Sometimes, I really am bewildered at the changes that happen to the human body over years and accumulated years of use and, occasionally, misuse. I am a doctor so, theoretically, I understand the minutiae of the process. To whit: cells have finite life spans and, regrettably, all the cell types of the human body are not renewable. Certainly skin regrows and the cells lining the intestines turnover in a matter of days. Even bone can heal itself, slower as the years accumulate but, even fractures in octogenarians close, eventually.

But, then, we of advancing years, stare into our mirrors and wonder, morning after morning, exactly who that old man is staring back at us, how did he come to take up residence in our bathroom and, most important of all, what happened to his hair? Even more curiously, why is he growing hair in such odd places like out of his ear canals, his nostrils and on his back? We quickly learn that, if one is not careful and diligent with the scissors, even our eyebrows will - spreading in old age like genetically-enhanced kudzu - begin to look like Andy Rooney’s after a short period of neglect. I ask this: If it is falling out of my scalp, why is it finding fertile ground which once was barren? Teeth crumble, knees creak their sad sounds on arising, and our vision, once so clear and sharp, fades and blurs. These are the toll that nature extracts from us for each year we are allowed to continue to draw breath.

Some never make peace with the inevitability of age. The vain seek solace under the knife of growing legions of "cosmetic surgeons" (which now surely outnumber pediatricians and GPs, which is to say, the ones actually caring for the ill) and endure all manner of pain and indignity to hold back the hands of time. All, I presume, in the furtive attempt to recapture the image of the youthful face that once started back at them from the mirror. Or, nipping here, tucking there and sucking fat from one place and injecting it (GADS!) into the derriere, they seek to fit into the dress they once slithered into before babies, osteoporosis and age wreaked their perfect size 2 frames.

Men, surely no less vain than women, go through the same medieval (ever watch Nip/Tuck?) torture. They spend thousands of dollars to replace hair where it has been lost or remove it where it has overgrown. They, like the prototypical postmenopausal female, undergo the same lid and brow lifts, "tummy tucks" and butt implants (yes, you read that last correctly). Last but surely not least, they endure the agony of liposuction to remove those unsightly "love handles". Apparently, like the Scarlet Letter, the presence of a sagging male midriff provides clear evidence to their prospective target population (i.e. women half their age), that their prime years are past .

Personally, I have several reactions to these observations. First, I am tempted to kick myself for laughing at the lone plastic surgeon (there was only one in the 1970s; there was little demand for their work other than reconstruction after trauma) when I did my rotation on his service in medical school. I could hardly hide my disbelieving smirk when he excitedly predicted: "Mark my word, Ron, plastic surgery is going to be the field for medicine in the future." I remember thinking, sure, dude, just as soon as they can find enough idiots to pay out of their own pockets for getting larger breasts or a face lift! Fat chance! Today, I write it off to the same brilliant youthful insight that told me not to buy Microsoft stock when it was first offered for, I think, a dollar a share. After all, my inner Socrates whispered, "What future do computers have anyway?"

My second reaction is an odd mix of empathy and sadness. Exactly when, historically, did enhancing the surface of the human become more important than cultivating that which is hidden from view? Certainly, I am not unaware that, in some professions, the superficial - which is to say, the external - is important. Actors, fashion models and the like are expected to cling to their

youth for as long as possible. I am sure that high-end realtors who peddle resort getaways to the rich, frivolous and the famous also have a certain job pressure to maintain a presentable exterior. Aside from these obvious examples, what, precisely, does a surgically-enhanced body bring to any other relationship, professional or casual? (I leave aside the unique "professional relationships" that involve an exchange of currency for intimate..er...ah...physical activities). If you were in a court of law, perchance, and could pick the attorney that was to represent you against a charge of murder, would you prefer a Brad Pitt look-alike or a Rudy Giuliani clone?  If you were about to undergo a heart transplant, would you prefer the John Stamos model or a 60-ish, bookish, balding man with bifocals and eyes that reflected back an assurance that he had seen all this many, many times before? Picture, for example, Fred Thompson, before senility set in.

And, yet, even in every day interactions, we are assessing the external, superficial features of all and move on to the true value of the person - i.e. what lay within - much further down the road, if at all. Even the most shallow among us will admit that a perky, taut, 20-something year old will be entertaining for a time but, when one might wish to discuss the cultural impact of Woodstock or the "good old days" when McDonald’s sold hamburgers for a dime, the exchange may bog down a bit. And don’t laugh too loud, Sparky. There will actually come a time when you will feel the need to actually communicate. Bouncing about in a bed can be entertaining, no doubt, but after a time, one does have to turn the lights on.

So, here’s to the passage of time and the ravages of aging. Wrinkles, sagging midriffs, lax eyelids and the many changes that strip away our youthful perfection are like the stripes on the sleeves of a serviceman’s uniform. They signify experience and a unique wisdom that can only come when one has seen the passage of the cyclical drama that is human civilization. Only when one has lived through the inevitable revolutions of hard times and good times, tragedy and euphoria, defeat and conquest, does one earn their stripes. You can’t earn them by reading books; they must be earned with tears, pain and heartbreak. They cannot (nor should not) be stretched out or cut away but, instead, worn with dignity and a certain pride. For they, like the chevrons of the infantryman who has survived the harshness and brutality of war, signify the time passed that makes a man not weak but wise and chastened.

Amos Bronson Alcott wrote: "To keep the heart unwrinkled, to be hopeful, kindly, cheerful, reverent that is to triumph over old age." Those are very pretty words, indeed. But to triumph over age also calls for one to become a calm realist. Which is to say, only with maturation can one know the irrefutable truth that as time passes, the tragedies and heartaches of the present fade and, though never forgotten, find their perspective and teach us their lessons. For sagaciousness is not cheap nor should it bought easily.

The wisdom of our passing miseries and fleeting triumphs bring many furrow to our face and may bend our frames but the insights and peace they cast over us is worth any cost. And how our exteriors have borne the expense only reflect how much the interior - our true selves - has been made wise and patient.

For as Cato remarked: "Old age isn’t so bad when you consider the alternative."