I recently read a Malcolm Gladwell piece in the New Yorker about Alberto Salazar. It has to be one of Gladwell’s finest essays—more elegant than usual, more poignant. Salazar, the famous distance runner, tolerated incredible physical discomfort in his quest to be the best. Now he excels at coaching. In 2007, Salazar suffered a massive heart attack, sudden death, and was brought back to life. He returned to work nine days later. The story seems nothing short of miraculous. A few nights ago I watched two of his protégés take the gold and silver medals in the 10,000 meter race at the Olympics. The camera showed a smiling Salazar mouth the words “I coach him!” about the gold medalist, Mo Farah. You have to admire that kind of dedication to running, the ability to run through pain and uncertainty, the competitive spirit that enables them to run marathons and race at the world level.Perhaps it was timing, perhaps it was seeing Salazar, alive and well, smiling and feeling triumphant, but even I felt motivated! Not to run 10,000 meters or a marathon, mind you. My goal is somewhat less exalted. It is called Couch to 5-K.In the past year, managing anxiety has become a constant struggle for me. It was a problem before—during my mother's long battle with dementia-but I thought I’d conquered it. For some reason it is back with a vengeance.I blamed the book. The year between selling it and publishing it took its toll on me. I worried constantly that people would judge me, that baring my soul would come back to haunt me. But the opposite occurred. People opened up, happy that I had shared my story. They were glad to have found someone with experiences similar to their own—a compassionate mate. I’ve received letters, emails, notes—all saying thank you. So the book coming to fruition was a blessing in more ways than I can count.Once the book was published and the letters started to arrive, I thought I would finally relax. Instead, I am not relaxing. I have mood swings and worsening anxiety.I have exercised to control mild anxiety most of my life. I have biked, done aerobics, taken brisk walks, all in an effort to keep my breathing normal and the unnamed demons at bay. But the usual tricks don’t seem to be working anymore. Bulging disks in my neck keep me off the bike, for the most part, and I’m too tired from working to get myself to the health club. I’ve worked through the most pressing issues with my therapist, so this resurgence of breathlessness comes as a bit of a surprise. But I can no longer deny its presence.All in all, things are good. My life is where I want it to be, within reason. My kids are doing well. I have a horrible job, but who doesn’t? I have my little weekend retreat. What the hell is the matter with me?My AHA moment came when I Googled menopause and anxiety.It was all there, in black and white. All my symptoms. In a website about menopause. It mentioned mood swings. Hmm. And anxiety. The website reinforced what I’d been loath to suspect: there may be a hormonal reason for my state of mind. And a few relatively straightforward ways to deal with it: mind the caffeine, exercise religiously, meditate, dump the baggage, try yoga, and so on and so forth.Hormones were to blame. Just as hormones have been to blame for many of life’s ills, for centuries.My daughter Liz told me about a two-month interval-training program cleverly entitled “Couch to 5-K”. I looked it up online. You can download the original version, in which a lovely British voice tells you when to walk and run. Or you can wear a watch with a second hand and just do it yourself while listening to music. I prefer the second option. But I haven’t run in years. Not since I had two ACL reconstructions, one on each knee.I don’t plan to run any real distance, mind you. I’m just trying to get off the couch and take a deep breath.Will I ever run a 5-K? Hard to say. I’ve done the first few days of the program. I’m alive. My knees still work. And I managed a couple of deep breaths today. And while I really hate to blame my hormones for anything, they do tend to control us more than we like. Life is a constant series of trade-offs, e.g. sore knees vs. shortness of breath and a sense of impending doom.I will never run like Alberto, but I understand what it’s like to be down and come back to life. I’ve done it before. If it takes sore knees, then so be it. I’m packin’ Aleve.

Nora Ephron’s recent passing was a sad day for our household, as it was for America. I was working when Jocelyn called to say she had read the news online—we were both stunned that this woman, a heroine and role model, a favorite writer and filmmaker, could be taken from us at such a young age. The next day, Jocelyn found a quote in the Times from Ephron’s commencement address to her alma mater, Wellesley, in 1996.“Maybe young women don’t wonder whether they can have it all any longer, but in case any of you are wondering, of course you can have it all. What are you going to do? Everything, is my guess. It will be a little messy, but embrace the mess. It will be complicated, but rejoice in the complications. It will not be anything like what you think it will be like, but surprises are good for you. And don’t be frightened: you can always change your mind. I know: I’ve had four careers and three husbands.”Jocelyn put the clip on the refrigerator door, where we collect quotes and New Yorker cartoons and bon mots to supplement our daily nutrition.After Anne-Marie Slaughter’s essay in the recent Atlantic, in which she explains why she gave up after trying to “have it all”, the question is very much on my mind. I think it is on the minds of many women, young and not-so-young.Perhaps the answer depends on the type of mother you want to be, and the type of children you are trying to raise. Perhaps it depends on what “having it all” means to you and how you want it look to others.I look back on the years when my kids were young and there is no denying that they were difficult for all three of us. I had one daughter while I was in medical school and another during my third year of residency. I took three months off with the first and six weeks with the second. I had live-in childcare from the very beginning, which was always the biggest source of stress in my life. Would the babysitter show up? Plan B invariably involved my mom, my mother-in-law, my sisters, or one of my close girlfriends. I utilized all of them at one point or another. By and large, the eighties, as a decade, were lost to me. I never heard of The Talking Heads, the Police, knew vaguely of Michael Jackson’s Thriller, and missed pretty much every important cultural event from 1982 until 1989, when I passed my oral boards. I remember buying my first Sting CD in 1990. I roller-bladed in the house to his music.I have tried to remember when I first read Heartburn, and I can’t because I’ve read it so many times. Nora was one of the reasons I wrote Good in a Crisis. I remember thinking, if this funny, hardworking, single parent can write a book about leaving her husband, so can I. Our experiences were different, of course, as were our books, but there is no doubt that she inspired me. During the pre-publication process, we had hoped to get a blurb from her, but Nora didn’t blurb. She blogged. And we weren’t able to get her attention. I studied her author’s video before I created my own.But in Nora’s memory, I find myself trying to devise my own commencement address. What would I say to young women about “having it all”? I guess I would say this:1. Marry a good man. Not having one makes everything much harder.2. You only get one crack at life. Either live it or don’t. If you want to have a great job or make art or write or see the world or have kids or all of the above, do it all. And have as much fun as possible. When it’s not fun, move on to something else. Life is about balance. You will make mistakes. Learn from them.3. You don’t have to plan everything. Actually, you can’t plan everything. Part of having life skills is being able to handle whatever comes next. And as a parent, you want to teach those skills to your kids.4. There are times when you make hard choices, kids over career, career over family. Feeling pulled in two directions is not the end of the world. Jocelyn still chides me for not breastfeeding her. Get over it, I tell her.5. As Nora said, Don’t expect it to be easy. But then again, don’t expect LIFE to be easy. Don’t expect KIDS to be easy. If a career is to be rewarding, don’t expect THAT to be easy. It will all be messy. Along the way your children will learn about messes and learn how to handle them by your example. What more valuable lesson can you give them?

A friend recently told me that a woman had broken his heart. He is a divorced man, middle-aged, a grown-up. He met this woman the old-fashioned way, through a mutual acquaintance and not through an Internet dating site. She was nearly but not quite divorced. They had both suffered through long, loveless marriages.He told me the story in a meticulous, measured fashion, careful not to leave out any details. He told me the story in a chronological fashion. It seemed to me that he had memorized every detail of their relationship, every word she had ever uttered.Before he began his story, I asked how long they had been together.He said, five weeks.I felt doubtful that a brief relationship could generate such heartache, such devastation. And yet, as he spoke, I realized that he was indeed devastated. He had attached himself to this woman with a fierce ardor born of many years without passion. I listened to him quietly until the pattern of his story revealed itself. I listened patiently until I understood what had happened.I understood because she was me ten years ago and I was him four years ago. And after twenty years of therapy it is easy to recognize patterns of behavior in people.My friend wanted reassurance that his love would see his value, come back to him, that they would be together again.And because I had been, at various points in my life, both him and her, I gently told him he should not wait. He should move on. The odds are not good that she will ever want someone who treats her as well as he treated her. She was used to someone less kind, more hands off. His kindness smothered her, terrified her. Love itself caused her to run. Unless she received therapy, she would not change. He doubted she would.I told him what I tell my daughters. Don’t fall in love with someone’s potential. Fall in love with the person you see before you day after day. But don’t expect change. It is easy to fall for the one you think they can be.I told him that his mistake was in falling too quickly, in not really knowing her before he gave her his heart. The signs were all there in the facts of her life. He chose to ignore them. After two and a half hours during which he benefitted from my twenty years of psychotherapy, albeit in a highly condensed form, he thanked me profusely. He said I helped him.Speaking with my friend about his loss made me think about how love can enter your life suddenly and without warning. But it doesn’t mean that you’re ready for it. Timing is everything in life.I felt sad for him, jealous, and a little superior. I felt sad that he was hurting, jealous of the intensity of what he experienced, and superior because I am years past those emotions through oodles of therapy and painful hard work.But it begs the question: Is love worth it? Is it worth the potential heartache, jealousy, anguish? I would answer that with a resounding...maybe? If everything is a matter of timing and luck, plus navigating your own past as well as the emotional baggage that most people carry with them, it does seem a wonder that couples over forty-five ever get together.And yet, the amazing thing is that it can and does happen. So I guess the answer is yes, love is worth it, when you're lucky. But the process is never painless.

In the three months since my sweet dog Olga passed, I’ve gone through the usual and expected process of grieving. I miss her presence on the hallway carpet near my front door when I arrive home from work at night. My trips into the kitchen in the dark used to be cautious excursions in which I stayed close to the walls to avoid stepping on her; now I walk more carelessly as I know she isn’t there. I miss our slow forays to the park in the evenings. The house seems cleaner but more sterile without her. Quieter. Empty despite all the people. I kept her collar and bowls out until my daughters decided they needed to be put away, for my sake.Olga was an exquisite animal. She walked only on your left. She didn’t jump on people or sniff crotches. She never got up on the furniture. She didn’t bark or bite. She leaned. She sometimes sat on my feet and stretched her head straight up so that I’d rub her neck. When I sat at my desk, she put her nose beneath my elbow to lift my arm for a pet. She loved to swim, but loved holding still and hiding under a towel even more.Now as I walk in my neighborhood I miss the old camaraderie of dog ownership. I stop and pet other people’s dogs much in the way that other people once stopped for Olga. Our dog walker Will was a sweet and popular man. He let himself into my apartment every morning at 5:30 to take Olga for her first walk of the day. When I had houseguests I had to remind myself to inform them that a 6’5” African American man with dreadlocks and a British accent would come in early for Olga, not to worry. He came back in the afternoons, fed Olga lunch, and walked her again. She stayed at his house when I had to go out of town.I decided not to get another dog after Miss O died. I work too much, long hours, and had grown dependent on my kids’ help. I think living in a condo in the city is hard on a dog as well as being expensive for a dog owner. And it’s not as though you can just replace a pet that has been an important part of your life for over fifteen years.But Sunday I met Athena.She is a smallish boxer, a rescue dog that belongs to my nephew Jack and his wife Katie. They came to stay with me for the holiday weekend. Then they went off with Liz to the beach and someone’s house for a party. Athena and I stayed home. We took a nap. She got into my bed with me. She doesn’t snore. She woke me up when she wanted dinner. So we ate dinner together. We read the newspaper on the porch. Or rather I read the paper while she took a nap on the sofa. And now she’s sleeping beside me while I type. I think she’s a little large for a lap dog, but she doesn’t seem to know it. Over the course of the day I realized I could love again. I still miss Olga the Magnificent. But it turns out there is room in my heart for another dog. My heart just needed to be pried open a bit.

People always ask me what I am reading these days. They want to know if I am up on the latest fiction, the latest book club novel, the most recent New York Times bestseller. I answer vaguely about being busy, reading the paper, mention a few favored periodicals. I do not tell them the truth. I read obsessively about death.I also read about dying. I include the fear of dying. I read about the economics of health care as it relates to the last six months of life. I’m interested in hospice and palliative care. I’m particularly interested in the plethora of books and articles being written now by people my age and older that reflect their fear of death, either through observations of their parents’ aging, or death, or meditations on their own. Illness has always been a ripe subject for writers. The inevitability of death, the fear of death, the question of an afterlife, the nature of suffering, the question of surrender vs. control, these are all topics that thinkers have pondered for centuries. Only now it seems worse because life isn’t ending as it used to, with a brief illness or some short period of suffering. Life isn’t ending at all; life is petering away in an interminable decline more often than not. That awareness has come to the fore of the collective imagination. It is an ugly thing to watch.A couple of years ago The New Yorker published a terrific cartoon. It showed a couple sitting at their kitchen table going over a ledger. The caption read: “If we take a late retirement and an early death, we’ll just squeak by.” Or something to that effect. But the point is that we can’t afford our long lives, and the government can’t afford our long lives, and everyone thinks they want to live longer. But I would argue with that. I guess that’s why I read about it so much. It’s research for the next book, it’s partly obsession, and it’s my work. I spend a lot of my time taking care of patients who have outlived their bodies or their minds.I work with surgeons who happily replace body parts on elderly patients who are never the same afterwards, who will never be able to do the rehab required. They don’t think twice. I don’t know what they tell themselves to justify the surgery. If I ask, they don’t respond well to the question. Maybe it’s a matter of denial. I used to think that the difference between those who like old people and those who are intensely uncomfortable around them is simple: You can handle being around old people under one condition only, and that is if you see yourself in their shoes someday. But now I see more subtlety at work, especially in the medical field.I had friends and family members who visited my mom and I was struck by the way some infantilized her. I see the same behavior in the hospital all the time—treating the elderly as not quite human, calling them “dear”. I wonder at the people who do this: do they think old age will never happen to them? Old people can make us very uncomfortable because they force us to face our future. I had a lot of trouble with it myself when my mom’s dementia grew worse. I went dutifully to visit and stayed as long as I could stand it. At the same time, I knew that my visits were the best part of her day. But I was looking down the nose of a cannon.So that’s what I'm reading these days.