I’ve been thinking a lot about death and hot fudge sundaes.
Yesterday, there were no blog entries because I spent most of the day on a train, traveling to and from the funeral for a member of my extended family. His death was tragic and completely unexpected—a healthy man who should have lived for decades more, he died at work from a cerebral hemorrhage.
A few weeks ago, I also lost a patient to a chronic and incapacitating illness. The death was horrible, culminating in pain and cachexia, but it was not unexpected, and perhaps there was, at least for the patient, some sense that death would yield relief.
At any rate, death has been on my mind lately.
So, we try to live life right: there is a list. The list is fairly long, though I think I can summarize at least some of it. Low fat (or, this week, low trans fat), diet, regular exercise, lots of calcium (oops, that may have been last week), no smoking, drink only in moderation—and, please, red wine. Seat belts. No illicit drugs; caffeine (sorry, Clinkshrink), and aspartame are a little lower down on the list but still there. Smoke detectors, definitely, and remember to check the batteries once a month. Multivitamin and baby aspirin, perhaps. Sunblock. And finally there’s the medical screenings: mammogram, Pap smear, PSA, colonoscopy, to name just a few. Hormone replacement therapy is out, fish oil supplements are in. I’m sure you can add to the list.
We grow up listening to directives on how we should live as determined by the medical community, or perhaps by the medical community in concert with the pharmaceutical industry and unclear political agendas. The Food Pyramid, as taught to all our children and described on the back of every cereal box, was never a scientifically-determined recipe for good health, it was voted on by a committee, and it sure sounded good.
The pretext of how to live life right is that if you follow the directives, you get to live a long, healthy, and fruitful (pun intended) life-- if all that exercise doesn’t destroy your joints, that is. The subtexts, however, are ones of guilt, fear, and social ostracism. We live in a society that praises “taking care of yourself,” where foregoing hedonist pursuits and rigid self-discipline are something to aspire to. Of course our neighbor had a heart attack, didn’t you see him chowing down that chocolate éclair the other day? Do you know how many grams of fat are in that thing? And if you aren’t on a low-fat, high-fiber diet, exercising a minimum of four hours a week, then perhaps you deserve to have that recurrence of your breast cancer. We fool ourselves into thinking other people get what they deserve and if only we do it all exactly right, we won’t die. While, as a physician, I won’t encourage anyone to smoke or drive after drinking-- or even to skip the next dose of lipitor-- the truth, I believe, is that we live until we die and we have much less control then we think.
People have many anxieties, as a psychiatrist I get to hear them. Terrorists, bird flu, violent criminals, shark attacks, plane crashes-- we all have things we worry about, many of them are things beyond our control.
I am worried that I will miss a hot fudge sundae. I carry this fear that I will do it all right, follow all the rules, say No to yet another hot fudge sundae—all in the name of healthy living and the pursuit of longevity-- and what if, in the end it doesn’t matter?