“I’m not your Typical White House Doctor”

In AGEIST’s journey to better understand a redefined later life, there are very few people as qualified to talk on the topic as Dr. Connie Mariano.

As the personal physician to two US Presidents, and the first Filipino doctor to hold the post, she has been at the vanguard of developing strategies to living a longer and healthier life. Now, as a 61-year-old in private practice (and with a book entitled My 11 Presidential Secrets to Longevity in the works), I sat down with her to understand which of the learnings she applies to to her own life and find out why so many ex-Presidents seem to live so damn long.

Dr. Connie Mariano: David, I’ve heard so many nice things about you.

David Harry Stewart for AGEIST: Thanks! I’ve spent a couple of days reading your book [The White House Doctor] so I feel I know more about you than you do about me. The book was fantastic, an amazing story. From your father being a steward to you becoming a Rear Admiral and White House Medical Director—the personal doc for George H.W. Bush and Bill Clinton. Wow. What really comes through is how you know yourself and what you were capable of.  I love this “Semper Gumby.” What is that about?

CM: The motto that the Marines use is “Semper Fidelis.” Semper is “always”, fidelis [loyal]. And in my medical school we said, “Semper…Gumby.” Remember, when we were growing up, they had Gumby, that little green little funny thing that you bend, it is flexible?

AGEIST: Yes.

CM: We use a motto, “Semper Gumby” [meaning] always, always flexible. (chuckles). You always have to be flexible.

AGEIST: Now that you have moved on to a second career, a whole second life, that must really come in handy.

CM: Absolutely. I tell people that when I do my calendar… I put birthdays in pen and everything else is in pencil.

AGEIST: What are you working on now, in addition to your executive medical practice?

CM: I’m working on writing my next book… on longevity, and how I see that in presidents, and how I look at the news on how people are living longer. They said, “In order to have a good life you have to have three things: you have to have something to do, someone to love, something to look forward to.” It’s simple as that. And it’s the “looking forward to” that makes it important because … If you are always looking forward to the next day, you’re going to be around, you’re motivated to stay here, you’re also motivated in taking care of yourself.

I am in Scottsdale where, it’s almost Beverly Hills. I argue with my patients, “How are you going to lose weight?” You show them the numbers of cholesterol— that’s not going make them lose weight. What’s going to make them lose weight is that their daughter’s getting married and they are going to wind up seeing the ex-wife.

AGEIST: Love that.

CM: I have a motto of “too vain to gain.” Like, “dude you know, I want to be a size two and I want to look young and leave my hair long.” And it’s almost, “raging against aging.” I use that expression because they’re not going to go kicking and screaming. They say, “I have the money to pay to look young and to feel young and to feel good.” They do lots of things to stay and feel wild and young. They refuse to be old.

AGEIST: Extraordinary. And in our lifetime—I mean, you especially, as a physician you must see it —how 20 years ago, 60 was old.  Now people are living these amazing lives in their 50s, 60s, 70s. They are expecting to live so much longer and so much healthier at that age. How does that affect how people behave?

CM: I became a grandma this year and there’s no way I’m “grandma.” They call us “glama” more like “glamorous.” We don’t look like grandma. We refuse to be old. We are breaking stereotypes. We really are, our generation. We’re not going to live like old people.

I remarried 5 years ago. I was married for 29 years and when I turned 50 I realized that I didn’t want to spend the next 30 years in a marriage that was unhappy. I was wanting to be single. I had a practice that would keep me busy full time, my kids were in college, I had wonderful women friends. I wasn’t going to get remarried until one of my [divorced] patients, who I’d known for 5 years prior, found out that I was going to divorce and said, “Marry me?” And I said, “Are you kidding me?” So, I had him leave my practice and I dated him. We got married 5 years ago and he’s lost about 40 pounds. He works out; he looks younger than ever. He’s 59, I’m 60. We’re just so happy. We count our blessings every day that we can enjoy good health and our adventure and our life. Now he’s retired. He flies airplanes and we’re just, we’re blessed to have our love in our relationship, and just the things that you would expect in a youthful relationship, we have it. And being old doesn’t deny you that. We’ve had lots of birthdays, sure, but whatever.

AGEIST: Tell me about “old” and what that word means to you.

CM: We don’t consider ourselves old in the least. It’s really a mindset…you don’t accept that stereotype. You know, all my life, David, I’ve never set a stereotype. I’m not the stereotypical White House doctor. So if those don’t apply, why should the aging part apply, right?

There is an old saying that we have engraved on our wall in our home in Colorado: “It’s never too late to live happily ever after.” Never too late. When I bought my wedding gown 5 years ago in LA, I asked the lady, “How old was your oldest bride?” and she said, “My oldest bride was about 75 and she had to call her mother who was 96 to ask her about the dress, to tell her about the dress.”

AGEIST: What do you think separates the people who have this attitude from the people out there who don’t?

CM: I think number one, it’s having the positive attitude towards life. Without that, you cannot accomplish the other things. The other thing you have to believe is that you have a calling in this life, that your life is significant, you’re not here by accident. That there is a reason you’re here, in your way to touch people around you to make things a difference. And the way I think about it, the book that I am writing [titled] My 11 Presidential Secrets to Longevity, one of the secrets is the pulpit. Presidents, they live more. Even though they look crappy in office after 8 years, they outlive everyone. George Senior is 91, although he has Parkinson’s and then Jimmy Carter got brain disease but is 91 and his whole attitude is of adventure, right? “I’m looking forward to the next adventure.” But [the role of the] pulpit is, they are valued, they really had the purpose in life to lead and guide this country. Each of them believe that they have a reason to be here and that they are spokesman, that they are useful.

AGEIST: Yes, working is living if it’s work you love.

CM: And find your purpose, and also have partners. I want to still be part of that dance where you have a partner who loves you and you have a family that loves you and you don’t want to leave yet. It’s not time to die. My patients give up when they think, “I am only in the way of my kids.” That’s when they die. They think, “I don’t have a reason to be here.” That’s when they die. And I have patients who are CEOs and still running companies in their 70s. They are not going to give up. They are the founders of the company; they are not turning it over to their kids. They are vital: “I don’t have time to die, I am too busy to die.”

AGEIST: I love that. It seems to me some of what you’re speaking about has to do with— these people all have a certain curiosity. You mentioned in your email that you were writing something about women over 60. What’s that about?

CM: That was a chapter in a book [by] Dr. Joyce Knudson, a Ph.D. in Psychology. I write a chapter about rejecting stereotypes. It talked about how we approach aging, and I really came from the message that I have always rejected stereotypes so I would do that as well when it came to aging.

AGEIST: Ah yes. I mean why stop pushing on the expected. Right? You were the first Rear Admiral of Filipino descent, first woman White House Medical Director; I can’t imagine you doing anything other than living the life you want to.

Even so, It’s very interesting that you talk a lot in your book about how you felt like you were never quite…

CM: Good Enough.

AGEIST: But you made yourself not just good enough but you made yourself better than everyone.

CM: But you know a part of this is that you’re just competing with yourself. You grow up in a family that says, “Don’t be big on yourself, you’re just got to be humble.” But part of it is, I always believed that I can be an example to somebody else and give them a hope. And it is not about me being great, it’s me being an example to somebody else to give them a message that they needed to hear, that: “You’re not old,” that, “You’ve got years ahead and it is not too late to look better. You don’t have to look 20 but you can look a really good 60 years old.” I have been vain enough to train myself not to read the menu with reading glasses because automatically makes you feel older.

AGEIST: So you clearly don’t feel 60. How old do you feel?

CM: Probably in my 30s— without having anymore periods, which is nice. Probably 30.

AGEIST: Tell me a bit about this investigation you are doing into longevity. You mentioned The Blue Zones. What are your findings on longevity that really interest you?

CM: You know, I based it on my experience with presidents. I read The Blue Zones. I think that it’s fantastic. I loved studying what makes those civilizations, those cultures live until they’re a hundred. But the thing is, I don’t live in Loma Linda, I don’t live in Costa Rica, I do not live in any of the Blue Zones. But what it is about them that I can remind my patients every day? And what I have done is looked at how presidents lived, having known 3 of them. Even after they left office…the presidential perk is you outlive your constituency. And I call them “The Eleven”—which I won’t reveal, because I will put them in the book—but it is also looking at the longevity…they are physically active, they are always moving, none of them are obese and really it’s a mindset that they truly believe they have a calling in this life.

AGEIST: What I am hearing you say is, really the defining variable is this idea of having a purpose. People talk about diet and exercise and courage and curiosity, but what I am hearing you say is that it really comes down to the purpose. This sense of purpose is what drives the rest of it.

CM: Exactly: “Why I am going to look at that if I don’t have any reason to be here?” I took tennis lessons way up in Colorado. My instructor is 70. He just won a tournament. He is running around at [high] altitude, slamming tennis balls and he is 70 years old. At 70 people say, “Wow… a senior citizen.” One of my oldest patients is 91 and he plays doubles tennis.

AGEIST: If someone is our age and they have this expectation that they think they are going to live much longer, they then tend to live much longer. What are they doing?

CM: Number 1, they don’t do risky things, but they also are pro-active. They don’t wait for things to happen to “get fixed.” They come in for their annual physicals, their colonoscopies, they get their prostate checked. They make sure they avoid the preventable things that fall on people. They listen to their bodies…they are religious about working out. They want to look young, they also want to look younger than what they are.

AGEIST: So people manage physical risk, but what about other sorts of things people may think would be risky?

CM: Yeah they will take a business risk. They realize, “Do I want to do the same thing I am not happy with? Do I really want to do it for next 30 years?” It’s like a bad marriage. “Do I really want to be stuck? So I will make a leap of faith.” Part of it is hope. Hope that it’s going to be better than what I have experienced. The other is taking the risk knowing that you also have financial stability…that is when they do the encore careers.

AGEIST: Right.

CM: What are you going to do? If you won the lottery today, let’s say you won 180 million, what would you do? How would your life change? Get more stuff? Not really. What are you going to do?

AGEIST: And how do people approach that question of essentially reimagining, reinventing. How do they do that?

CM: They look at what brings them joy, because instead of the things they had to do like a career to support their family, it’s what they want to. They go from have to, to want to. You know if money wasn’t the issue, what you would be doing tomorrow. For me, I will love doing what I do. If I had [won the] lottery and hired another doctor on this practice and make visits periodically to see the patients, I would be writing. I’d be writing full time because I like doing that, and speaking. Writing and speaking, because those bring joy. And doing my radio show, that I like doing. I will be doing that.

AGEIST: We talked a lot about people not wanting to age. “Raging against aging” I think is what you said.  You think society as a whole perceives people who are older…

CM: It’s all the unglamorous things that Hollywood does, it’s all the marketing. Aging has gotten a bad rep. It is almost equivalent to being useless.

AGEIST: Right.

CM: But I look at my dad, he is 91, he is retired military guy, retired post office, and he lives in the same house he lived in 1970. My brother lives with him. My dad doesn’t drive…he walks one to two and half mile every other day. He gets up every day and works on the garden. [If] you put him in a nursing home and he couldn’t take care of the garden, couldn’t make sweet tea, he will die. I am certain of it. He works on his garden every day, he has a project every day. That mentality— he always worked hard all his life. My patients to whom things have been given are really the losers, because they don’t have the “can do.” They have never struggled. For my patients who have always been sort of the feisty ones, they have always fought for things all their life, they have always struggled, they have always worked hard, they have not been lazy, and nothing has been given to them.

AGEIST: So you said, maybe society thinks that old is useless, then we have this group of people who are really determined to stay purposeful and significant. If there is all this messaging coming at us, that we at a certain age should be useless, we need to be able to fight against this. I thought that was really interesting about the people who were given things early on, they are the ones having problems because they are not ready to resist and make their own way.

CM: No, because all was given and there is no reason to work for anything. Right?

AGEIST: And perhaps the fight now is this fight; it’s actually the same fight that you had when you were younger, the fight of the internal message or the internal truth versus the external messages coming in.

CM: Yes it is interesting for you to do an article of every person over 60, over 70, who still works full-time. What they do? You know many people are still employed, I mean look at the presidents. Potentially you may have a president who is 68 years old. (laughs) I mean look at who you got running for office. None of them are 40 or 50. They are all older, they are in the 60s. So look at these people, how old they are. Look at world leaders, how old are world leaders.

AGEIST: Right.

CM: Look at Warren Buffett.  Look at all the billionaires, guys on Wall Street who run companies.  How old are the big ones who run companies? You know the companies that don’t have the restriction on age and you can be here as long as you want. I mean the guy who handles my finances at Morgan Stanley is 60. I ask him, “How long do you want to work?” He said, “Until I die.” Until as long as your brain works, you know. He does what he loves.

AGEIST:  These people have real sense of agency in the world.

CM: Yeah, Yeah. You can’t wait. We need you.

AGEIST: Right.

CM: You essentially become ageless. You know when you look at age you are ageless. At that point it does not matter how old you are if your brain still works. You are still able to get around. I mean, if you are still able to function, you have a purpose. Does it really matter how old you are after a while? No, in Hollywood it does because they look at how you look, they worship what looks like youthfulness, but again you are having actors like Meryl Streep who is what, in her 60s, Helen Mirren, who are still very very good actors. Still they have not given up.

AGEIST: One of the things I read was Madonna who gave a rant about ageism —she and I are the same age —and how her feeling was that racism is kind of out of the window now along with sexism, sexual orientation, and all that is left is …

CM: Ageism: “They are picking on me because I am old.”

AGEIST: Right, exactly. That’s the last thing you can make fun of somebody for. How do you feel about that?

CM: Yeah I agree, it’s the last thing. You know, when someone says “old person” you think of somebody in a walker who’s got a Cassidy or a diaper.

AGEIST: Right.

CM: Look at the rockstars. One of my patients is the doctor of the Rolling Stones. Look how old Mick Jagger is. On stage they dance around, they have incredible energy. They smoked, they have young wives and children. But they are out there, and they have tremendous aerobic capacity because they are out there bouncing around entertaining.  I mean, they are working.

But they are still vital. I mean, so the point is, does it matter? Since I would say if someone dies at 60 or 65, that is not old. 70 is young. 80 I called “the glide”; we fly a lot so, “final glide slope.” Getting up to 80 can go very smooth and then from 80 to 90 can be an acute drop or very smooth. Depends on what you can do to lessen the trajectory and how severe that angle is to 90. How you can minimize that is by being slender, being active, being purposeful. Part of it is access to good care, making sure you are get checkups. You know, listen to your body…have a doctor who listens to you.

AGEIST: How do you feel about people doing hormone replacement?

CM: I do it. Oh I do. I think it is important. My own story– yeah, I started doing [testosterone] pellets and estrogen. I absolutely do. I mean, you look at the risk versus the benefit, and the whole thing with the women’s health care initiative that came up 10 years ago. They reversed the lot of the risk factor. I mean what you have to do, is talk to your doctor individually, one on one. Meet with your doctor, look at your risk factors for cancer. It’s not been proven that hormones cause cancer. What they do is, if you have breast or prostate cancer, they make the cancer grow faster. But they don’t cause it.

AGEIST: Right.

CM: But what I noticed from my experience and my patients, is that women that go into menopause, the brain fog, the feeling old, the waking due to lack of hormones; body is dying. So if you have the technology to slow that down by replacing hormones, why not do it? People will go, “Why would you do that? That is not natural.” What about antibiotics? We use antibiotics a lot. That is not natural. So why? I mean, you have the technology and we keep an eye on our patients, we monitor them, make sure we do no harm. They feel great, their minds are active. We think it gives them more time, so be it. The quality of life is so much better.

AGEIST: Right. Absolutely. I am glad. I am glad to hear you say that. I think a lot of people take an almost religious approach to this, which does not make a lot of sense to me. And as you said, antibiotics aren’t really natural so… (laughs)

CM: I mean, God, there is a lot of stuff.  I mean, my gosh, why not?