Friday, February 2, 2007

A surprising secret to a long life

The article “A surprising secret to a long life: stay in school,” New York Times, January 3rd, 2007,) was prominently placed on the front page. Perhaps it struck me with more force than it did most people, because I am the only one in my known genealogy who went to college. No doubt, it is the reason why “going to school” was the only advice I gave my children as they grew up. I figured all the other lessons that a father may need to impart, were best exemplified in they way I led my life, particularly how I related to people around me, especially my own children. The greatest lesson of all, that is, loving one another, is not believable, especially to children, unless they sense it, and see it in the daily behavior of their parents. Everything else, in my opinion, is peripheral, and easily available through a good education.

No doubt some of you will disagree with these brain-droppings, and may, by now, be wondering what does all this have to do with health. I can only say that it has been shown that children do best when they are loved, regardless of the parental tools, or dogmas used. Besides, an education avails children, and adults with the tools to explore both their inner, and outer worlds.

The main reason I chose medicine as a profession, is that I felt called to this noble work. Other reasons pale in comparison. But, after the obvious desire to be of service to others, I felt that medicine would satisfy my insatiable thirst for “further light and knowledge.” Insatiable means I am still learning. Now you may see why I read voraciously. In fact, from now on I would like to include comments on the 4-5 books I read each month in this blog. Since I alternate between fiction, and non-fiction, I will be recommending to you world literature as well.

Before I get back to the subject of reading, books, and growth, let me finish reporting on the article in the NYT about living longer through education. Since most of you are baby-boomers like myself, you are likely deeply interested in not only living longer, but better. Well, it turns out that “education” was the factor most associated with longevity: the more years of education, the longer people live. If you are thinking that good relationships should be number one, you are not wrong. It turns out that the more education one gets, the better their relationships are. No doubt there are those who are so emotionally gifted, and so advanced in their ability to love, who did not need an education to shine their wonderful light on us all. I know a few people like that, and I am sure you do, too.

But, most of us mortals had to learn, through sound education, to listen, to communicate, to respect others, and to question the outer-world, while favoring the exploration of our inner-world. No doubt those lucky enough to be raised by loving parents understand these concepts readily, and likely have a steady, and calm mind that allows them to buckle down to get an education, to explore their own souls, and the material world with equanimity and open mindedness.

A higher education allows us to earn more money, too. It sounds a little crude, but, the more money we have, the better food we buy, the more we read, and the less we stress about providing for our loved ones’ and our own basic needs. We are likely to have more time to exercise, to relax, to travel, and devote more time to enriching our lives, and the lives of those around us. We also may afford living further away from polluted environments. Recently, we learned that our kids’ lungs’ development is hurt by living near freeways, which is the equivalent to living in the most polluted cities of the world (J. Lancet, February 2007.)

Perhaps the most glaring example of these points, is the fact that those in the lower socio-economic segments of our increasingly polarized society, tend to eat mostly at fast food venues. Also, they tend to have less access to the dismal health care system we have developed in the USA. The number one reason for going bankrupt is an inability to pay for health care bills. There is no question that poverty deeply handicaps our fellowman from enjoying good health (“Status syndrome,” JAMA 2006;295:1304 & “Poverty and health,” Robert Sapolsky, J. Scientific American, December 2005, p92.)

No doubt there are a lot of people with lots of education who have very poor health, due to bad relationships, too much work, poor diets, and questionable lifestyles that are facilitated by their good fortune. But, the article in the NYT is talking about averages, and trends. So, I am sure we all know poor people who are deliriously happy, healthy, and wise. This is where we interject that “money does not buy happiness,” to which Will Rogers would reply, “I have been poor, and I have been rich. I would rather be rich.” Tavia (“Fiddler on the roof”) would agree.

Before you jump to conclusions, I must tell you that a significant percentage of the money I make, I give away. I live “a threadbare and genteel existence,” in a very humble neighborhood, drive a 2000 Jeep Wrangler, and I have no expenses, other than an occasional book. I am deliriously happy with my simple life. I only work two days a week, enough to pay the bills. I wish you could say the same, I really do. By now you have figured that my education has allowed me to command a high enough salary to live like this.

This reminds me of a book that borrows from the dreaded sentence we hope we don’t hear in some dark alleyway: “Your money, or your life,” by Joe Dominguez, 1992. Sadly, this is the choice that too many of us may have to make. In other words, I wish you the food fortune to simplify your life, so that your expenses are reduced, then, you may get away with less of a need to work so hard.

There was one odd comment in the NYT article, which I paraphrase: those who live to enjoy the present day, cannot invest the time to get an education. The philosophy of living for the moment is destructive. OK, I can understand the sentiment that a sign of maturity is to postpone pleasure, so that we may have more intense, and durable pleasure in the future. Investing one’s life in long, tedious hours of schooling, especially with lots of kids, and working at the same time is no fun. Believe me, that is exactly what I did to get through my 13 years of post high school education (I know, I, too feel I am overly educated!)

But, another sign of maturity is the ability to take contrasting points of view, and hold them in one’s mind at the same time, to end up with a composite of both ideas, or extremes. Hopefully, that middle ground enriches your life, and the lives of those around you, before the tension of the extremes drives you mad. And, who said all this? Christ, Budda, Kierkegard, and even F, Scott Fitzgerald. A whole lot of other people have said the same thing, even myself, in my up-coming book “The fence boy.” In other words, “carpe diem” is just as valid. Ask Robin Williams in the film “Dead poets’ society.” Enjoying the present moment may be done while we engage ourselves in the quest for further light and knowledge. And, such is life, which beckons us to incorporate contrasting ideas with courage, and determination to develop our greatest potential.

I was saddened to see that the Utah legislature voted down a proposal to charge in-state tuition in our universities to illegal aliens. In my opinion, this is penny wise, and pound foolish. The same goes for investing in our children’s education. I feel we ought to heavily subsidize higher education in our country. “Reducing poverty by investing in young people” (J. Lancet 2006;368:1128) has this to say:
Investing now in better education, preventive health care, and vocational training for children could produce substantial economic growth and sharply reduce poverty. Failure to do so may lead to disillusionment, social unrest and fragmented societies.”

Reading is fundamental” (J. Archives of Internal Medicine 2005;165:1943) adds that low literacy leads to worse health and more chances of depression. There are 30 million Americans with educations below basic, 63 million basic, 95 million intermediate, and 28 million proficient. Surely we can do better. I urge you to vote for candidates who will invest in the future of our children. And I urge you to join me in my quest for further light and knowledge. Now, enjoy the words of Sir William Osler, M.D., the father of modern medicine, who happened to be president of the American, Canadian, and British Library Associations. Coincidence?

Nothing will sustain you more potently than the power to recognize in your humdrum routine, as perhaps it may be thought, the true poetry of life, the poetry of the commonplace, of the ordinary man, of the plain, toil-woman, with their loves and joys, their sorrows and their grief.”

“The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.”

“To carefully observe the phenomena of life in all its phases, normal and perverted, to make perfect that most difficult of all arts, the art of observation, to call to aid the science of experimentation, to cultivate the reasoning faculty, so as to be able to know the true from the false, these are our methods. To prevent disease, to relieve suffering and to heal the sick, this is our work

While on the one hand I would encourage you with the firmest faith in a few drugs (the friends you have and their adoption tried,) on the one hand I would urge you to cultivate a keenly skeptical attitude toward the pharmacopeia as a whole.”(“The quotable Osler.”)

The calling” (NEJM 2005;352:1845) was written by a doc who felt called to medicine by reading “Lady Chatterley’s lover,” where he learned about Phillip, a club-footed medical student who did very well with patients: “There [Phillip] was humanity there in the rough.” His readings of “Of human bondage,” “Lolita,” “The Citadel,” Arrowsmith,” and “Love in the time of cholera” also contributed to his decision to pursue the healing arts. Out of all those books, I would recommend the last one, by Gabriel Garcia Marquez.

The author of “the calling” feels that today’s students may be missing out: “Entering classes don’t seem to include as many avid readers as they once did… A prevalent form of blindness, caused by the terrible and crippling atrophy of the imaginative faculty... where will their sense of calling come from? ‘ER’ and’ Scrubs’? The thought is chilling.”

He concludes by saying that “A good novel can offer a formative experience to prospective doctors,” and for patients, too. “The writing cure: can understanding narrative make you a better doctor?” (New York Times, April 18th 2004) agrees. In fact, medical students at Columbia, and Harvard are asked to read world literature. The doc who wrote “Compassion’s way: a doctor’s quest into the soul of medicine” (JAMA 2003;290:1645) tells us that he grew up on Don Quijote, Pickwick papers, David Copperfield, and Mark Twain.

I have a statue of Don Quijote on my desks at home at my clinic. Many feel it was not a coincidence I played Don Quijote in a neighborhood adaptation of “Man of La Mancha.” Do you want to hear me sing “the impossible dream?” I am sure now some of you feel this is the proof you were looking for that I am nuts!

Could these ideas truly lead to a better, longer life? Are these the things missing from our chaotic health care system? “Goethean science: an alternative approach” (J. Alternative and Complementary Medicine 2003;9:311) would agree:
The human being is the most sensitive instrument…[this is a] profoundly different way of looking at nature that celebrates the subjective and relational to perceive the whole... [which is] implicit in integrative medicine philosophy... [which] cannot be understood by the intellectual mind.”

Narrative Medicine: a model for empathy, reflection, profession and trust” (JAMA 2001;286:1897) recommends the close reading of literature to understand patients, and humanity:
Physicians have turned to a study of the humanities, especially literature, to grow in their personal understanding if illnesses... The teaching of literature in medical schools has become widely accepted as primary means to teach about the patient’s experience and the physician’s interior development...Students already gifted with narrative skills are better able to develop into effective physicians than are students deficient in them… Unlike logico-scientific knowledge, narrative medicine leads to an understanding of particular situations… to establish a therapeutic alliance… "

If the physician cannot perform these narrative tasks, the patient might not tell the whole story… The resultant diagnostic workup might be unfocused… The physician’s most potent therapeutic instrument is the self, which is attuned to the patient through engagement... Physicians have learned to practice medicine through detachment.”


Sadly, many docs resemble those remarks. I am in contact with medical students on a weekly basis. Although most of them resonate with the concepts in these pages, we sometimes fail to screen out students (I am on the admissions committee,) whose only concern is to make a living. Valid as that is, medicine is a calling, not a regular job.

So, we want to live longer: let us commit to continuos learning, and to keeping an open mind, and open heart to new ideas, and people.

Hugo Rodier, M.D.


At September 22, 2010 at 12:40:00 PM PDT , Blogger Katrina said...

I couldn't agree more with the life long learning. The men and women I admire the most I recently came to realize were all avid readers. It influenced all aspects of their lives.


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