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week after my heart attack was Christmas Day, and I was deeply shaken as I began to take the first tentative steps back into my life. I wanted to begin the day with a slow stroll around the block, but only got to the end of the driveway. My right calf felt tight and achy and my toes were numb. I came back to the house with a grim face: “Something’s wrong.” My girlfriend rushed me back to the hospital, where I received an ultrasound on my leg and, sure enough, a dangerous blood clot was found in my femoral artery. There were multiple days of treatment with a vascular surgeon, angiograms to examine the clot, and various tubes inserted through my left groin down to my right calf. (The right groin couldn’t be used, as this was the side that they had gone up in order to place the stent in my heart.) The surgeon was unable to remove the clot, so he opted for an aggressive intravenous clot buster treatment combined with high doses of blood thinners. I was unable to eat or stand for three days. Every hour, nurses would measure the size of my calf to see if blood was flowing, and each hour I was gripped by terror that the clot was getting larger or the pulse in my right foot was getting weaker. Each night was a din of buzzers, beeps, blood tests, and vital sign checks. I slept in fits and starts.

I was finally released from intensive care after the clot buster medication had done its work, and I was able to move to my own hospital room for observation. The diagnosis was that a clot in my heart had been discharged during the heart attack, and that I would need to be on a battery of blood thinners to prevent future clots from forming. On the second night of observation, an alarm and flashing red light erupted from the heart monitor that hung on the wall; it signalled a thirty-second burst of ventricular tachycardia. The next morning my cardiologist warned me that I had experienced a potentially deadly arrhythmia, which made me vulnerable to what he called “sudden cardiac death.” The solution was to wear a portable heart defibrillator (or “life vest”) for the next few months, as the clot dissolved, and then decide whether or not to implant an electronic defibrillator in my chest.

The combined effect of these events left me shattered. I was only forty-eight years old but suddenly felt old and frail. Ordinary tasks such as walking up the stairs or getting out of the car left me exhausted and out of breath. My future, once open and expansive with possibilities, had collapsed. And the interpretation I had of myself as a healthy and energetic college professor fell to pieces. I felt trapped in a meaningless present, left to the moment-to-moment rituals of taking medication, checking my blood pressure and pulse, and arranging the next doctor visit. I was suddenly forced to confront the existential questions I had spent so many years teaching and writing about, “Who am I?” and “What is the meaning of my life?” Indeed, the ideas of existentialism, that distinctive brand of European philosophy that exploded on the scene in mid-twentieth-century France, became an obsession for me as I convalesced at home, frightened and vulnerable. Its focus on the flesh-and-blood experiences of the individual, its emphasis on being authentic and honest about our condition, and its engagement with the ultimate questions of human existence, of the meaning of life and death, were more pressing and vital to me than ever. And I began to see the ideas of existentialism being played out in real life in my biweekly sessions of cardiac rehab.

Here nurses would put a group of heart attack survivors on treadmills and rowing machines and gently encourage us to exercise for thirty minutes while carefully monitoring our heart rate and blood pressure. I was at least twenty years younger than anyone else in the room, and over the course of these sessions I began to talk with and learn from my elders. What struck me initially was how differently they seemed to interpret the experience of their failing bodies. Whereas I was gripped by dread and was hypervigilant about every skipped heartbeat and flashing pain in my chest, they appeared far less shaken. They spoke of the importance of not worrying about things you can’t control, about letting go and taking pleasure in little things. There was an elderly woman, Beverly, who appeared to sense my distress. She sat next to me at the end of one of my final sessions and said: “As you get older, Kevin, these kinds of things just get easier to accept. I can’t explain it.” Her words were strange, but they comforted me. Here, in a cardiac rehab clinic, I seemed to be surrounded by folks who already embodied a kind of existential wisdom. Whereas I was riddled with despair, they seemed clear-sighted about their condition, talked openly about their physical pain and losses, and appeared calmer and more sanguine in the face of mortality. Their weakened and frail bodies reminded me of death, but their attitudes seemed freer to me, more life-affirming. I began to think that maybe there was something about growing old that can make us more honest and accepting about who we are, something that can help us place our everyday worries in a proper perspective, and that maybe we become more like the existentialists as we get older.

As I began to do more research on the wisdom that comes with growing old, this suspicion grew stronger. A key moment occurred when I happened across a remarkable series of articles in the New York Times by journalist John Leland, who had spent a year closely documenting the lives of six ordinary New Yorkers from diverse backgrounds who were all members of the “oldest old,” that is, eighty-five years and up. Leland’s series was later published as a book, titled Happiness Is a Choice You Make: Lessons from a Year among the Oldest Old, and in its pages the reader is introduced to elders who struggled with painful illnesses, loss, and bodily diminishment but who nonetheless lived with a marked sense of purpose and joy. Like Beverly, who consoled me at cardiac rehab, these elders weren’t dwelling on their losses or missed opportunities, nor were they overly anxious about the nearness of their own death. Indeed, they all seemed to shatter the ageist stereotypes I had grown accustomed to. Fred, for example, an eighty-seven-year-old African American and World War II veteran with debilitating heart disease whom Leland became especially fond of in the course of his research, accepted his bodily limitations and the proximity of death with a kind of ease and lightness. He embraced his age and savored each moment as it came with a clear knowledge that his time was short. Leland was struck by how Fred didn’t look backward with regret or forward with anticipation. He existed in the present. When he asked when the happiest period of his life was, Fred replied without hesitation, “Right now.”¹ Fred was what the German philosopher Friedrich Nietzsche would have called a “yes-sayer,” someone who embraces and affirms life as a whole, and all the gifts and losses and delights and pains that come with it. Fred wasn’t overly depressed and wallowing in the loss of his physical strength, his mental sharpness, or his friends and lovers. He embodied the Nietzschean principle of amor fati: he loved his fate and was overflowing with life right up until the end.²

To those already familiar with existentialism, it might seem odd to apply this particular brand of philosophy to the phenomenon of aging. We tend to associate “the existentialist” with the commitments of youth, of doing rather than being, of embracing freedom and rebellion against bourgeois conformism, moral absolutes, and metaphysical security. This figure is often viewed as the embodiment of vitality, courage, and agency, qualities that emerge in the heroic archetype of what the French existentialist Albert Camus branded “the rebel” (l’homme révolté). The rebel is the incarnation of “unbounded freedom,” someone who is “born of abundance and fullness of spirit” and actively embraces “all that is problematic and strange in our existence.”³ Wearing his signature black sweater and black pants and perhaps smoking a Gauloise cigarette in a Parisian café, he presents a dashing figure, passionate, creative, and wholly engaged in the world. It’s no surprise, then, that the weaknesses and vulnerabilities of old age are rarely discussed. Indeed, the only major figure who seriously explores the issue of aging is the French philosopher Simone de Beauvoir, in her work The Coming of Age—a massive tome that paints an especially bleak picture of older persons as beings scorned by society, trapped in their bodies, and largely stripped of any kind of meaningful agency. But existentialism is not just a philosophy for the young and healthy. Indeed, the core aim of this short book is to show that existentialism is perhaps most applicable to our later years, as we struggle with illness, physical limitations, the stigmas of our ageist society, and the imminence of death. In fact the true rebel may well be the octogenarian in a wheelchair or a nursing home, not the twenty-year-old nihilist who is drawn to the radical ideas of existentialism but has not yet had to confront the painful realities of life. As the German language poet Rainer Maria Rilke said, the twenty-year-old may grasp the existential questions intellectually, but without the nearness of death