy

The robots getting the most attention are companion robots, which interact with patients and respond to voice and touch. They are promoted as a way to relieve loneliness. The most popular to date is Paro, a Japanese product resembling a plush baby seal that has won FDA approval. Paro has sensors that detect light, sound, touch, temperature, and posture. It doesn’t talk but it responds to petting and displays emotions. Essentially it works like pet therapy, but without needing to be fed or taken for walks. Also it doesn’t bite, scratch, or trigger allergies.

ElliQ, a table-top robot of Israeli design, is a talker. It engages adults in conversation, gives reminders about medication, even poses riddles. It can be found in apartments across New York City in hope of abating loneliness.

A humanoid (i.e., resembling a human, as in Star Wars’ C3P0) robot called Ryan is being designed specifically for adults with early-stage dementia or depression. Ryan has speech and facial recognition, engages in conversations, and can initiate cognitive games.

Physical Assistance Robots

Another avenue of robotics is physical assistance. These bots lift or physically support adults or assist with household chores. Scientists at MIT, for example, are developing a robot that can help a patient get in or out of a bathtub, go from sitting to standing, bend down to reach objects, walk, or get up from the floor. One model has inflatable airbags to catch a person if they fall. At Stanford, researchers are designing “wearable robots,” such as a device strapped to the ankle to make walking or climbing stairs easier. Other teams are working on companion robots for adults with low vision that can warn about uneven pavement or curbs, offer physical support, and sound an alert if the patient’s gait looks unsteady.

But Are They Worth It?

Most popular articles about healthcare robots follow the gee-whiz style of science writing, long on future benefits and short on evidence. Clare Yu, a researcher on dementia prevention, and colleagues at University College London analyzed 66 studies of robots being used to support people with dementia. They concluded that there is no clear evidence that robots improved patients’ quality of life, cognition, or behavior. The studies often used small samples, didn’t randomize participants, and did not compare robots with other forms of care.

“I think they are something that can be used in the future, but not at this present moment,” Yu told an interviewer. “We need some time to do more research to be able to say they are definitely beneficial.”

There is also resistance from healthcare staff and patients. Some researchers report that workers are suspicious that robots might be secretly recording them. People living with mild Alzheimer’s disease told researchers they were concerned about privacy and loss of human connection, and a majority said they would prefer visits and calls from friends and families over robot-led activities. In another study, adults who are tech-savvy called companion robots “creepy,” “manipulative,” and “unethical,” offering merely the illusion of intimacy.

Cost is another issue. While the simpler companion robots cost hundreds of dollars, more sophisticated (and more humanoid) models can cost $30,000 or more. Saving money, in other words, is not likely to be an immediate benefit.

But given the serious, long-term shortage of healthcare workers, together with the rising tide of the older population, many voices in the eldercare industry believe robots are the industry’s best hope for meeting the needs of older patients.

So don’t be surprised to find yourself chatting soon with AI-powered devices, ready or not, in a setting near you.

Leave a comment

No. 111/July 22, 2026

NewScan is a biweekly briefing on news relevant to readers of The EndGame. NewScan is a premium feature exclusively for paid subscribers.

Nearly Half of Older Adults Improve Over Time

A long-term study from Yale University’s School of Public Health found that 45% of the 11,000 older adults in the study improved their cognitive functio…

Read more

Photo by Toni Reed on Unsplash

In 2023 U.S. Surgeon General Dr. Vivek H. Murthy declared that Americans were experiencing an epidemic of loneliness and social isolation. An AARP survey in 2025 reported that 40% of adults aged 45 and older reported feeling lonely.

My first impression on reading this was that it must be referring to older adults living alone (“solo agers”), but I was mistaken. For one thing, you don’t have to be living alone to feel lonely. You can be surrounded by people and still be lonely. And for another, many people who live alone do so by choice.

Share The EndGame

Solitude is not the same as loneliness. Being alone is a physical state. Loneliness is an emotional state.

My roommate for two years in college has, to the best of my knowledge, lived alone ever since (perhaps as a direct result of our roommate experience). A world traveler and successful executive, he is by no measure lonely or isolated. And my mother-in-law had no problem living alone for 45 years after her divorce. It didn’t keep her from enjoying an active social life of concerts, performances, and family ties.

Loneliness Hurts

This is not to make light of loneliness and social isolation, two conditions that frequently overlap. Both are widespread and pose serious health risks. The lonely or socially isolated are more likely to be admitted to emergency rooms and nursing homes. Both conditions are associated with higher risks for high blood pressure, heart disease, anxiety, depression, cognitive decline, obesity, weakened immune function, and death. The emotional pain of loneliness can activate the same stress responses as physical pain, and that stress can lower immunity, leaving the body more vulnerable to chronic and infectious diseases.

But some people – and I know this because I am one of them – seek solitude, prefer solitude, need solitude. We can spend considerable time alone and still not be lonely, because we happen to be comfortable with our own company. As the archetypal loner Henry David Thoreau put it, “I never found the companion that was so companionable as solitude.”

The common prescription for loneliness, of course, is to reach out to others and engage more socially. Those of us who enjoy our solitude would rather not.

“I know what the experts say. I must be diligent about maintaining social contact,” writes Georgia Kreiger, an English professor, poet, and essayist who enjoys her time alone. “But how much social contact do I need? How many meaningful relationships must I have? And with whom?”

The War on Solitude

We live in a culture waging a quiet war against solitude, argues RJ Starr, a theorist in integrative psychology. In an essay exploring solitude and loneliness, he writes that many struggle with solitude “in a culture that prioritizes productivity and stimulation” and don’t know “how to be alone without anxiety.” Solitude is often interpreted as a personal failure. He suggests that “in a culture that rewards constant communication and punishes quiet withdrawal, reclaiming solitude is a subversive act.”

Just as there are people who prefer solitude, there are others who find it agonizing. Starr says many people fear being alone because the quiet might force them to confront “unmet needs, emotional injuries, or the vast space between the life we are living and the one we long for.”

Or they may just be extroverts, who need human contact to feel truly alive.

Kim Samuel, the author of On Belonging: Finding Connection in an Age of Isolation, makes the counterintuitive suggestion that solitude actually can be an antidote to loneliness. “When we know ourselves, we are better able to know others,” she writes. “When we feel at home in the here and now, we feel more at home in the world at large.”

I don’t know about that. I only know that I and my fellow introverts socialize when necessary but find these interactions a serious drain on our energy. We need periods of solitude to recharge our batteries. But that doesn’t make us lonely.

Leave a comment

Photo by Juan Bacab on Unsplash

At the grocery this week, I glimpsed a magazine cover featuring 80-year-old Cher, and my first thought was how very old she looks (notwithstanding the best plastic surgery money can buy). Cher is definitely aging. So are Bob Dylan, Harrison Ford, Tom Hanks, and Dolly Parton. You can see the ravages of aging in their faces.

Share The EndGame

It makes me sad to see other people aging. Fortunately, I’m not aging at all. I don’t feel old. I don’t look old. My face looks the same as it did 30 years ago (if you don’t look closely at the baggy folds below my eyes. And a few speckles of gray in my beard).

I lift weights three times a week and walk almost daily. I’m more fit now than I have ever been in my life (aside from the 20-pound hemisphere protruding from my midsection).

I eat a mostly plant-based diet, supplemented occasionally by fish and animals who also maintained plant-based diets. I can eat virtually anything I want (except fried foods and sodas, which trigger acid reflux).

My eyesight remains keen (or will be, after cataract surgery next year).

My hearing is quite good (although it does bother me that everyone around me mumbles).

I am an excellent conversationalist (although sometimes I leave a thought dangling because the word I am looking for won’t come to me for 15 minutes.)

The fact that I receive Social Security checks and Medicare benefits is not proof that I am aging. These rewards are based on reaching a chronological age and say nothing about how fit and alert one might be. I also accept senior discounts because I am entitled to them.

Despite not aging, my wife and I have put our names on the waiting list for an independent living unit in a senior housing project. I have mixed feelings about doing this. I’m not sure how I will feel about being surrounded by old people. My wife, who is five years younger, feels the same way. But the waiting list is rumored to be about six years long, so we think of it as an insurance policy in case one of us does start to age. You never can tell.

It pains me to see some of our friends aging before my eyes, brought down by arthritis, neurological diseases, cancer, cardiac issues, or cognitive decline. Yet we remain friends because I appreciate the value of intergenerational relationships.

I’m lucky that I am not aging. As long as I continue to ignore any evidence to the contrary, I’m certain I can make it go away.

Leave a comment

No. 110/July 8, 2026

NewScan is a biweekly briefing on news relevant to readers of The EndGame. NewScan is a premium feature exclusively for paid subscribers.

Congress Can’t Keep Kicking the Can Down the Road

If Congress does not act to strengthen Social Security’s finances before 2034, benefits to retirees and the disabled will have to be cut about 17% - …

Read more

Photo by Anika Mikkelson on Unsplash

Happy Fourth of July!

I am vacationing this week. Here is a dusty, but perhaps useful post from the archive for your information and entertainment.

When Bob and I walk together around the neighborhood, meeting our minimum daily requirements for steps, we always compare notes on how we’re faring against the slow, inexorable advance of decrepitude. We each do our “organ recitals,” and then Bob asks the tough question: What’s normal aging and what’s something to worry about?

Share The EndGame

Today I am attempting to answer Bob’s question. I’ve compiled information from the most authoritative sources on the internet – carefully reviewed by my friend Dr. Carla Rosenthal, an experienced geriatrician - and I’ve separated out normal signs of aging from symptoms that may signal serious health concerns. (Trigger warning: if you are a person, like me, who reads about lung disease and immediately feel short of breath, maybe you should stop reading.) Remember that the list of “normal” events isn’t a prediction; it’s only what happens to many people as they age. You, on the other hand, may have won the genetic lottery and get to take a pass on several of these.

I hope you find this information reassuring that many of these events happen normally and are not cause for alarm.

Executive Summary:

Whatever you had at 30, you have less of it now and will have still less going forward.

That said, let’s look at the details.

Bones

Normal: Bones lose mass (osteopenia), making fractures a higher risk. The losses are speediest in post-menopausal women. You may find yourself a few centimeters shorter.

Worrisome: Hip and wrist fractures are more likely if osteopenia progresses to osteoporosis, or loss of bone density,

Joints

Normal: You are less flexible, and your joints feel stiff and tight. You feel a kinship with the Tin Man.

Worrisome: Joints become inflamed and arthritic.

Muscle and Fat

Normal: Muscle mass and muscle strength tend to decrease, but not enough to prevent you from performing normal tasks. As the percentage of body fat doubles by age 75, body shape changes. (Like the baggage in the overhead rack, “Items may have shifted during flight.”)

Worrisome: If the increased fat percentage triggers diabetes or other conditions.

Eyes

Normal: You have trouble reading things up close, or in dim light. You may perceive colors differently. Your eyes feel dry.

Worrisome: You see a blurry spot near the center of your field of vision (age-related macular degeneration), cloudy vision (cataracts), or experience any sudden change in vision.

Ears

Normal: Everyone who speaks to you mumbles and you can’t catch all the words. You have trouble hearing in loud environments or over background noise.

Worrisome: You can’t hear most conversations clearly, or what you hear sounds muffled.

Mouth and Nose

Normal: Your senses of smell and taste diminish. Some foods taste bitter, others bland.

Worrisome: You lose interest in eating.

Brain

Normal: Learning takes longer. You draw a blank on a person’s name. You enter a room and forget why you came. You forget where you left your car keys.

Worrisome: You forget that you need keys to drive your car.

Heart

Normal: Your heart doesn’t speed up as quickly or pump as fast as when you were younger.

Worrisome: You have trouble keeping up with regular activities, feel short of breath, feel dizzy or lightheaded, have chest pain when you’re active, or have an irregular or fluttering heartbeat.

Lungs

Normal: You may have more difficulty exercising or breathing at high altitudes.

Worrisome: You experience sudden breathing difficulty.

Digestive System

Normal: You may become lactose intolerant, your metabolism slows, and you may experience constipation. You may have more difficulty swallowing.

Worrisome: You have reflux frequently or inflammation in the colon.

Kidneys and Urinary Tract

Normal: You’re peeing more often, sometimes with greater urgency.

Worrisome: You’re leaking urine before and after you pee.

Reproductive Organs

Normal: Men feel lower sex drive and may have full or partial erectile dysfunction. Women after menopause may feel dryness or itching in the vagina.

Worrisome: You contract a sexually transmitted infection.

Skin

Normal: Your skin wrinkles, dries out, becomes less elastic, and develops age spots. You develop more jowls around your jaw and more hollows around your eyes.

Worrisome: Spots triggered by sun exposure may be malignant.

Teeth and Gums

Normal: Your mouth is dry, your gums begin to recede, and cavities are more likely.

Worrisome: Diseased gums or teeth may be linked to diabetes and heart disease.

Sleep

Normal: Your sleep is interrupted more; you have trouble staying asleep. Your existing tendencies, whether to rise early or stay up late, become even more so.

Worrisome: Not getting enough sleep consistently.

What Can You Do?

You’ve heard it all before, but it’s still true: Eat a balanced diet heavy on the fruits, vegetables, and whole grains; go easy on the dairy, sugar, fried foods, and alcohol. Keep moving. Exercise your body. Exercise your mind. Drink plenty of water. Get all the sleep you need. Reduce stress. Stay current on vaccinations. Use sunscreen religiously. Brush and floss teeth daily.

And keep smiling. Aging may be a bitch, but it still beats the alternative.

Admittedly, this was a whirlwind tour of a complex human system. Here are links for more information:

“The Aging Process: Signs, Effects, and What to Expect as You Get Older,” Greatseniorliving.com

“Changes in the Body with Aging,” MSD Manual Consumer Version

“Aging: What to Expect,” Mayo Clinic

Leave a comment

Photo by Yunus Tug for Unsplash+

Fresh from a recent adventure in an emergency room, I was intrigued to learn of a trend in emergency medicine that is gathering momentum: the Geriatric Emergency Department.

I grew up in an era when “separate but equal” was associated with outdated, politically incorrect thinking. Consequently, I tend to be skeptical of separate anything. In the case of separate emergency rooms for older adults, however, I’m willing to make an exception. Evidence suggests that these separate facilities can lead to better outcomes for older patients.

Share The EndGame

“The emergency department is a very fast-paced, loud environment,” says Dr. Liz Goldberg, associate professor of emergency medicine and geriatrics at the University of Colorado School of Medicine. Because of overcrowding, she told an interviewer, patients may spend hours or days in a hallway, under bright lights and with constant activity all around.

Older patients who stay overnight in an emergency department “are at greater risk for developing delirium, even potentially having an inpatient mortality,” says Ula Hwang, professor adjunct of emergency medicine at Yale School of Medicine.

Hwang co-authored the first nationally representative study of hospital admission and mortality associated with Geriatric Emergency Department care. Published in April, the study found that receiving acute care in a Geriatric Emergency Department was associated with lower odds of hospital admission and 30-day mortality after the visit.

How Geriatric ERs Differ

Hwang says that in an urgent situation, patients of all ages receive the same fast, specialized care. The age-related difference comes into play in more ambiguous cases, which lead to longer and more thorough workups.

Geriatric emergency rooms are staffed with medical teams that have geriatric training, and they follow structured processes that put a premium on careful assessment and coordination. Following these processes is more likely to identify and manage geriatric syndromes, reduce harmful interventions, reduce complications, prevent unnecessary admissions, and support safer discharge planning.

These ERs are also more age-friendly environments. Non-slip floors, plenty of handrails, and an ample supply of walkers can prevent falls. Clear signage helps prevent people from getting lost, while forms that use large print ensure that vision problems don’t prevent patients from understanding instructions. Quiet areas with ambient lighting (in place of harsh fluorescents) reduce anxiety and confusion.

One goal of Geriatric ERs is to lessen the likelihood of delirium, for which people with dementia are at higher risk. Protocols try to prevent delirium by keeping the patient hydrated and minimizing the use of equipment, such as monitors, that attach to the patient.

Another goal is better, more accurate diagnoses. As one geriatrician explained to National Public Radio, “If you don’t know that person’s baseline, if you don’t know that there was a new medication started, if you don’t know that they had a fall a week ago, and you can’t get that information because they’re not able to communicate, it’s very hard to diagnose accurately.”

For the record, older adults are the frequent flyers of emergency care. Data from the Centers for Disease Control and Prevention shows that older adults account for 21% of the 33 million annual visits to emergency departments.

Roughly 10% of emergency departments have some level of geriatric certification from the American College of Emergency Physicians, which started a certification program in 2018. Many of them are urban teaching hospitals.

Though the number of certified departments has expanded rapidly, the number of patients receiving care in geriatric emergency rooms is still small.

And there remains one major obstacle to further growth: the shortage of doctors specializing in geriatric care. In one year only 170 fellows were placed in U.S. geriatric fellowship programs, compared to more than 1,000 fellows in cardiology. But that’s another story, for another time.

Leave a comment

No. 109/June 24, 2026

NewScan is a biweekly briefing on news relevant to readers of The EndGame. NewScan is a premium feature exclusively for paid subscribers.

More Older Adults Require Care – No System Provides It

The first members of the Baby Boom generation turn 80 this year, signaling a sharp increase in the number of older adults needing care. With no…

Read more

Photo by Towfiqu barbhuiya on Unsplash

If you have not had the pleasure of visiting an Emergency Room lately, let me assure you that it is nothing like the televised medical dramas. On television, heroic doctors and nurses are the stars, and the patients are minor characters. But when you are the patient, you might think you are the center of the story, and you would be wrong. You’re still a bit player. Forget the suspenseful drama and fast-paced action – you will appear only in brief cameos, which break up long, monotonous stretches of fruitless waiting. This is not a formula for thrilling entertainment.

Share The EndGame

I was in the ER last week because I awoke one day unable to maintain my balance and sporting a pounding headache that would not quit. After another day of headache and unsteadiness and two nights with minimal sleep, my wife drove me to our primary care physician, who asked a few questions and then referred us directly to the nearest ER. During our 12-hour sojourn there, I went through a CT scan (negative), an MRI scan (negative), and a neurology workup (negative). These tests confirmed that I wasn’t having a stroke, a brain bleed, or anything else life-threatening. I received a pain medication for the headache that eventually worked. Those actions took about two hours total. The other 10 hours were spent waiting. For most of that time, I was shivering under a blanket because the ER temperature is permanently set at “Meat Locker” to minimize the spread of nasty little organisms, and I had come dressed for a warm summer’s day.

Trembling Hands

I was finally released, my balance still a bit wobbly, but the next day my hands were trembling violently. Eating was an exercise in frustration and futility, For the only time in recent memory, my wife finished her meals long before I did. To drink liquids, I had to place them in a cup with a lid and a straw – essentially, my very own sippy cup. Writing was impossible: It took me 10 minutes to get my quivering fingers to type a one-line message on the computer or the phone – when I could manage to unlock the phone with the correct password.

On the fourth day after my discharge from the ER, we scored a follow-up appointment with the primary care practice. A nurse practitioner studied the charts from the ER docs, asked a lot of questions, and finally said, “I think I know what’s going on.”

Huzzah!

Her diagnosis: The hand tremors occurred because the pain medication delivered in ER caused an adverse interaction with a prescription I was taking regularly. Eventually the drug would wear off. There was nothing to do but wait it out. (The original balance problem and headache might have been a drug reaction set off by dehydration.)

Just as she predicted, the tremors gradually receded, as did the balance issues. Three days after that visit, I was back to normal. One frightening medical mystery solved.

Drug Interactions

My experience, I have since learned, is not unique among older adults. The more medicines you take, the greater your risk of having an adverse drug interaction. Most of us, by age 60, are taking prescription drugs for one or more chronic conditions such as high blood pressure, high cholesterol, or inflammation. Studies have shown that patients taking more than five medications (a condition called polypharmacy) are up to four times more likely to be hospitalized from an adverse drug event.

The number of drugs is not the only issue. Our bodies change over the years, and a drug we’ve been prescribed for years may not work as effectively as it did. Even vitamins and supplements can trigger dangerous drug interactions. A spike in glucose or lack of fluids can set off a chain of events that can lead to scary symptoms.

Here’s another little surprise: Elderly patients are rarely, if ever, included in drug trials. So doctors know what to expect when prescribing for young and middle-aged adults but have little to guide them on how the drugs perform in older bodies, or what constitutes a safe dosage. There is more guesswork and playing hunches than we would like to think.

I am definitely in the polypharmacy demographic: I have taken seven prescription medicines and an over-the-counter nasal spray for decades. But after two tremulous experiences in six months, I will be insisting that my physicians take a fresh look at my medications, with an eye toward deprescribing some or finding newer, safer alternatives.

I’m too young to abandon my writing career because of trembling hands!

Leave a comment

Photo by Katie Rosario on Unsplash

Some birthdays are cause for celebration. I didn’t consider my 75th birthday to be one of them. Aside from my radical amazement that I’m still walking the planet after three-quarters of a century, it didn’t strike me as an occasion worthy of summoning friends and family to offer toasts, present gag gifts, and deliver snarky birthday cards poking fun at my whitening brow and steadily crumbling infrastructure.

Share The EndGame

Consequently, there was no party, and I observed an untraditional birthday signing copies of The AfterWork: Finding Fulfilling Alternatives to Retirement in a delightful Rehoboth Beach, Delaware bookstore. The bookstore was jammed with customers (drawn not by me but by a torrential downpour), and I sold a few books. So happy birthday to me.

But while my 75th was not a worthy occasion for celebration, I do think other significant milestone birthdays are. For example:

Memorable Milestones

1st – I don’t remember my own, but as a parent I adopted the widely observed ritual: Sit the birthday baby in their high chair, place a chocolate cupcake or a slice of chocolate cake on their tray, and laugh raucously as the baby slams their tiny fist into the cake and smears chocolate all over face, hands, hair, and floor.

13th – in Jewish tradition, the child celebrates a Bar or Bat Mitzvah and is treated like royalty for a day, followed immediately by a torturous six-year journey through darkest Adolescence.

21st – This is the date on which you are legally permitted to do what you’ve been doing illegally for years.

30th – This marks the moment you realize you are no longer just pretending to be an adult. A 4-day-old baby in my arms brought that reality home.

39th – On this day, I called my father and said, “I’m not sure how it happened, but now you and I are same age.”

52nd – Not normally a landmark, but it was on this birthday that I received a note from my son that read: “Congratulations! If you had received a card for every year you’ve lived, you would finally be playing with a full deck.”

60th – A small celebration marked the day I became a sexagenarian. It sounded a lot more exciting than it turned out to be.

65th – Until recently, this milestone represented the advent of retirement. Now it only means you can enroll in Medicare.

There is a clear pattern here: The older I get, the less thrilled I am by the prospect of cake and candles. As another writer puts it, birthdays become less like milestones and more like millstones.

Gaining Perspective

But what a milestone birthday is good for, if not embarrassment among friends, is for taking a step back, breathing deeply, and putting some perspective on life to date.

The ambitions of my youth were grand. Like Clark Kent, I wanted to be a newspaper reporter fighting for truth, justice, and the American way (or was that Superman?). I wanted to be an acclaimed figure in the world of books. I pictured myself writing in an upstairs garret of a townhouse overlooking a beautiful park.

I didn’t achieve those ambitions, but it doesn’t matter. Life took me in other directions I had not even dreamed of. In my first 75 years I managed to get an education, support myself, enjoy a 50-year partnership with the love of my life, raise two well launched and reasonably well adjusted children, make good friends, make stupid mistakes, and come out smiling. I have enough to eat and a roof over my head. My bottom line is that I feel satisfied and content. I have no regrets.

I have no clue what awaits me on the downhill side of 75, but I look forward to being surprised. I plan to stay curious, keep writing, nurture loving relationships, and encourage laughter. Especially laughter. We all need more laughter. If I can go out smiling, that will be something worth celebrating.

Leave a comment

Photo by Aysegul Aytören on Unsplash

Odds are, you have heard someone toss off the remark, “You can never be too rich or too thin,” as if it were true. Some people must believe it’s true, to judge from the images of impossibly trim young darlings bombarding us from movies, television, telephones, and Instagram sites. As a former beauty editor observes, “Some of our most visible celebrities have gone from merely thin to gravely gaunt.”

In fact, I would argue that “Never too rich or too thin” so brilliantly captures the spirit of our age that it should be printed on our currency, in place of “E pluribus unum.”

Share The EndGame

Regardless of contemporary ideals of beauty, “too thin” is terrible health advice at any age, but especially for older adults, where it can lead to frailty. Frailty in a clinical sense means you are less resilient to health events such as falls or surgery and more vulnerable to bad health outcomes. Researchers at Johns Hopkins University report that frailty doubles the risk of surgical complications, lengthens hospital stays, and increases the odds of landing in a nursing home or assisted living.

Frailty happens when our bodies lose muscle mass, our bones become less dense, and our cells experience more inflammation. All these are normal effects of aging, but frailty results when these changes occur at an accelerated pace.

Frailty will be the death of us all, eventually. We would be wise to forestall it for as long as possible.

What Counts as Frail

A large global review in 2020 estimated that frailty affects about 11% of adults aged 50-59, while about half of all adults aged 50 and older were “pre-frail.” Interestingly, and contrary to popular belief, only 25% of adults aged 84 and older are considered frail.

Diagnosing frailty and pre-frailty used to be strictly a matter of how a patient appeared. Today doctors use one of two different methods to make a determination. The first assesses five physical abilities: weakness (in grip strength, for example), slowness of gait, exhaustion, physical inactivity, and unintentional weight loss (10 pounds or more in a year). A patient with one or two of these conditions is pre-frail; three or more qualifies as frail. The second tool, called the deficit accumulation model, rates whether the patient presents any of about 30 different symptoms, including high blood pressure and cognitive decline, and their ability to perform everyday tasks. The more conditions, the more likely the patient is frail.

Hold It At Bay

If you are not frail now and don’t plan to be frail in the near future, several actions will help you remain strong and vital.

Eat well. People who faithfully follow the Mediterranean diet – fruit, veggies, protein, good fats, whole grains, and low-fat dairy – are 74% less likely to become frail.

Get your protein. Vegetarian and vegan diets require extra effort to get sufficient protein, which is necessary for building up muscle. Protein is most abundant in meat, fish, poultry, and dairy. Dried beans and yogurt (especially Greek yogurt) can make up some of the deficiency.

Work those muscles. Walking is nice, but not enough. Working out with weights is highly recommended, if not exactly popular (only an estimated 10% of women age 75 and older engage in strength training, despite their higher risk of falls). Practicing Tai Chi and doing resistance exercises are another alternative. Aerobic exercise helps build endurance.

Think positive. An upbeat attitude about aging has been linked to a lower risk of frailty. As the oft-cited study by Becca Levy of Yale University has shown, adults with positive views about their age outlive their negative contemporaries by an average of 7.5 years.

I avoided weight training for my first 72 years, but fear of falling finally forced me to overcome my own resistance to weight-bearing, balance, and aerobic exercises. The results aren’t obvious on the surface, but my incidences of tripping and falling have declined about 90%. It’s never too late to start taking action to postpone the inevitable. And anything you do is helpful. A little bit is better than nada.

Leave a comment

No. 108/May 27 , 2026

NewScan is a biweekly briefing on news relevant to readers of The EndGame. NewScan is a premium feature exclusively for paid subscribers.

Few Retirees Work

Although 75% of American workers expect to supplement their retirement savings with paid work, only 27% of retirees actually do, according to EBRI’s 2026 Retirement Confidence Surv…

Read more

Photo by Sabine van Straaten on Unsplash

Note to Readers: Today, May 23, is my father’s birthday. (It is also my birthday, and my grandfather’s birthday, but that’s another story.) In his honor, I am reprinting this post from the archive.

Life dealt my father a pretty lousy hand at birth. As an infant he had asthma so severe that he almost didn’t make it. His parents had to drive him to a hospital in another state to bring the illness under control. When he was not quite 3 years old, his mother committed suicide. That left him with his father, an immigrant from Latvia, and his 11-year-old sister, who reluctantly babysat him while the father worked as a traveling peddler. About a minute after the sister graduated from high school, she left home. With no other options, his father sent the 8-year-old to an orphanage.

As orphanages go, it was better than average. The children were enrolled in a top-flight private school. In the summers, my father returned home to his father, who took him along as he sold goods and collected payments in poor city neighborhoods and rural communities. He was only 17 when his father died (at age 53). Thus ended childhood. My father entered adult life virtually alone in the world.

These experiences did not embitter him, but they did kindle a deep desire to have a family – to ease his own loneliness, certainly, but also to see that another generation would not have to begin life as he had. At the age of 24, he married my mother, whose positive attributes included membership in a large extended family.

From Orphan to Father

Then he became a father of four. Considering that he had no model of what a healthy, happy family should look like, I stand amazed at how much he got right. His marriage was not idyllic, but it lasted 48 years, right up to the moment that his death did them part. And it succeeded in creating a stable, secure, and safe home environment that launched the four of us into our own adulthoods.

My father was a salesman, sometimes at retail furniture stores, sometimes on the road. He changed employment frequently, but his job hops never seemed to lead upward. He also tried a number of entrepreneurial adventures: Selling fallout shelter supplies, franchising, home repair, property management, turnkey bridal trousseaux. All of his ventures lost money, and most added to his debts.

He was never a success by the standards of American culture. Unfortunately, he believed that was the standard that mattered most, and it grated on him that he was falling short. He understood his male role as the family provider. When he wasn’t providing, and my mother had to work to pull us through, he felt ashamed.

But as a father, he was top-notch. He taught me to throw and catch a baseball. He taught me to drive. He taught me to shave. But most of all, he taught, by his example, values I have incorporated into my own life.

• He taught me to give of myself. My father volunteered his own time readily, to us and a variety of community causes, from synagogue activities to high school clubs.

• He taught me to be generous in spirit. My father knew what loneliness felt like, so he was quick to befriend the friendless, the newcomer, the acquaintance down on his luck. He was even quick to lend money to people he believed in, regardless of whether he had it to give.

• He taught me to love justice. By his actions he demonstrated his conviction that African Americans were being denied the fair chance they deserved. Today that sounds obvious. In Louisiana in the 1950 and 1960s, it was virtual heresy.

• He taught me courage. He knew it was not easy to be in the minority religiously, politically, or ethnically, but he showed me there were values worth standing up for.

Asthma and Depression

Only later in his life did I come to understand something else about my father’s courage. He had two serious, lifelong medical challenges. Asthma was the one I knew about. It had hospitalized him more than once, and it flared up to dangerous levels at irregular intervals. What took me longer to understand was his severe depression. In retrospect, it is clear that he was bipolar. At the high end, bristling with self-confidence, he would launch into a new job or venture that was sure to bring him riches. These were always followed by a crash and a descent into a dark place where he could hardly speak or bear to be seen on the street.

The depression (but not the bipolar component) is part of my inheritance from him. For me, it was a simple matter to seek help and treatment. My father did not believe he had that option. In his mind, if he told a psychiatrist about his thoughts, he would be hustled away to an institution in a straitjacket , leaving his family destitute. So he kept it all inside and dealt with it as best as he could. Through years of despair, he found the courage to go on living because it was the best thing for his family.

Two years before he died at age 72, he found the courage to seek help for his mental health. I thought it was incredibly brave of him.

Forty-five years ago I became a father. I tried to pass on the values I had learned to my children. I passed along bits of wisdom my father had shared with me, and I tried to add what I had learned. I don’t know what took. To be a father, I believe, is to light fuses each day that are 25 years long, and you live in suspense about which will fizzle out and which will detonate someday. But what can you do? You work with the hand you’re dealt, and you do your best.

My father did his best with a terrible hand. That took tremendous courage. I am proud to be his son.

Leave a comment