He had become the local expert on what he called the “unwanted side effects of old age,” so Bob Ross, 75, rubbed arthritis cream on his hands and walked into an examination room to see his seventh elderly patient of the day. He had been a doctor for almost 50 years in the remote town of Ortonville, Minnesota, caring for most of its 2,000 residents while growing old with them.
“What hurts you the most today?” he asked 79-year-old Nancy Scoblic.
“Let me get my list out,” he said. “Sore knees. Bad lungs. I have a sore spot on my leg and pain in my shoulder. Basically, if it doesn’t hurt now, it will probably hurt later.”
Most of Ross’s patients were white, geriatric and still largely self-sufficient—members of the same demographic as the country’s two leading presidential candidates, Joseph R. Biden Jr., 81, and Donald J. Trump, 77 years old. The conversations of an election cycle were the same ones taking place in Ross’s office: What were the best ways to stem the agency’s decline? How did aging affect cognition? When were adaptations necessary in terms of decision making? These were the questions he asked every day of his patients, and also of himself.
He checked Nancy, checking for circulatory problems while palpating her lymph nodes and carotid artery for signs of swelling. She pressed her hands against her abdomen to look for liver masses or an enlarged spleen. It was the same geriatric exam he performed at least 25 times a week, just as baby boomers showed up at his office showing more evidence of cancer, more bruises from falls, more diabetes, more strokes, and more signs of memory loss and possible dementia.
To listen to Nancy’s heartbeat, Bob used an adaptive stethoscope that he had purchased a few years earlier when his own hearing began to deteriorate. Lately, he could detect symptoms of her aging in the weakness that overwhelmed her hands and in her occasional errors with the names of her patients, even as he could remember decades of her medical records.
Every two or three months, he gathered his medical partners to ask them if they had noticed any signs of incompetence. “You have to promise me that you will be honest with me if you ever see anything that worries you,” she told them.
Ross had surpassed the average life expectancy at birth for an American man, 73 years, which was longer than he anticipated being alive. His parents died before the age of 60, his mother from cancer when Ross was in high school and his father from a heart attack a few years later. One of his brothers served 20 years in the US Army and then died in a motorcycle accident; another, a smoker, died of lung cancer at age 74. Ross’s wife, Mary, had gone into premature labor in the 1980s with her twin sons, and one died in the hospital two days later. The other child survived and then thrived for 15 months until the following winter, when he developed croup and Ross found him lifeless in his crib.
He had seen and grieved enough deaths to believe that aging was a privilege and he planned to preserve it.
His version of 75 meant starting each day taking a half-dozen medications to help treat his hypertension, diabetes, arthritis and high cholesterol. It meant diet shakes at lunch and a nap every afternoon. It meant spending an hour each night doing balance exercises, cardio and strength training. It meant traveling with Mary to Norway and Africa, even if she had to travel with a sleep apnea machine. And it meant continuing to work five days a week at the clinic, because caring for his elderly patients gave him purpose and community, and lately they seemed to depend on him even more.
“I wake up in the middle of the night and I’m out of breath, like I’ve just run a marathon,” an 81-year-old patient said one day. “It is normal?”.
He had been trying to answer his patients’ questions and anticipate their needs since 1977, when he began working at the under-resourced Ortonville hospital as one of the county’s two doctors. He and Mary opened a foundation for the hospital, which was used to build a state-of-the-art rural healthcare system. He had attended more than 1,500 births over the years, of which at least 100 children had grown up to work alongside him in the hospital.
But lately, during some of his appointments, he felt like he had few solutions to offer. All he could do was listen to his patients’ concerns, empathize, and explain the inevitable reality of what happens to an aging body. The brain’s frontal cortex begins to shrink over time, leading to slower memory, reduced attention span, and difficulty multitasking. The valves and arteries of the heart stiffen with age. The spinal discs flatten and then become compressed. The metabolism becomes slow. Muscles tighten, skin bruises, bones weaken, teeth decay, gums recede, hearing decreases, vision deteriorates—and everything is normal.
“I don’t like getting older either, but it’s definitely better than the alternative,” Ross told a 71-year-old patient.
Ross considered retiring several times over the past decade, but always opted to reduce his workload. He stopped performing surgeries, working in the emergency room and serving as a coroner. But he never wanted to stop seeing his patients. “I’m not sure exactly who he would be without that centerpiece of my identity,” he said one morning, as he went to visit the patient who knew him best.
His older brother, Jay Ross, was 83 years old and lived with his wife near the hospital. Sometimes Bob would stop on the way to work to check his brother’s lungs or monitor his back pain, but now he handed Jay a cup of coffee and the daily crossword puzzle.
“I know they’re supposed to be good for my mind, but sometimes I know the answer and I don’t remember the right word,” Jay said.
“I see it in myself and generally it’s not a significant sign of dementia,” Bob told him. “Memory becomes slow. It happens to all of us as we get older.”
“No joke,” Jay said. “Just look at our potential presidents.”
Jay is a Democrat and Bob is a Republican. They had been arguing about politics for 60 years, but lately they often studied the physical condition of the two candidates. Who, if anyone, was still fit to hold the position?
According to reports of President Biden’s most recent physical examination, he suffered from neuropathy in both feet, sleep apnea, arthritis, a stiff gait due to degenerative changes in the spine, and an irregular heart rhythm that was under control. His doctors said he was in good mental health and did not need a cognitive exam, but in recent months he had confused the President of Egypt with the President of Mexico and had tripped on the stairs while boarding the presidential plane.
At the same time, Donald J. Trump, 77, was overweight, liked fast food and often said he didn’t believe in exercise. Recently, he had apparently referred to his wife, Melania, as “Mercedes.” Twenty-seven mental health professionals came together to publish a book in 2017 about his mental state, titled “The Dangerous Case of Donald Trump.”
“My preference would be for Joe and Trump to go away and give us two new, viable options,” Bob said.
“It’s nice to finally agree,” Jay said.
Ross often told his patients that they could either fear death or prepare for it, so he and Mary had spent the last few years creating their own plan. They had chosen one son to make end-of-life decisions and another to manage their estate. Bob wanted to be cremated, but Mary planned to be buried.
“I like to be aware of my mortality,” Mary said. “It’s comforting to know what’s coming.”
“I get a lot of reminders,” Ross said. A few hours earlier he had signed the death certificate of a 91-year-old Alzheimer’s patient. It was at least the 400th death certificate she had signed in the last decade.
“Our minds and bodies are not made to last forever,” he told Mary. “There is no use pretending otherwise. We all get our turn. We grow old and die.”
