Time's Winged Chariot

You don’t need to be a physician or sing depressing Brecht/Weill songs to know that mortality is an evanescent state. From cradle to grave, certain biological values decline: heart rate (from a fetal heart rate of approximately 120-150 to zero), the number of brain/heart/kidney cells, all measurements of cognitive function. Other values may increase: blood pressure commonly rises as aging arteries stiffen, sodium is retained, and renal filtration worsens.

Those wishing to know the actual probability that they will die can easily consult an actuarial table. The benevolent souls calculating your health-insurance premiums do this with the same empathy they experience while urinating. Perhaps your need-to-know has lured you into the over-decorated salon of a psychic. Otherwise, how could you possibly know how long your “life-line” is? This crucial information was left out of all my medical school textbooks.

Allow me to simplify this. Life tables reveal such information as the chance that you will survive any given year of your life, your remaining life expectancy, and what percentage of people born the same day are still alive. Here is a straightforward way to determine this important information as you begin a new year and a new decade:

If you were unable to calculate your answer readily, you might have to adopt a different philosophy, namely that each day requires ongoing life-sustaining efforts and life-affirming projects. In fact, you might have to reconstruct the aforementioned approach as a double-negative. Allow me to explain.

Diabetes, hypertension, obesity, overweight, insulin resistance, hypercoagulability of blood, arterial wall inflammation, and elevated cholesterol can and will shorten your life. Perhaps a few hours, perhaps a few months, perhaps a decade. I often ask patients who are unable to control these conditions “How much less do you plan on living?” It has recently become clear that elevation of blood sugar is the last step in the development of diabetes, not the first. Most of the damage done to the circulation occurs in the “quiet” stages when the patient feels well. Where ignorance is bliss, breakfast is an overdose of calories.

In a political environment where the term “healthcare” means some odious type of government program, the true definition seems totally antithetical. Nevertheless, healthcare is what you do for yourself, not what is done to do. Preventative medicine requires self-control, foresight, and delayed gratification. You might be fooling yourself through disordered personal myths, but your bodily organs experience the brunt of unhealthy eating and thinking.

“I can eat diabetic cookies because I take medication”—“I know fat people who never get sick”—“My good deeds will cancel out my bad habits”—there are delusions that can be custom-fitted to any unhealthy lifestyle. “I eat whatever I want to because some day I’ll drop dead” a corpulent patient once boasted. I asked him “How do you know that you won’t have a paralyzing stroke and be in a nursing home for years?” The silence thereafter spoke volumes.

Conversely, living life to its fullest, enjoying the moment, developing new and surprising relationships, and reinventing yourself periodically are techniques of survival and templates for happiness.

The ancient Greeks thought that the sun moved across the sky drawn by Apollo’s chariot and horses. In high school I became fascinated with a poem by Andrew Marvell, “To His Coy Mistress” wherein the “horny” narrator puts the moves on his reluctant girlfriend. The description of mortality is particularly haunting:

“But at my back I always hear Time’s winged chariot hurrying near...
"Though we cannot make our sun stand still, yet we will make him run."

Staying a few steps ahead of our fate, instead of unwittingly hastening it, is distilled wisdom from poets, psychics, and actuaries. So what are you waiting for?