Mr. Katz sat on the edge of his chair in my clinic room, teetering as if he might fall at any moment. He was 86-years-old, and his thin body had become weak and tired. But his angry eyes, like a petulant child, stared at me.

“Doc, you should have just let me die,” he said to break the ice.

I had just discharged Mr. Katz earlier in the week from the hospital. His stay in the hospital was one complication after another. His final list of problems when I sent him home was a page long. He had developed blood clots in his lungs, and the strain from those caused heart failure and subsequently, excess fluid in his lungs. Those setbacks caused him to get weaker and weaker. When I finally was able to send him home, he needed a walker and oxygen. He had gone from tending to his acre sized garden one day to having his wife follow behind him with his oxygen tank. His eyes and mannerisms told the story of a man beaten and down.

Caught off guard, I tried not to look too surprised and said, “Well Mr. Katz, You’ve been through a lot. I’m so sorry you’re so frustrated.”

Mr. Katz chose his words slowly, “Dr. Mashaw, I used to have a one acre garden. Not 6 months ago I went on a trip up to Maine with my wife. Now I’m not even able to walk to my bathroom without getting short of breath.”

He went on hesitantly, “Yesterday an old friend of mine had invited me to go visit them at their cabin in Tennessee. I sat there holding the phone and cried. You see, I don’t think I’ll ever be strong enough to travel again.”

The problem when we get older is that we don’t rebound as well. When an elder can’t rebound from one illness and develops another, and another, then sadly sometimes they just spiral towards death. Like a leaf floating towards a raging rapids. There are a million factors that can determine whether an elder can rebound from an illness or not. In geriatrics we sometimes use the term “frailty.” There is a lot of research done to see why one person is able to rebound from a disease and another isn’t. But in the end many times there are those intangibles that you just can’t measure.

“Mr. Katz, you’re standing at a doorway,” I said with confidence. “You have been knocked down and I can tell you feel like you don’t see the light at the end of the tunnel. But I promise you, you can get better from all of the problems that have happened when you were in the hospital.”

My words seemed to overwhelm him. He had a look of confusion, like an exhausted mountain climber looking at another half of a mountain to get over.

“Listen,” I began as honestly as I could, “I’m not the best person to tell you this, because its even hard for me, but you just have to take things one at a time. You have recovered from the worst of it, your body is weak as a kitten right now. If you could just focus on getting stronger, everything else will follow.”

Mr. Katz’s demeanor changed from one of skeptical to a glimmer of trust. His eyes followed me as if they’d found new purpose.

As a geriatrician, physical therapy is one of the best tools to improve my patients endurance and strength. I was able to convince Mr. Katz to start physical therapy. He seemed to get up out of his chair that day with something new to accomplish. We agreed that he would try to do his best with physical therapy so that he could feel strong enough to visit his friend in Tennessee.

During my lunch break every day I go over to the gym and jog. It is the same gym that the physical therapists use to work with patients. A week after I saw Mr. Katz in clinic, he was sitting in the waiting room at the front. He looked up at me and smiled, “I guess I’ll try this out,” he said, a look of newfound hope in his eyes.

And from there, each day, there he was, working with therapy. Intensity in those eyes. After about 4 weeks I walked into the gym and saw him on the treadmill walking. I was stunned. I’ve seen elders die 4 weeks after being unable to recover from illnesses like the ones he had.

Geriatricians have studied many factors contributing to the concept of frailty. Some are easy to measure, but Mr. Katz’s wasn’t. His inner spirit to live, to get up from the boxing mat when it looks hopeless was one I admire. Many of my patients just give up when they’re faced with illnesses. But taking things one at a time led Mr. Katz to recovery and independence. The other day I got a letter in the mail.

Inside was a picture of Mr. Katz smiling next to a cabin in Tennessee.

Arsheeya Mashaw is a geriatrician who blogs at A Doctors Guide to Healthy Aging.