Being human Archives - Page 16 of 50 - Man, Medicine, and Mike

In the movie, ”About Time”^[1] Tim finds out that he can travel through time. At the age of 21, Tim’s father sits him down for a serious talk. It is then that he tells him that all the men in their family have the ability to time travel. Tim’s father goes on to give him some basic advice on how it works and how to use it. The time travel is limited to his own life. In other words, he cannot go back and see Abraham Lincoln. He can go back and relive his life as a child, or an awkward conversation at a party, etc. At first Tim doesn’t believe him but then he tests it out and his life is changed. This newfound ability allows Tim the opportunity to redo or relive events in his life. As he relives each moment, he can, and often does, change things.

The concept is fascinating. If you could relive a moment what moments would you relive? Are there times when you would go back and do things differently?

Tim’s father retired young. Later in the movie we find out why. He is dying of cancer. He tells Tim that in spite of his time travel he could not find any way to prevent the cancer or his death. Instead he could only change how he lived his life. Knowing he was going to die, he retired young. That way he could spend hours playing table tennis with his son, living on the beach in Cornwall, and interacting with his family.

What would you do if you knew that you were going to have a premature end to your life? Would it change anything? What would you do differently? Would you immediately retire to spend hours playing table tennis? Would you go through a “bucket list?” Would you want to achieve some great thing before the end?

Several years ago, I was on an airplane when the woman next to me began talking to me. She noticed the medical PowerPoint I was working on. As we talked we realized that I had known her husband (also a doctor). She told me that he had recently retired but then shortly after retirement he became ill and passed away. Prior to his death they had many plans of things they were going to do together. They wanted to travel. They wanted to visit their children. They wanted to spend days together. Retirement was when they planned to do all the things that they did not have the time to do when he was busy working.

Now she was trying to do the things alone. She was traveling. She was going to see their children. She was going to have the experiences they had planned. But she was not going to get to do them with him. It was hard. She was going through the motions of what they had dreamed to do together. But she was alone.

What would her husband have done differently if he had known? Would he have retired earlier? Would he have done things differently even before retirement? That conversation has remained in my mind. It pulls at me. It challenges my decisions and choices.

We of course have plans for retirement someday. They are not necessarily very specific or in great detail. For me, a lot of them have to do with just not being so busy. It includes the luxury of getting up in the morning and not having to immediately do anything. When I go to the health club to exercise, the idea of having an extra hour to do more exercise and then go sit at breakfast is immensely appealing. A few days ago, while on vacation I walked in the morning sunshine to a coffee shop. I brought lattes and biscuits back to our Airbnb. That felt like the greatest luxury in the world. My wife and I love to travel. The idea of being able to plan long trips is exciting to me. We love to go visit our daughters. I also picture the idea of a winter in a warm place. I imagine getting up each morning and taking a walk down through a golf course with just a light jacket on and not feeling rushed. Sometimes I wonder about the indulgence of writing. These quiet moments with a cup of coffee and my computer are enjoyable to me. Instead of 7 am meetings, 7 am in a comfortable chair with a cup of coffee and my computer are what an enjoyable retirement could mean to me.

Getting diagnosed with cancer makes all of these questions more intense. Before cancer it was okay to work really hard now and put off things for the time of retirement. But if retirement never comes, and all I ever did was work; would I have been a fool?

The answers are not easy. There are important questions about life and purpose that go beyond just what I want. As I dig deeply within myself, a few themes keep surfacing:

Is my current life so bad? When I start thinking about the ideal life, it occurs to me that what I have now is not so bad. I get a lot of vacation days. We use them. We have travelled a lot. We do visit our children. We go sailing. I do have Saturday mornings and vacation mornings to sit and drink coffee. I am writing blog posts. By questioning my current life, it feels like I am at least partly betraying the wonderful good things that define my life now. I am blessed. Is the answer that I need to make structural changes or is it that I need to enjoy the life that I already have? If you are at a restaurant eating a steak, can you enjoy it for what it is? Or are you a fool that looks to what someone else has ordered and who then longs to eat that instead? Can you enjoy the steak? Or do you spend the meal dreaming of pizza? And then at another meal when eating a pizza, do you spend that time dreaming of a steak? I have a good job. It is what has been my calling and my passion. My patients thank me for what I have done. I have a lot of extras in my life. I have a great family who loves me. If I were to die tomorrow, isn’t that enough?
Is our purpose in life really about enjoying things? Is that what it is all about? Am I intended to go and find just what makes me happy and do that? Is my personal happiness what is truly important in life? Or is there more? Should life be more about meaning and purpose? Should it be about calling? Is this life about living out the purposes and will of God for my life? Jim Elliot said, “He is no fool who gives up what he cannot keep to gain that which he cannot lose.”^[2] Jim died young following God’s call on his life. Jim had a life well lived. Is life really about being an awkward old man in shorts, sandals and black socks walking down a golf course with a cup of coffee each morning? Are we really intended or promised a long retirement? Maybe life is more about doing good in the time that we have. What defines that good is unique to each of us. What that good is also may shift and change through the phases of our lives. But a life well lived is perhaps not about personal or selfish desires and goals. This means that it really is not a tragedy to die in the saddle. It is ok and it may even ideal to die working at what is your current purpose and calling.
I don’t know what is going to happen. I could be fine. Do I really blow up all that is my current life over fear of something that may not happen (recurrence of cancer)?
Is the question a different one and perhaps one that applies to all of us at any point: What is my best lived life now? With where I am now, with where the Lord has put me with the abilities, opportunities and responsibilities in front of me, how do I make the best of that? I think that is the key question and the one I hope to explore a bit more.

So now I understand. If you are facing your mortality and even if you are not, the key question is to ask, what does it mean for you each and every day to live a life well lived?

First off is to perhaps reject the idea of some future ideal. I am not sure that the image of me as an old man walking in shorts, sandals and black socks with a coffee cup each morning is necessarily nirvana. I suspect if or when I get to that point I may find myself longing for something else. The ultimate deception of this world is this ever reaching for the future ideal. Some who are retired tell me of how they long for their younger years when they had purpose and meaning and work. Even now I look back fondly at times from my past life. I would gladly jump back to many of them and live them all over again.

This world is broken. This is not the place where we will ever have everything perfect. Our purpose is not to seek our ultimate happiness in this world. If this is what we pursue, we will end up empty and in sorrow.

Second is to enjoy and appreciate the blessings of today. I have a lot of amazing things and people in my life. I am truly a fool if I do not enjoy them for the sake of longing for something else. Even now I feel grief at how apt I am to do this. I hope that you, my family and friends, will forgive me for the times when I have not truly and fully enjoyed the gift of being with you and the experiences we have had together. This is indeed perhaps the most important thing that I must remember and live.

Third is to seek purpose and meaning. For me I have learned that I do not do this selfishly or of my own power. I seek to do this as a humble servant of my Lord and Savior Jesus Christ. I have learned long ago that my greatest victories and things that I celebrate the most have not come from amazing things I have achieved. They instead have come from humbly being used by my Lord for good. He can do so much more with my humble submission than I can ever achieve by my active intervention.

My favorite scripture verse is 1 Peter 4:11, “If anyone speaks, they should do so as one who speaks the very words of God. If anyone serves, they should do so with the strength God provides, so that in all things God may be praised through Jesus Christ. To him be the glory and the power for ever and ever. Amen.”

I must now tell you a very wild and deep secret. There are some cool things that I am proud to have achieved in my life. In retrospect I think these things make me look like I am an incredibly clever guy. I feel like it looks like I carefully planned and worked and built to achieve them. The truth is that most of the really important things that I have achieved are things that I didn’t really know I was doing while I was doing them. I was just walking through them by faith and by the incredible grace and gift of God, He used me in ways that were bigger than I would have planned.

This blog is getting long, but I think we are reaching some key and important points. Interestingly they match the conclusions that the main character (Tim) reaches in the moving, “About Time.” If I knew that my end was going to come soon, the most important thing for me to do would be to live each and every day, including the moment right in front of me, to its fullest. This means enjoying what I have rather than longing for something else.

Enjoy what you have today, in this moment. Live your best day today.
Don’t spoil what you have today by longing for an idealized tomorrow.
Seek a life of purpose and meaning rather than selfish desires. Joy comes in fulfilling these purposes and meaning.
Purpose and meaning for me comes from humble submission to where the Lord has put me. It comes from desiring to be used for good rather than seeking personal glory.

So, what do I change? Should I retire early? Is the solution really about playing table tennis for hours on end? Is it really about a leisurely walk each morning with a coffee cup in hand? Or is it more about enjoying what I have now?

It doesn’t mean that we don’t ask strategic questions about purpose and how we use our time. Much of life is vanity (chasing after things that may not be important). We can and should look for what is important. What does the Lord have for me to do? Am I being a responsible steward of my time now? This is a question entirely independent of having had a cancer diagnosis.

The key question is, however, not what I want to do. The question is what defines for me, today, a “life well lived.” And that is what I must do.

Thanks for reading along.

Please, today, would you live your life as a life well lived?

^[1] “About Time”, Universal Pictures, 2013

^[2] This was a journal entry from the missionary Jim Elliot. He wrote this on October 28, 1949. He was killed 7 years later at the age of 29 while trying to reach out to the Hoaorani people. https://en.wikipedia.org/wiki/Jim_Elliot

⁽³⁾ If you would like to read more about finding purpose and meaning, here is one of my prior blog posts: https://manmedicineandmike.com/mediocrity-mediocrity/

It was 1916. Harry had graduated from medical school and was doing his residency in general surgery. He took care of all sorts of patients, but one changed his career. One patient, and one physician who asked questions, provided treatment for millions of patients – including me.

Harry’s patient experienced a tremendous tragedy.

The patient had his kidney removed because of a cancerous tumor. After the kidney had been removed, the surgical team realized too late that the patient only had one kidney. It was years before the technology was available that made hemodialysis possible. With no technology to replace the missing kidneys the patient was doomed to certain death. Harry was tasked with taking care of this patient and doing whatever he could to help him. The patient died 6 days later. But as Harry took care of him, he found a surprise. The patient did not develop high blood pressure.

Harry had seen many patients die of kidney failure before. Each and every time the patients developed tremendous elevations of their blood pressure. His patient who had no kidneys did not develop any high blood pressure. Harry reached an interesting conclusion: the kidneys must be responsible for causing high blood pressure.

Harry got called to serve in World War 1. In 1924 Dr. Harry Goldblatt returned from the war to Western Reserve University. There he began to research his theory that the kidneys were the cause of high blood pressure. He developed a clever technique of applying clamps to the renal arteries (the arteries that supply the blood to the kidneys) of lab animals. He found that by restricting the blood flow to the kidneys he could cause the animals to develop high blood pressure. Once he developed this consistent reproduceable model of high blood pressure, research was able to move forward. Eventually this led to the understanding of the renin angiotensin aldosterone system.

In October 2018 I went to surgery for resection of a large mass near my left kidney. At the time of the surgery they noted that my cancer shared a blood supply with part of my left kidney. My surgeon called a urologist to the operating room to discuss options. They clamped the artery and waited. The kidney looked ok. It is not unusual for our organs to have collateral (duplicate) blood vessels. This means that the organ can have two different blood supplies. They concluded that I might have enough collateral blood flow to protect my left kidney. They tied off the artery to the cancer and removed it. They didn’t really have any choice and it looked like it was not going to cause a problem.

I went home from the hospital two days later. Three days later I developed progressively worsening back pain along with shaking chills and fever. I had my wife bring me back to the hospital. In the emergency department I told the physician that I thought I might have a renal infarction (death of part of the kidney due to impaired blood supply). They gave me some morphine and took me to the CT scanner. I was right. The upper half of my left kidney was dying.

I was like a Goldblatt dog. Like Harry’s dogs, part of the blood supply to my left kidney was blocked off. I had never had high blood pressure before. Would I get high blood pressure I wondered?

I went to the pharmacy with my wife and bought a blood pressure cuff. I started monitoring my blood pressure. Just as consistently as in Harry’s experiments my blood pressure starting rising. The next week I was going to have an appointment with Dr. Hammer at the University of Michigan. I became worried that if I showed up with my very high blood pressure they might end up hospitalizing me. I called one of my colleagues on a Saturday and asked her if she would be willing to prescribe a high blood pressure medicine for me. She phoned in a prescription for amlodipine and I started on it right away.

Amlodipine works by acting directly on the arteries to cause them to dilate (enlarge). It is a safe and effective high blood pressure medicine. But it does not directly counter the activation of my renin angiotensin system. The amlodipine helped but it didn’t completely control my blood pressure.

A few months later a vender for a new home monitoring system for heart failure patients was meeting with us. Their device included a blood pressure cuff. To demonstrate the system, they put the cuff on me. The machine registered a blood pressure of 205/115. I laughed that maybe I had a little too much caffeine that morning. I reassured them that I was fine. After the meeting I went up to the clinic and measured my blood pressure again. It was 185/105. That was a little bit better but still not good enough. My amlodipine alone was not doing the job.

I called my primary care physician. I asked if he would consider prescribing an angiotensin converting enzyme inhibitor for me. He put me on lisinopril. That medicine blocks the hormone that Harry discovered in his dogs that would cause high blood pressure.

I tracked my blood pressures. Within a few days my blood pressure was trending down very nicely. Eventually my blood pressure was low normal. I talked with my PCP again. He told me to start reducing my dose of amlodipine while I continued to monitor my blood pressure. Eventually he had me stop the amlodipine and my blood pressure remained in good control. Later I changed to the medication candesartan (an angiotensin receptor blocker). This is another medicine in the class of medicines discovered because of Harry’s work with the dogs. I continue to take candesartan to this day.

The other evening, I was taking my evening pills. As I grabbed my bottle of candesartan it occurred to me. I am like a Goldblatt dog. I laughed and wrote it down and promised myself that I would someday write a blog post about it.

Because of an inquisitive mind that asked questions, Harry Goldblatt concluded that high blood pressure must come from the kidneys.
Because of his clever techniques, Harry proved his theory with his special clamps on the arteries of lab animals.
Later Harry isolated a chemical from the kidneys of his lab animals that later led to the discovery of the system that drives a lot of the cases of high blood pressure.
Because of all of this work, and dozens of clever scientists, I have one tiny little single pill that effectively and consistently controls my blood pressure.

I am like a Goldblatt dog. Thank you Harry Goldblatt for what you did. You would have never realized that your work would change the life of a cardiologist become patient in 2018.

But why do I write this post? Is it just about the one tiny pill that controls my blood pressure? There is more to it than that.

Because Harry was curious he did a tremendous amount of good. He was bothered by the one thing that didn’t fit.

Let me explain more.

When I was in medical school we had huge amounts of material to learn. In class we would take notes. Later I would go through the notes studying. When I did I would look for the things that I didn’t know. There were things that made sense, things that I had already learned or things that I could determine by common sense or logic. But the things that I hadn’t remembered or seemed to not make sense or surprised me, those were the things that I needed to learn. I developed a technique of taking notes off of my notes. As I went through the all the material I would end up with just a few pages of things that I really needed to learn. I could then go through those notes again and again and even once more just before the test.

That is a valuable principle in life. Look for what surprises you or doesn’t fit.

We can spend our lives only looking at what fits nicely and comfortably into what we expect. But if you look for what doesn’t fit – that is when you will learn and grow.

In medical practice we look for abnormal labs or test results. The important ones are often the ones that don’t fit or make sense. When we see those, they can drive us to look harder. It might be the key to finding the problem that has been missed.

When I study the Bible, I look for things that surprise me or catch me off guard. This then drives me to start digging deeper and asking questions. When I do I am rewarded with insights I would not have gained if I had just read looking for only what made sense to me.

You are sitting at coffee with a friend. They are telling you about something they have done. I would encourage you to look for things that surprise you or don’t quite make sense. Tease those things out. When you do I suspect you will be nicely surprised with wisdom and insights that you might have otherwise missed.

Harry noticed what didn’t fit. His patient didn’t develop high blood pressure. He asked questions. Because he did, my blood pressure is nicely controlled on a single tiny little pill.

Thank you Harry Goldblatt!

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