When Blair Justice was on his way to the emergency room with chest tightness this September, he wasn't thinking about what he had written in A Different Kind Of Health: Finding Well-Being Despite Illness.

When Blair's doctor stood by his bed five hours later and introduced him to the surgeon who would perform the emergency quadruple bypass, Blair wasn't reflecting on what he had written in the chapter "Resilience in Later Life." But he might have remembered the quote from Peter Marshall, "The measure of a life, after all, is not its duration but its donation."

Now that Blair is home and recovering from the surgery and aphasia from a stroke suffered during the operation, he indeed is having the opportunity to both reflect on and live out what he shared with others about resilience.

As his brain remaps the speech pathways, which it is doing with great alacrity, this seems an ideal opportunity to present what he has shared in print and lectures on the subject of resilience in later life.*

"Old age challenges not only our resilience but our mental acumen," he wrote. "Although brain shrinkage is not significant in the elderly, decline in episodic memory—for what we had for lunch last week or what we read two nights ago—will occur if we don't keep novelty, new experiences, and other forms of stimulation in our lives. Some sense of control and a feeling of being needed also are important."

The afternoon that Blair went to the ER, he and Rita took their dogs Tashi and Bodhi to do their Caring Critters volunteer work with stroke patients at the TIRR (Texas Institute for Rehabilitation and Research). Two weeks later, Blair was a patient in the same group when Tashi and Rita came again to volunteer there, this time with Blair as their patient.

Blair had been hesitant about participating because group members introduce themselves at the beginning of the session. He wasn't sure he could do that. But Blair knew Tashi would be comforted by seeing him and that both the group and Blair would benefit by participating. When it was Blair's turn to introduce himself, he said, "I'm Blair Justice. This is my dog Tashi. I'm a member of this team." Those were the first consecutive sentences he had said since before the surgery.

"Setting goals," Blair wrote, "and having positive expectations about reaching them significantly influence our capacity to retain a sense of well-being during a severe illness or a long-term course of medical treatment...Studies show that patients in pain who strongly expect their future health to be better rate their present health positively, regardless of their medical status. People's 'expectancies for the future,' researchers have found, have to be understood to account for the ratings they give their own health. Positive expectations, in turn, are related to establishing goals that keep us committed."

Despite the radical invasion of his body required in a quadruple bypass operation, Blair required no pain medicine after he left the ICU. The goals he now sets for himself change daily. As he reaches one, like getting up the stairs, he sets another: walking to the corner with the dogs. Recovering his autonomy and getting back to serving others are the ultimate goals that propel the small ones.

"Resilience often depends on our having an enthusiasm [Greek word meaning] literally, a God within—for life, which in turn depends on our seeing life as an adventure...Taking delight in the ordinary adds small drama to our lives when we are limited physically but not spiritually or emotionally."

In a study in Milan, Italy, of 25 persons who had been blinded in adulthood and 20 who had become paraplegic, those who were the most resilient were those who looked at everything anew, as a "how-to challenge" from getting around a room to learning to eat.

Instead of taking life for granted, as they might have before their misfortune, "now every little thing they accomplished made them feel good. They had to plan. They had to develop a skill to do things." This added oomph to their flagging self-esteem, restoring their positive self-perception, even during life-altering trials.

As Blair begins his thrice-weekly rehab in physical, occupational, and speech therapy at TIRR, he approaches it the same way he did when working toward his two masters degrees and Ph.D. He's willing to tend to the minutiae and to do it with the enthusiasm of someone earning an advanced degree in a subject he's passionate about: life.

Finding the Meaning

One final task facing Blair, as it faces everyone who encounters traumatic experiences, is to find meaning in what happened. Prime Minister of England under Queen Victoria, Disraeli said, "There is no education like adversity."

"Pain," Blair wrote, "is a teacher, and purpose and meaning often emerge from what we learn...Physical health is more of a means than an end. Many who have it and take it for granted are among those who keep seeking 'something more.'
We need to be reminded that 'health enables us to serve purpose in life, but it is not the purpose of life.' "

Our friend the late Dr. Michael Hammond, who was the dean of the Shepherd School of Music at Rice University and battling cancer during the construction of a glorious new home for the School, said at the dedication of that building that he had learned that "life is not about just feeling good but about being human and fully living. When one lives to the fullest, one suffers. The point is to suffer for a purpose.'"

* All quotes and references in this article, unless indicated, are from Blair Justice's book, A Different Kind of Health, (Peak Press, 1998.)

UPDATED: 10-28-2004

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