Three old Italian men were sitting on a park bench on a cold, dreary day in Brooklyn.
As was their custom, they were arguing.
The first old man asserted "Da besta way ta die is ta be 77 ana drivin' a Ferrari atta hunn-ed an foaty mile-a-houa an ta hit a bridge. BOOM! Gone, justa lika dat!"
The second old man disagreed in his deep, gravely voice. "Na. Da besta way ta die is ta be 88 ana drivin' a jet aereoplana and playin' hinky-da-pinky wid a 22 yea-old and to fly inta da sida mountain. BOOM! Fireball, and gone justa like dat"
The third old Italian disagreed in his high, quavery voice. "Na. Ya boas a wrong. Da besta way ta die is ta be 99 an ta be shot in da backa da head by a jealous husband."
Side conversations
There was a side conversation in the comments of an earlier post that I am going to hi-jack.
But before I do that, I need to elaborate on my mental model of how most of us will meet our demise. Medical people: Feel free to take me to the woodshed in the comments.
Most of us will plateau in our late teens-to-mid-twenties and there will be a long, gentle glide-path of decline. At some point we will experience some major body function starting to "fail" or to rapidly decline. That will not be a big deal. Human bodies are extremely resilient and modern medicine can support us through one failed system.
It could be kidney failure and through adjustments in diet and dialysis we can coast along for many decades of life. It could be our pancreas going Tango-Uniform and through diet, exercise and insulin we can live a full life for many decades of our life. COPD, same-same. Diminished heart capacity: same-same.
The tip into the abyss happens after the second, major system goes into failure. The remaining systems, which have been laboring for years under stress often fail in an accelerating cascade after the second system goes Tango-Uniform.
The time-lag between the first system to fail and then the cascading failures is largely determined by how well we maintained the body God gave us. If we abused it with potato chips, cupcakes, lack of exercise, smoke... then the second failure arrives more quickly (perhaps triggered by a fall or seasonal viral infections or some other minor perturbation) than it does for the identical twin who did everything right.
Under this very simplified model, it can be very difficult to figure out the specific system that failed that was the "single cause" of the person's death. It is actually most precise to say "They died of old-age" because every system failure interacted with the others and the reason they failed is because all of the tread was worn off the tire and the patient was running with the reinforcing cords touching the pavement.
My evidence for this opinion is that I heard an interview held with a British doctor who performed a massive statistical study to build a computer model to "rationalize" or triage which patients got ICU beds. The plug was pulled due to political reasons so the results were never available to the general public.
That doctor said it was like economics when John Maynard Keyes who said "Do the maths until you understand the concepts and then tear up the maths". Once the statistics had been digested, it turned out doctors did not need a computer model. All they needed to know to was the number of systems "in failure". If it was just one, then they were justified in sending the patient to ICU. If more than one, Hospice.
Ultimately, we are all going to die of SOMETHING. Some of us will die relatively sooner. Others will pass the century mark.
In this model of Health (or Death) lifestyle does not cause death. Death is a given. Lifestyles set the pace of the metronome that ticks off the seconds until our first and time between our cascading system failures. Some of us are genetically gifted and we have a lot of tread on our tires. Others were born with tires that were already bald.
OK medical folks. Flame away.
I am no doctor, but in principle I think you are right. At some point one of the major systems will fail (in my family, it seems to be the ability to make insulin). When that happens, one has a choice: change and learn to live within the changed circumstances or continue on and fail all the faster.
ReplyDeleteAlthough I will say - having my first major example of my body "failing" me - that accepting that realization is pretty hard.
I do think another general issue is just the acceptance that we will all die. We do not like to think of it as such and push it off, but if we truly understood that we would spend our time and health more wisely.
Could nitpick but the basics are correct.
ReplyDeleteGenetics mean a lot; lifestyle is a major factor in how systems fail or maintain. The human body aside from genetic mistakes like Diabetes is a wonderful self healing machine.
You gotta work. move, lift, shovel. The 99 old guy is doing something. Hes not setting in a car, or a airplane. Woody
ReplyDeleteAgreed. I'm not a doctor, but the older people I know in trouble are fairly sedentary and those doing well are active.
DeleteBut which causes which? If you aren't doing well, you are likely to be sedentary. If you are in good shape, you can be more active.
DeleteSometimes it's hard to call but I have noticed that if you live long enough something's gonna kill you. ---ken
ReplyDeleteSingle point failure: heart attack. Grand dad had some heart issues at 70 or so.... he died saddling up to work cows at 76. Dead before he hit the ground. But everyone else in the fambly that has gone on, did exactly the cascading failure mode.
ReplyDeleteNow that my lungs are compromised, I'm just a quick pneumonia infection away from the eternal reward. I always wanted my death to mean something... Not be taken out like everyone else by a bio-weapon.... Even with the limitations, you are spot on about "using it or losing it." Work to your physical abilities, or they will ossify.
Retired firefighter/EMT - 28 years. The sickest people I saw and the ones I saw the most had the most medications. The question then becomes which caused which. Medication or illness. I lean towards medication being the main cause of illnesses. I could share anecdotal evidence, but it's just that-anecdotal.
ReplyDeleteThat's one thing I'm afraid of at 67, overmedication because the MDs only seem to care about one symptom at a time. Med #1 has side effect #1, Med #2 mitigates SE #1 but causes SE #2, and on and on until you are on a dozen meds and never really healthy.
DeleteAt some point you have to tell the Docs Enough. At 90 years old my father was having issues that pointed to a pancreas problem and that doc wanted to do a study that would put an endoscope down his throat, so full sedation/intubation would be required. I asked the doc just exactly what they would do to a 90 year old man if they found cancer? When the answer was essentially nothing I vetoed the test.
I have COPD from 40+ years of two packs a day. I also have chronic AFib, which has been "fixed" a half dozen times. The first instance of AFib was a side effect from one of the medications I had to take 11 years ago. Once you have AFib, you're prone to get it again.
ReplyDeleteBut I also have the longevity gene, so I could possibly live another 20 years or so...or not.
Activity, lifestyle, diet, etc. are quite important, as is genetics
ReplyDeleteA quibble on the 1 vs 2 systems failure & ICU (or even ongoing treatment) (for example, COPD&Afib above, pancrease @ 90 yrs above):
There is a grey zone, and involves some complex analysis and choices by the physician and patient.
1 system, along with a couple of other system issues that are relatively easily treated/stabilized... even 2 system failures (with an acute cause)... I would still argue ICU first step and see how things progress.
Mind, I have NO issues with hospice as a first choice. We had decided years earlier what the tipping point would likely look like for our daughter and planned hospice. That point was 3 years ago, she was 28, and it was absolutely the right choice.
Hospice and the decision to investigate/treat are really two separate things BUT are driving in the same direction.
Hospice -- death is expected relatively soon, stop supportive treatment and focus on comfort/quality of life.
Not investigate/treat -- one understands that this choice may hasten an issue, but also understands that it just isn't worth the down sides. Depending on what 'IT' is, the individual may have quite a bit more time on this mortal plane.
You have my sympathy with regard to outliving your daughter. That can be very hard, especially if much pain is involved.
DeleteThe doctor was advising the British, socialized medicine establishment where the default is "no ICU" while in the US the default is more likely "if there is a bed, yes ICU". That is a big difference.
Thank you. There was a very real question that she would see her first birthday. We are overwhelmingly grateful to have enjoyed a tremendous number of happy days over 28 years. There were hurdles over time (as with anyone's life), but at the end, no pain or fear and only a few days. We learned in those first months to restrict ourselves to one day at a time. We have no regrets, we did absolutely the best we could and being human, we did fall short at times.
DeleteI appreciate your clarification on British vs American settings, and there is indeed a big difference. Both are off the mark in my opinion.
My dad told me a long time ago about R/C glider competitions where the glider had a really small engine that was designed to take the craft to altitude and shut off. the competition was to see who could keep their glider airborne the longest. Half the battle in the competition was the skill employed to maximize altitude before the engine shut off. From there on, the return to Terra Firma was imminent. It was only a matter of when. It's a deadstick landing; a controlled crash. In theory, the higher you got the plane before engine shutoff, the more time you had in the air.
ReplyDeleteEven at that young age it wasn't hard for me to analogize that with the "skill" employed when caring for the body. No matter how well it's cared for, there will be a time when its condition will deteriorate. From then on it's the deadstick landing. True, you may take excellent care of the temple of your soul and still die in a plane crash or car accident, but the odds are WAY better for you to have a long life if you care for the bag of bones carrying your soul around whilst on Earth! That being said, don't be so consumed with survival that you forget to live!
For the record, I'm notorious for not being a pill-popper, and have not regretted that lifestyle. Seems the more pills you take, the sicker you get. Medications are designed for one overarching purpose; TO MAKE PHARMA COMPANIES RICH! Most doctors aren't doctors to make you well, but to MAKE GOOD MONEY, some of which comes from commissions paid them by the pharma companies for each prescription written. In both cases the old adage stands; "A cured patient is a lost customer."
Eat healthy, within reason. Get exercise, within reason. Get rest, within reason. Back off on the booze, and read the damned ingredient lists!!! Treat your body like it's the only one you'll ever get, 'cuz guess what...
There are some meds that lead to an enormously improved Quality of Life. I take 2 generics for rheumatoid arthritis - mobic, and hydrochloroquine (yes, the stuff that was said to be helpful in avoiding Covid - VERY hard to get during the CDC-managed pandemic). Both treat my condition well enough that I can get around, with some limitations - I'll never again win dance contests, for example.
DeleteSome drugs sorta-kinda treat the condition. Doctors now used asthma drugs for COPD patients. It helps prolong their life, but they are still going to deteriorate, as the underlying condition doesn't really improve.
I, on the other hand, have classic asthma - that's ROAD (reversible obstructive airway disease). My husband and I take the same meds. In his case, he feels a little better for a while.
I experience a complete reversal of symptoms. And, with some meds to get me past the inflammation that caused an episode, I am soon back to breathing normally.
My new doctor was treating me, but I think he judged me yet another COPD patient (many doctors just tell the patients asthma, but it's really not). He came into the room after the testing, and told me (with evident surprise), "You have true asthma!"
Completely different prognoses with the two very similar presenting diseases.
I agree with your premise of cascading failures but there is one failure mode which can be singular and that is brain failure.
ReplyDeleteCancer can be effectively cured now, depending upon the circumstance. Heart / pulmonary conditions can be rectified also, this science has advanced mightily - so these techniques can effectively correct a system failure entirely, for all purposes.
ReplyDeleteMy mom had triple bypass, valve replacement and afibrillation-corrective surgery, and they even corrected a hole that she had had since birth. This corrective surgery was in her early 80's, and she was immediately removed from blood pressure meds afterwards. She lived another 15 years until, eventually, dementia crept in and she lost interest.
Plethora O wisdom here, from people who have thought, and researched, and experienced.
ReplyDeleteJoe, thanks for making a place where this wisdom comes out from people who care enough to post it!
My dad passed away in 2022 at the age of 98. But his health had been deteriorating, and frankly, I don't think he enjoyed much of the last couple of years. He was unable to walk, or even stand, as peripheral neuropathy had wrecked his feet and balance. His thinking was still sharp, but had slowed tremendously. A minor stroke had messed with his vision. Finally, congestive heart failure caught up with him.
ReplyDeleteWhat I learned was that there are some system failures that I don't want to survive. My goal is not to live as long as possible, but to live as long as I can still enjoy my life.