What I Realized as the Patient: We Are All Vulnerable

In his famously febrile ruminations, Hamlet contemplated suicide as perhaps the one and only way to avoid the “slings and arrows of outrageous fortune.” However grave the demerits of his melancholy inclination, his basic conclusion on the topic may well have been correct.

Worded differently: stuff happens.

I was scheduled, and honored, to give the keynote address this past Friday morning at a Harvard Lifestyle Medicine conference. Stuff, however, happened- and the best-laid plans in this case went awry as they sometimes do. I was hospitalized last Wednesday with viral meningitis, and not discharged until yesterday- Saturday afternoon.

I did not, however, go gentle into the role of patient; the show, as the saying goes, must go on. My hosts at Harvard were extremely gracious and accommodating, and rearranged the conference around my disruptions. My talk was bumped from Friday to Saturday morning; a Skype connection was set up. I gave the talk from my hospital bed.

I hasten to note that the point of this has nothing to do with telling you all how wonderfully tough and devoted I am, although to be fair, I am fairly tough and extremely devoted. But that is beside the actual point, which is all about vulnerability, and the body politic.

Ironically, poster child though I am for lifestyle medicine (i.e., I practice everything I preach, and generally, it shows in my vitality, fitness, and functionality)- I was sick and hospitalized at the time I was scheduled to address an audience at a lifestyle medicine conference. Ironically, these events were essentially concurrent with the momentous Supreme Court decision, preserving the nationwide applicability of the Affordable Care Act (a.k.a., Obamacare). Ironically, these all transpired even as I continue a campaign on behalf of a young man, and family, who technically have insurance “coverage,” but are not covered for what matters in their moment of most urgent need. Ironically, I, the passionate champion of our capacity to be “disease proof” was muddling through this confluence with crushing headaches courtesy of…a disease.

The universe may simply have a taste for irony, and the tempting answer is a sardonic smile and shrug of the shoulders. But reflecting on this- during those increasing interludes between crushing headaches (this is one of those)- I find something rather profound.

We are all vulnerable, and we need one another. Period. Run around down here long enough, and a projectile from one of those slings, or one of those arrows is going to find you, however outrageous such fortune may seem.

Of course, fortune truly does favor the prepared, and the best preparation for ill health is well-practiced prevention. That, in turn, depends substantially on lifestyle. We can, in fact, slash our personal risk of all major chronic disease by a stunning 80%, give or take. We can, in fact, by means of simply living well, make ourselves members of a society where chronic disease is rare; vitality is long-lasting; hundredth birthdays are celebrated routinely and with gusto; and when the time comes to go, we can in fact go gentle- not cannulated copiously in ICUs, but just by failing to wake from a final sleep into which we entered peacefully, in a bed at home.

To invoke Hamlet yet again: that, surely, is a consummation devoutly to be wished. And it is achievable. Because it is achievable, I am devoting my full measure to seeing some measure of it achieved before it is my time to go.

But stunningly good though it may be, the good that can be done with lifestyle as medicine is not perfectly good. Stuff will still happen.

Sometimes, that stuff will be exquisitely unpleasant but ultimately inconsequential, like my meningitis. Sometimes, it will be life threatening, and life altering- like the largely inexplicable occurrence of shockingly rare cancer in a 23-year-old college student.  

We may consider that our bodies are vessels, and we, captains all. Life is the sea, sometimes placid, sometimes tempestuous. A seaworthy vessel, well captained, is far more likely to sail long and well and visit all the invitations of distant shores than a neglected craft, or neglectful captain. But there are storms at sea that can cause the very best ship and crew to founder. We can be masters only ever of ship and sail; never of wind and wave.

So the case for lifestyle as medicine. It is the case for well-fashioned, well-kept craft, and the aptitudes of a fine crew. It is the promise of a safe crossing for all aboard. But it falls short of a guarantee.

One of the polarizing debates of our time, extending well beyond health and health care to almost all aspects of our collective conduct, pertains to personal responsibility. My impression is that those who beat most fervently on this drum are also those inclined to see excesses, rather than redress of deficiencies, in the Affordable Care Act. The reality is, though, that personal responsibility, however inclined we may be to invoke it; however artfully we may practice it- is an imperfect defense. So we are warned across the centuries by the musings of that melancholy Dane. So we are shown, trivially, by my meningitis; so we are shown, profoundly, by Manny Alvarez, fighting alveolar soft part sarcoma.

We are vulnerable, all, to the slings and arrows of outrageous fortune, and no portion of personal responsibility will alter that common state. I am enormously grateful to the doctors who stood at the foot of my bed this week and wrestled through challenging decisions on my behalf. I am grateful to the technicians who cannulated my veins with every effort to minimize my discomfort. I am grateful beyond words to the nurses who have always best represented the caring in health “care,” and who lavished on me not only their professionalism and proficiencies, but a deeply human kindness. I am grateful in ways I cannot say to my wife, whose loving hands massaging my scalp continue to relieve pain for which narcotics have no answer.

We can do much- far more than most do- to safeguard our own health and vitality. We can do much to add years to our lives, and life to our years. But sometimes, the only defense of this vulnerable human body resides with the body politic. May we embrace the vicissitudes of fate we share- and always be there for one another.*

-fin

*Please start by lending all help you can to Manny Alvarez and his family. The family’s fund-raising effort is here; my petition on their behalf is here; and the story in my words is here. Manny’s cancer has nothing whatever to do with anything he did, or didn’t do; it is simply one of those rare and epic gales at sea to which we are all entirely vulnerable. Thank you.

David L. Katz, MD, MPH, FACPM, FACP

Director, Yale University Prevention Research Center; Griffin Hospital
President, American College of Lifestyle Medicine
Editor-in-Chief, Childhood Obesity

Founder, The True Health Coalition

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Author: Disease Proof