I met two 84-year-olds in pre-op last week.
The first one, I'll call him Earl, walked into the holding area on his own two feet. Sat down on the stretcher without help.
When I asked him what he does to stay in shape, he shrugged. "I still cut my own grass. Push mower. And I get down on the floor with my great-grandkids, because somebody has to."
The second one arrived by wheelchair, same age, similar surgery. It took three of us to move him onto the table.
He wasn't sick, exactly. He'd just gotten weak. A little less every year, for thirty years, until a knee replacement, a surgery designed to give him his life back, had become the biggest physical challenge of his life.
Same birthday, give or take. Two completely different bodies.
I put both of them to sleep that week. And I couldn't stop thinking about the space between them.
The test everyone takes
Here's something my job has taught me that I don't hear people talk about:
Almost everyone gets old. Almost no one trains for it.
We train for weddings. We train for beach vacations. Some of us train for a marathon we'll run once, post about, and never run again.
But the one physical event that nearly every single one of us is guaranteed to enter, being 80, needing to get off the floor, carry the groceries, climb the stairs, get up out of a chair without using our hands, we walk into that one completely unprepared.
We just assume our body will show up for it.
It won't. Not unless we send it an invitation now.
Because here's the part that took me embarrassingly long to understand, even as a physician: you don't get weak at 80. You get weak at 50 and 60 and 70, a little at a time, quietly, and then at 80 the bill comes due all at once.
Strength you don't use is strength you're scheduled to lose. The decline is slow enough that you never feel it happening, and steep enough that by the time you do, climbing back is brutally hard.
Earl wasn't lucky. Earl had been paying into an account for decades. The other man had been quietly overdrawing his.
The list
A few months ago, I sat down and did something that felt a little morbid and turned out to be one of the more clarifying exercises of my adult life.
I wrote down what I actually want to be able to do in my last decade. Not vague stuff like "be healthy." Specific, physical things:
Get up off the floor without a production. Carry a suitcase through an airport. Walk eighteen holes. Pick up a grandkid, and more importantly, get back up while holding them. Climb the stairs at a stadium to watch one of my boys' kids play ball. Drive myself. Open the jar.
Read that list again. Nothing on it is impressive. Every item on it is the whole ballgame.
Then comes the uncomfortable math. If I want to get off the floor easily at 85, I can't just barely be able to do it at 55. Everything erodes on the way there. That's not pessimism, that's biology.
So the version of me that's 55 has to be strong enough to lose some and still have plenty left.
That reframed everything about why I exercise.
I'm not training to look good at the pool this summer. I'm training to get off the floor in my last decade.
Squats stopped being about anything you can see in a mirror. They're a deposit toward getting out of a chair in 2060. Carrying heavy things is practice for the suitcase, the groceries, the grandkid.
Every unglamorous workout is a letter to a man I haven't met yet, the 85-year-old version of me, telling him I was thinking about him.
Dale
I have a patient, Dale, in his early sixties, who told me he'd started lifting weights for the first time in his life. His buddies gave him grief about it. What are you training for at your age?
I loved his answer.
"My funeral," he said. "I want it to be a long way off, and I want to walk into every event between now and then."
His friends laughed. But Dale understands something most people don't: the goal was never to be impressive. The goal is to be functional, for as long as humanly possible. Independence is the trophy. Everything else is decoration.
And there's a bonus nobody tells you about. The same things that keep you strong at 85, muscle, the ability to climb a hill without gasping, decent balance, are the same things that make you feel better at 45.
The deposit pays interest immediately. You're not choosing between your current self and your future self. The same check clears for both of them.
The bottom line
I can't promise you the last decade. Nobody can. I've been in medicine long enough to know that genetics deal some people a bad hand, and luck deals others a worse one. You can do everything right and still draw the short straw. That part isn't in your control, and I won't pretend it is.
But the quality of your last decade, whether it looks more like Earl's or more like the man we lifted onto the table, that's influenced, enormously, by what you do in the decades before it.
And unlike almost everything else about aging, this part responds to effort. Not heroic effort. Not a 5 a.m. ice bath and a supplement drawer. Just consistent, boring effort: pick up heavy things, walk more than feels necessary, don't stop getting down on the floor.
You don't have to become a gym person. You have to become a person who plans on being 85.
So here's my question for you this week: What's one physical thing you want to still be able to do in your last decade, and are you currently strong enough to lose thirty years of strength and still do it?
Reply and tell me. I can't write back to everyone, but I read every single one.
That's all for this week.
See you next Saturday.