Of health, death and disease and bodies breaking piece by piece
Grandma fractured her hip Tuesday at dawn. She is at least 94 years old. I say at least because officially she is 97, but circumstantial dubious evidence (a handwritten note scribbled by her father on the blank first page of an old book) points towards the former. At any rate, she is roughly 20 years past her life expectancy, and it shows. If you'd just seen her 20 years ago, dolled up and sharp as a tack, you wouldn't recognize her today. My grandma, who was once hailed as the most beautiful woman in Damascus, is a dried up, shriveled, shrunken remnant of her former magnificent self. Her brain scan testifies strongly to that effect, as does a two-minute conversation with the woman who once knew five thousand arabic poetry verses by heart. But why is it that things have to turn this bitter while one is still alive and reasonably healthy? Is aging and all the dismemberment it brings a state of physiologic degeneration? a systemic apoptosis of sorts? Nothing I perceive in my grandma's physical and mental faculties seems normal to me. Nothing. And yet, one can seamlessly attribute it all to old age. Senility. A state of generalized deterioration that inevitably leads to death. Much like cancer. Or SLE. Or amyotrophic lateral sclerosis. Much like a serious, fatal disease. So where does one draw the line? What is normal and what isn't? The medical profession has long treated death as a disease. But is it not as intuitive and as natural as life itself? if that be the case, I can now claim, without much qualm, that cancer, or for that matter any biologic state that leads to death, is nothing but a normal, physiologic variant, with a normal, natural, expected state as outcome. Numbers don't do much to contradict this premise. Consider the following. During any person's lifetime, their chance of developing a malignancy is 20%, a number I consider astonishing. Consider another, similar statistic. A woman's lifetime risk of developing breast cancer is close to 12%. A little bit like being left-handed. But one is considered disease, while the other isn't, solely based on the outcome, an outcome that is natural, expected, and most importantly, normal. Which grants me a reasonable, albeit counterintuitive answer. What is happening to my grandma is not disease. In a sense, there's no such a thing as disease. It is but a natural state whose outcome we so desperately try to postpone, short of dismissing and eliminating it altogether. Our quest, as humans, and especially as medical doctors, does not seem to be one against disease, but one against death. One towards our biggest and most persistent obsession, immortality.