I’ve seen too many patients who “did everything right” and still developed cancer or a random life-threatening infection. I’ve seen too many young people who won the birth lottery – loving parents, many unfair advantages – only to lose it all to addiction. Bottom line: No matter how well you maintain your Honda, it’s simply not going to avoid damage if you are on the freeway when an oncoming semi truck flips into your lane.
Still, I try to rage against the dying of my particular light. I eat food, not too much, mostly plants. I hike or kayak whenever I muster the motivation, which is less than I should but more than most (let’s say twice a week). I have a free weight set purchased for a pittance off craigslist that I’ll cycle in and out of using every few months, which is a far better value than the gym membership I cycled in and out of using for years. I feel healthy most of the time. Every now and then, however, I catch myself in a moment where the facade slips back to reveal the frailty that lies beneath.
For example, when I rush my eating and don’t chew food finely, it catches in my lower esophagus and results in either temporary esophageal spasm or (infrequently) vomiting. I had an endoscopy a few years back which revealed nothing. My best guess? Perhaps a sliding hiatal hernia.
But when it occurs, at least weekly, in the dark recesses of my mind I think “pancreatic cancer” or “lymph nodes surrounding my chest, inoperable, obviously due to lymphoma.” When I wheel our portable ultrasound machine from a patient’s bedside back to the storage area where it is kept, I resist the urge to place the probe on my liver and reveal the Swiss cheese appearance that I am certain will confirm my suspicions of metastatic disease.
I envision my life ending tragically, just before I reach my FI number and leave the stresses of medicine behind; I feel heartbreak that I’ll not grow gray alongside my clearly-out-of-my-league wife; won’t see my kids spread their wings in some way I could never have predicted, walk them down the aisle for their wedding, or cradle a grandchild in my arms. It’s a genuinely awful feeling, and it washes over me like a blot on the sun.
I find two elements help keep these intrusive thoughts at bay. The first is the realization that, if one of these ominous premonitions came true tomorrow, I really wouldn’t change all that much about my life. I spend time with the people I love most. I engage in activities that bring me a modicum of joy and self-fulfillment, teach me new skills, and challenge mind and body in situations that test my comfort levels. I’d live the same life if I were on death’s door.
The second element is allowing the completely mundane moments to anchor me to my (mostly) happy reality. My reverie of self-pity is interrupted by my son pleading for my attention! He’s asking me to please tell his sister that no way are you allowed to take the card from the pile after you already put it down! My heart soars to recognize the warm body in bed next to mine is my wife! She shakes me from slumber (with unnecessary roughness) to let me know I was snoring, and could I please lower it a notch to a 747 rumble since she’s working the early shift tomorrow.
I used to regard my doctor goggles as an annoyance that created unnecessary doubt and anxiety like Shel Silverstein’s notorious whatifs. I’ve since reframed them to create an opportunity for appreciation. When medicine helps me realize what a thin veil separates me from the land of the dying, unglamorous reality returns me to a position of gratitude at my good fortune.