I am a doctor and I changed my way of seeing aging
When doctors talk about patients in the hospital, their age is usually the first thing we mention.. A 75-year-old man with difficulty breathing. A 30-year-old woman with joint inflammation. Knowing the ages of our patients allows us to focus on the most likely diagnosis and develop a mental image of the patient before entering her room.
But this also has another function. Physicians use age to contextualize the patient’s history and in effect measure his level of tragedy. A college student who is in danger of dying from respiratory failure after a flu is unacceptable, something we must combat with all our ability. But if this same patient were over 80 years old, perhaps we would see the narrative differently and, therefore, the appropriate clinical interventions. Someone in their 30s should receive intense chemotherapy or undergo a risky operation or organ transplant, but for someone in their 70s, those same interventions could do more harm than good.
This used to be logical to me. The life expectancy of a human being has a clear arc that naturally ends sometime in the eighth or even ninth decade.. But more recently, as my parents have aged and I become a 41-year-old mother with a “geriatric pregnancy,” I have found that I think differently about age and its meaning in medicine.
We are living in a unique time in the United States with regard to aging. Our President recently turned 80, and the members of the Senate, on average, are the oldest in history. Today, people survive medical diagnoses that in years past would have resulted in premature death.
At the same time, the anti-aging field is gaining credibility, with tantalizing data suggesting that science may be able to extend not only life, but also “healthy life expectancy,” that is, the length of time people remain healthy and activewith a good quality of life. Although I am an intensive care physician and tell my patients and their families to look death in the face and admit reality, I am captivated by the promise of longevity medicine.
Throughout my second decade of life and much of my third, the years slipped away like sand through my fingers, barely noticing their passing. But now, at 41, I am pregnant for the first time, an act that assumes a reasonably long future. Maybe it’s also an act of denial. I’ll be over 60 when my son goes to college, my partner isn’t much younger. Now that I plan a new life, I am more aware than ever that time is finite.
However, the aging process looks and feels very different than I thought it would. On a recent trip to my family’s home in Miami, I stood on the back lawn and watched my 70-year-old father, who used to be very sedentary, jump to grab onto a pull-up bar. He lifted his body against gravity and did one pull-up after another, a feat I’ve never accomplished, even before pregnancy. My dad keeps about six bottles of supplements in his fridge, on the same shelves where I once found half-eaten bars of chocolate. As his 60th birthday approached and the reality of old age began to creep in, my father—a cardiologist and researcher with no plans to retire any time soon—began to dig through the growing body of academic papers to find out how he could slow down. your biological clock.
From time to time, he emails me the investigations and I review them. One of his mail items read, “I think I will make it to your high school graduation.” I paused before realizing he was referring to the graduation of his first grandchild, the fear that his life might only briefly coincide with this little person’s, everything we wish we could ignore.
It is said that thinking about death is like looking directly at the sun: you can tolerate it for just an instant before it becomes too painful. It’s easier to approach it from my father’s point of view, reading not about death, but about the science of prolonging life. I find the images of aging mice running longer, the promise within science, fascinating. What if the arc of aging I’ve learned to expect in my hospital job isn’t inevitable?
Longevity researchers would tell you that aging itself is a disease we can understand and treat, and that cancer, heart disease, and dementia are just its symptoms.. They would tell you that the first person to live to be 150 years old has already been born. In a way, this sounds absurd, a dream of biotech billionaires fueled by denial, fear of death and an illusion of control. But on the other hand, the science behind it is real. So, I allow myself to imagine that maybe my father will make it to that high school graduation.
Just being able to contemplate this reality, and what’s more, to think that somehow this is something we can control, is a privilege, just as it was deciding that I wanted to have a family after turning 40. The richest people, on average, live almost 10 years longer free of physical limitations than the poorest. As the data supporting the science of antiaging becomes more robust and actionable, this difference is likely to become even more profound.
At the hospital, we see this firsthand. I recently saw a 50-year-old man on dialysis who had smoked and drank for much of his life, had fallen in his bathtub at home and had lain there for a day or more waiting for someone will hear him call for help. Standing outside his hospital room, his nurse and I noted his age, he was a few years younger than the nurse and not ten years older than me. “A 50-year-old man,” said his nurse.a, a quick way to describe a body battered by disease, by decades of chronic stress, by factors within and outside of our control.
If you could calculate the physiological, not chronological, age of my patients, what figure would you give? We are talking about measuring frailty: weakness, fatigue, and weakened physiological resilience. This may be more significant than chronological age in making medical decisions about what interventions a patient can tolerate, but this metric is fuzzy and does not have a gold standard.
At the forefront of longevity science are companies that offer simple answers. If you prick your finger and send them a few drops of blood, they send you a report with an estimate of your genetic age, based on the impurities in your DNA and the length of your telomeres, that is, the protection at the base of our DNA that shortens and wears out over time. Perhaps this value is significant, but it’s not entirely clear whether having a genetic age younger than your chronological age gives you a longer or better life.
But it could be, so a part of me is tempted to send a blood sample, but I’m not sure I want to know what information I’d get in return. Maybe I would worry; perhaps it would give me a false reassurance. In any case, as I visit my patients in the intensive care unit and suddenly feel the baby growing in my womb move, I am aware that even if I could slow down the clock, there is never enough time.
A few months ago, I had a panic attack because of a mole on my back, I was sure it had developed a melanoma. This is not an implausible fear, we see stories that start like this all the time in the intensive care unit. I could already imagine my patient presentation: a 41-year-old woman with no relevant medical history, she was six months pregnant when she was diagnosed with metastatic melanoma. I made an urgent appointment with a dermatologist who took one look at my back and announced that she had nothing to worry about. They are just “age spots”. For a moment, the comment took me by surprise. “Age spots? But I have…”.
“He is over 40 years old,” he interrupted me, kindly and firmly. “It’s natural”.
Daniela J. Lamas (@danielalamasmd)an Opinion columnist, is a physician specializing in pulmonary medicine and critical care at Brigham and Women’s Hospital in Boston.
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