The family was waiting for me.
It had been an arduous day. I had seen patients in the hospital at 6 am and started my office at 8 am. I had to interrupt my work to go to the elementary school to watch a performance by my daughter, a welcome interruption, nonetheless. Then I was back in my office to finish the day. Once the office was done I had to stop at the nursing home to see my patients there, which was when I received a call from the hospital. The family of one of my long-term patients, who was admitted to the hospital hospice services, wanted to speak with me. I made my second trip to the hospital that evening, and it was 8 PM. Mr. Albert Smith (AL) had been a patient of mine for 5 years. Two years ago he was diagnosed with lung cancer.
A week ago he slipped and fell at home and bled into his brain. His family, a daughter, and his wife were the ones who were there at the initial admission. His 2 other kids a son and daughter had arrived from out of town and had a question- ” how long?”
AL was 86 years old. He had an amazing life, a career in the automotive industry, and was leading a very active retired life, mostly traveling to meet his kids and grandkids, and golfing with his long-term friends. For the last 2 years, however, he struggled with his health, mainly having shortness of breath, and a multitude of doctor’s appointments, tests, and treatments. He became progressively weak and his wife who was 8 years younger became his primary caregiver.
As his primary care doctor, I had to coordinate much of his care and it was exhausting, but definitely not as exhausting as it was for his wife who had to execute all of this. AL was one of the 20-odd patients whom I had, that needed a lot of coordination of care, at any given time. Each time I heard about a family or a person in their last hours of life it was always the same question- how could we have prevented this? Can we create a dignified exit from life? Above all how long to death?
Health is not always a choice, but “the disease” is not inevitable either. So how does one stay healthy without too much effort? Is it even possible? Effortless health- what does it need?
Everyone knows or realizes that eating fast food or smoking or drinking too much can get us into trouble, yet we do these things. Why? Many of these habits do not have immediate and reproducible consequences. Our body is so amazing that despite all the abuses we put it through it continues to function for years without discernible consequences.
Let’s begin with how we get to learn about health.
It is certainly not from our parents. Today’s parents can barely live their lives and bless those who have survived COVID -19, juggling between work, home, and the education of their kids.
Education about health is not from our community either. Our community is where we learn that to have “fun” in life we need to be able to eat pizza and burgers and drink beer or wine.
Our education is mostly through ads, it is from people who sell a product or food. So there is so much confusion- is milk good for your bones? Do you need meat every day for your protein? Is cane sugar healthy? Are eggs a wholesome food to eat every day or do eggs cause diabetes and on and on?
We can delve into these answers soon, but for now, let’s look at how we need to think differently so we have control over our lives.
The medical system, as we know it is designed to help with disease. Medical school education is learning about the body and about all the things that can go wrong with it. It teaches us, as doctors, that disease is inevitable. We are trained to catch a disease early, slow the disease progression, and make sure one does not die prematurely from the disease. The tools we are taught to use, are medications and surgical techniques. The more they use these tools the better they get at their craft- hence the practice of medicine. In short medical practice in the true sense is a technical skill, knowing your protocols and being updated on the newer medications and surgical techniques. It is less a science and more of an art. The whole practice of medicine can be summed up as a battle against the body that dysfunctions.
When we look at the evolution of diseases, we need to remember that the body evolved from 2 cells- an egg from the mother and a sperm from the father. This tells us the whole body works as a system as every cell came from the same foundational cells. Yet, medical schools spend a lot of time educating doctors on the function of each part of the body as if it were functioning independently.
A surgeon removes a gall bladder and a year later the patient is diagnosed with pancreatic cancer. This cancer is considered a surprise, but the gall bladder was a warning that things were not normal a year ago. Most physicians are taught about organs and systems in silos and rarely are asked to put them together.
We are taught to learn about each organ, the diseases it can get afflicted with and the solutions we can have for them. We keep updating the solutions without understanding the problem. None of the solutions are about restoring the normalcy of the organ but are focusing on the reduction of the symptoms of the dysfunction.
The way disease evolves it may seem like a simple problem that needs a quick fix. This is why in your twenties you get a little heartburn, a headache, or menstrual irregularities, you seek out an over-the-counter remedy or a medication so you do not get bothered by these symptoms. Then things quiet down and a decade later you may have gallstones or a kidney stone or a heart attack a little more severe disease. You may survive that and get put on medications or in extreme cases have surgical removal of the affected organ if it can be done. Temporarily the problem seems solved.
A few decades later there is a stroke or an autoimmune disease or even cancer, now these would be considered catastrophic. Somehow we see these as different and unrelated. That is why you as a patient see different specialists and start taking different medications thinking these medications will help diseases get better. They help blunt the severity of symptoms and in some instances slow the progression of the disease to prevent premature death. None of these approaches will reboot health or keep you from getting new symptoms or disease diagnoses.
The changes we have seen in the last few years are that diseases of moderate severity are developing in the younger age group. So when we see cancers in 30-year-olds, significant depression and anxiety, autoimmune conditions, and so on, we have to stop and ask some questions.
Why is this happening? What are we missing?
In short, an answer would be we have a crisis of abundance. This is unlike our ancestors who had diseases of scarcity initially then diseases of ignorance now we have the polar opposite- diseases of abundance.
We have abundant stress, abundant food, and abundant inertia( or lack of movement).
Most of us sit 10 to 12 hours of the day glued to a screen of some sort. This sitting comes with constant doing and stressing over projects and deadlines. We eat at the same place we are sitting to work, where we are stressed over things, so we no longer rest and digest our food.
We ignore a little pain, a little heartburn, or a little headache. We find quick solutions because we have to live life and not allow these inconveniences to disrupt what we are doing – till it becomes something catastrophic.
When these aches and pains become frequent, annoying, or disruptive then you seek medical help. At this point, you want a quick fix, and, the “good news” is your doctor is educated to give you that quick fix in a fifteen-minute appointment. So when newer problems with a more involved need for care arise, suddenly the medical system is scrambling to find a quick fix but this becomes a game of whack-a-mole, as they fix one problem another surface, as we do not find the time to address the root cause of the problem.
So what can we do differently?
Let us begin by taking care of our own health, as you have heard me say “health is intuitive it is your business and totally free, disease, on the other hand, is what costs you and it is the business of medicine”
Here are a few things you can do to lay the foundation to live a full life without too many restrictions but with a reasonable goal to live well and die with dignity.
We are all in the race for life, and the endpoint is death. So let us face this obvious truth as we build our life of health. The analogy is for wealth and a legacy- you lay the foundation with savings and investments if you seek a comfortable retired life and the ability to leave an inheritance.
“A healthy man has several desires and a sick man has one”. To ensure you are not stuck with one desire here are some steps to take:
- Connect to your purpose. What would your desire be for health? Do you want energy to play with your grandkids, do you want a sharp brain so you can continue to build your future, or, do you want to feel strong to be there for a family member? ( you can see I did not ask you if you want to lose weight or look good- those are side effects of a higher goal). So answer for yourself why you want this.
- Choose one thing you believe is the stumbling block when it comes to attaining your goal. For simplicity let me pick a simple habit- “I love to have ice cream after my meals.” How do I tackle this desire or habit? You seek awareness and an alternative. I tell my patients it’s okay to eat the ice cream, but maybe try a cup of blended frozen fruits instead. Be aware having ice cream after every meal is not normal- it is common but not normal. Another way to tackle this is to have the habit of climbing up and down the stairs 5 times if you do eat ice cream. So you are adding an alternative action. Master this.
- Eat whatever you eat with awareness. Sit at the designated place not where you do work or pay bills but a dining spot in your home. Smell the food, feel the food, taste the food, chew the food, and be grateful for the food you have. Do not judge the food as good or bad. Focus on how you eat it and be grateful. You are among the lucky millions who have access to food.
- Move after you eat. Go outside if it is possible or take your pet for a walk or even go down to the basement and do laundry. Any movement after a meal is good, so your cells and muscles can utilize the energy you have just consumed. Drink plenty of water after the movements.
The reason most people do nothing about their health is that it is overwhelming to make a lot of changes as everyone wants to be a Ph.D. in health when they have not mastered kindergarten. So start with the basics and we can build from a foundation.
Coming back to AL, my patient never envisioned his life ending the way it did. When we are young we never realize youth does not last. Set practical goals but have clarity as to what you want. He did have a great life except for the last 2 years which were plagued with an incurable disease. Whether this disease could have been prevented, I do not know as AL lived through the era of diseases of ignorance where cigarette smoking was fashionable, and he also lived all the way into the ers where we see diseases of abundance. All I could do that night was to be supportive of his family. I had no way of knowing when the end would arrive, but I did have the tools to make sure he was comfortable till the end. What I could not do was to have prevented the 2 years of fight and struggle he had to his end. the foundations for that were laid decades before I saw him.
So when I see a patient today, I ask them to seek to be less ignorant and be more mindful and have small simple goals. For example- getting to bed on time, drinking plenty of water, or chewing our food mindfully. Pick the habit you want to address and build from there. If you need accountability seek the help of an equally motivated friend or pay for a coach.
You do not have to eat healthy all the time, go on any special diets or even go to the gym every day to be healthy. All you need is clarity and awareness of your specific health goals. Once you identify your purpose and goal for health then, start with small changes, stay consistent, and know it is feasible to be healthy at any age and at any time, till it is time for your heart to stop, on your terms.
Life is to be lived with purpose, not fear, the journey is to make choices with awareness, death is inevitable but can be dignified, the choice is yours to make. dR. Chellam