Mystery maladies and quality of life: Is 75 enough?

It’s common to divide people into two opposing types. There are optimists and pessimists, extroverts and introverts, people who love cilantro and those who think it tastes like dirty dishwater. Add to this, people who run to the doctor at the first sign of something wrong and others who wait, trusting that the body will normally sort things out on its own.
I’ve been thinking about this last binary distinction over the past few months as I’ve been hit by a mysterious virus, one that remains undiagnosed; not especially debilitating, certainly not fatal, but nonetheless symptomatic enough to generate a kaleidoscope of modulating aches and annoying pains.
My family doctor is pretty sure that whatever this is, it will most probably pass on its own and I’d be best served allowing patience to trump concern. So while I practice being part of the slow-to-medicine camp, I’ve had plenty of time to meditate on how my body – and the bodies of those around me – is starting to act up in ways that do not bring easy comfort as I firmly claim my place in the middle age years.
Reciting a litany of ailments, illnesses and worse has become a regular part of the casual “how are you and how’s your family?” conversation. Worse still, at least two family members are now fighting cancer. Others in our community are sick; some have died. My mystery malaise seems pedestrian by comparison; definitely not worth complaining about to casual acquaintances
So when the latest symptom arose and my gums started bleeding, I figured it was just more of the same, connected to the overall Theory of Everything That’s Wrong with Brian right now.
My wife Jody was having none of it though. Usually firmly on the side of wait and see, she suggested that a visit to the doctor would not be unwarranted.
“No, no, I’m sure it will pass in another week, I’ll just sweat it out,” I countered. “Anyway, what’s a little pain? There are people with far more serious problems.”
A week passed and my gums were still red. Plus now my throat and my sinuses hurt too – could a sinus infection be the cause and was it triggering inflammation in my mouth?
“Fine,” I said, finally giving in, “I’ll see the doctor.”
I was able to get an appointment the same day. My doctor looked up my nose and down my throat and didn’t see anything. “Of course,” I grumbled to myself. “Story of the last three months.”
He wrote me up a note and sent me on to my dentist.
“My gums have been bleeding, maybe you could have a look?” I wrote in an email I fired off to Dr. A, pleased that he’d entered the digital age and I didn’t have to pick up the phone.
“Can you come in now?” came the quick response. Yes, I could. He’d save the last slot of the day for me.
Despite my professed nonchalance, the realities of my middle age maladies have thrown me for an existential loop. I have long nurtured a fantasy that I’ll live to be a vigorous 90 or maybe 95. I’ll be lucid and clear, exercising up until the end, writing thoughtful articles and books, continuing to ingest comfortable amounts of salt, sugar and fat, all while enjoying my golden years with Jody disease and wrinkle free. Now I’m not so sure. Maybe I should downgrade my expectations? If I make it another 20 years, would that be enough?
Ezekiel Emanuel (Chicago Mayor Rahm Emanuel’s brother) thinks so. In a controversial, much-cited essay published in The Atlantic magazine last year, Emanuel put forth his reasons for “Why I Hope to Die at 75.” His thesis: medicine may have prolonged life expectancy but not quality of life. Once we hit 75 (on average), we start to slow down. We get sick more often. We suffer through chemo and broken bones. That clear thinking I’m so attached to goes muddy.
“Healthcare hasn’t slowed the aging process so much as it has slowed the dying process,” he writes. Death usually results “from the complications of chronic illness – heart disease, cancer, emphysema, stroke, Alzheimer’s, diabetes.” To bolster his point, he refers to predictions that there will be a 300 percent increase in the number of older Americans with dementia by the year 2050.
Emanuel wants to go before he deteriorates both mentally and physically. “I won’t actively end my life. But I won’t try to prolong it, either,” he writes. Today (he’s in his 50s, like me) “when the doctor recommends a test or treatment, especially one that will extend our lives, it becomes incumbent upon us to give a good reason why we don’t want it.” After age 75, though, “I will need a good reason to even visit the doctor and take any medical test or treatment, no matter how routine and painless.” That means no screenings for cancer, no colonoscopies, no cardiac stress tests, no flu shots; not even antibiotics.
His friends and family are sure that by the time he reaches 75, he’ll push back his date – to 85, 90. But “I am sure of my position,” he states. “By the time I reach 75, I will have lived a complete life. I will have loved and been loved. My children will be grown and in the midst of their own rich lives. I will have seen my grandchildren born and beginning their lives. I will have pursued my life’s projects and made whatever contributions, important or not, I am going to make.
Emanuel makes a lot of sense. I’m not sure I’d have the courage to turn down possible treatments while my family casts their concerned eyes towards my mental competence, but the thought of there being an “end date,” at least to medical intervention, if not to life itself, is oddly comforting.
With my monkey mind jumping from neuron to neuron, I drove to the dentist at the appointed time. Traffic was heavy and there was no parking anywhere near his office, so I wound up getting there quite late. I was afraid he’d have left for the weekend, but he was there waiting, eyeing me with unusual compassion. “Leah, let’s get some X-rays for Brian,” he said to his assistant as he laid me back in his chair. “No, wait, I see the problem,” he quickly added as he glanced towards my gums.
I’d broken a tooth. A tooth! Not sinusitis, nothing related to my mystery illness at all. “That’s where all your pain is coming from,” he said. “I can fix it on the spot. Do you want to?” Yes, please.
His expression was still one of exaggerated kindness as he wiggled the numbing needle into my inner cheeks and fired up his collection of whirring drills and fluorescent flashers that would soon fill the hole in my tooth where food had been collecting for the last week. “This is what’s been hurting you the most,” he said, holding up a collection of food particles he’d scooped out from my makeshift oral compost pot.
“I can show you more,” he intoned.
“No, that’s OK, really,” I mumbled, though with my mouth propped open by instruments, I’m not sure he heard.
When the procedure was done and the cotton balls extracted, I asked him about those looks he was giving me. “When you wrote you were bleeding from your gums, I thought, oh God, it’s early stage leukemia,” he confessed. “I imagined all your gums were gushing blood!”
There was no leukemia; just a simple toothache, easily fixable. I still have to get to the bottom of my other ailments. But for now, I may not be so reluctant to see a medical professional.
At least for the next 20 years.