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Hilton Head is an odd place to practice medicine. No one is from here. They all spend their lives somewhere else (usually Midwest or Northeast) working hard enough to make enough money to retire in a place like Hilton Head. Then they move down here and begin their long-anticipated life of leisure. They sleep until they’re hungry and they eat until they’re sleepy and after a few years of this they notice that they don’t feel very well, their pants don’t fit, and they’re on more BP meds now than they were when they were stressed out and working so they decide to get in shape.
My patient Jim followed this path and reached the point where he decided to rededicate himself to his health. I tell him that’s a great idea. He says he’s going to buy a bicycle; I tell him that’s a bad idea. I tell him that bicycles make you healthier but they don’t make you live longer. I’ve seen horrible accidents over the years. I mean horrible stuff. I have four close friends who either died or were crippled by bicycle accidents. Jim figures that I’m just being a typical overly cautious doctor (which was probably true), and buys a bike. He rides a lot, starts losing weight, and feels much better. We even stopped some of his meds.
Then, he wiped out. He wasn’t going very fast (he says less than 10mph), and he thinks maybe he hit a pine cone or something. Anyway, he broke his pelvis in two places plus various other bones. Very serious injuries for a 68-year-old man. The surgical repair went well, but he developed pneumonia in the hospital. We treated that, sent him home, and he came back a week later with a blood clot. The next year was a brutal journey of one setback after another, being transferred from nursing facilities to hospitals to rehab centers and back again, but he eventually overcame everything, and a year later was nearly back to normal, although he had a lot of back pain at that point. Since his wife now takes a similar view of his bicycle as I do, he’s looking for another way to get back in shape.
I see this sort of thing all the time. What’s frustrating is that Jim really didn’t do anything wrong. He worked hard, and saved for a nice retirement. He sat around a bit too much for a while – big deal. Then he responds appropriately by getting back in shape, and in the process nearly dies several times in a long series of medical catastrophes. It happens. Where exactly did Jim screw up? I’m not sure.
Because of my job, I have a bias against bicycles, but a lot of people really do get healthy on them.
If they don’t end up in a wheelchair.
But that’s the trick, right? Was it a good idea for Jim to start riding a bicycle? Absolutely. Of course, it was. Until it wasn’t.
How is he supposed to be able to anticipate when that is likely to transition from a good decision to a bad decision? It’s still the same decision. It only looks different in retrospect.
I’m sometimes asked how much of what I treat is a self-inflicted disease. I’ve noticed that the people who ask me this are often very trim, fit, and tan. But whatever.
I answer that everything I treat is self-inflicted. Or, possibly none of it. It’s surprisingly difficult to say because it’s not always clear which of our actions are self-destructive until later when we see how everything turns out.
I’ve noticed that my 90-year-old patients generally did not follow a particularly healthy lifestyle. Some of them did, of course, but many did not.
Americans have the longest lifespan on the planet (if you don’t count inner-city gun violence), and we’re mostly fat and out of shape. We eat garbage. We drink and smoke too much. And we live a really long time. I don’t get it.
So how does one live a long, healthy life? My first two suggestions are genetics and luck.
Some things are clearly dangerous. Cigarettes, excessive alcohol, street drugs, motorcycles, bicycles. But some people who indulge in all those things live long healthy lives. Still, you’re not helping your odds by engaging in certain behaviors.
But I see so many horrible things happen to people for no real good reason.
So my patients ask me how they can live a long, healthy, happy life. Early in my career, I wasn’t sure how to answer that. Now, after decades of study, I have absolutely no idea how to answer that. The more I learn, the less I understand. This stuff doesn’t make any sense.
It was simpler when I didn’t know all this stuff. “Get in shape! C’mon!” But now, having studied this for decades, I really don’t understand what it is that makes people live long, healthy lives. I just don’t understand.
Gosh, I’m a great physician. Sheesh…Published in