His Last Public Service
A man my exact age died last weekend. The words on his death certificate are the most useful thing any of us will read this year.
A man my exact age died last weekend.
Not a man of my generation. Not a man in his seventies. A man born the same year I was born, who ate what I ate, who was told what I was told, and who was walking around last week with exactly the same number of years behind him that I have behind me — and who is gone now, while I am sitting here at seven in the morning having already run three miles in the dark.
A prominent man. A long public life, real accomplishment, the kind of position that comes with the best medicine in the country: the specialists, the annual workups, the hospital twenty minutes away that would take his call at any hour. Whatever care exists in America, he had access to it.
The end was ordinary. Chest pains. A call. Emergency workers doing CPR on a man in cardiac arrest. And then the medical examiner’s preliminary finding: a tear in the main artery that carries blood from the heart — a tear, in the report’s words, stemming from arteriosclerotic cardiovascular disease. Which the reporting glossed, correctly, as a gradual weakening and hardening of the arteries.
One word in that sentence matters more than all the others, and it went past everybody.
Gradual.
That artery did not harden last week. It hardened across the same decades I was living through. Quietly. Invisibly. In a man who had every reason to believe nothing was happening at all — right up until the ordinary evening when it finished hardening, and tore.
The tear is what killed him. The hardening is what happened to him. Those are not the same story, and we only ever tell the first one.
The word that closes the file
Here is what I keep turning over.
The diagnosis satisfied everybody. Arteriosclerotic cardiovascular disease. It has the sound of an explanation. It is Latinate and clinical and final, and when it lands, the room nods and stops asking, because a question has apparently been answered.
Look at what it actually says. It says: his arteries hardened over many years. That is not a cause. That is a description of the ending, dressed up as a cause. It tells you what failed. It does not tell you what did it, or when it started, or whether anyone could have looked.
And nobody asked. That is the part I cannot get past. Not one question about what fifty years of ordinary living had done to that man’s arteries — what he had been eating while they hardened, whether anyone had ever thought to check, whether any of it had ever been on the table as a question at all. The disease was named. The naming closed the file.
I know that move. I lived inside it for forty years.
The word that closed mine
I was falling apart at sixty-six.
Heavy. Exhausted. Aching every morning before my feet hit the floor. Foggy by mid-afternoon. Taking the elevator up one flight because the stairs had become a negotiation. And every single person in my life had a word for it — including me, a trained scientist who had spent a career diagnosing complex systems for a living.
Age.
Age explained everything. Age asked nothing of me. Age closed the file.
Age was not what was doing it. When I finally changed what I ate, most of what I had spent a decade charging to age simply went away. The weight. The fatigue. The daily back pain. The fog. Not all of it — not the fused neck, not the gallbladder, not the teeth I broke. Those are permanent and I carry them. But most of it, and enough of it that at seventy-one I run most mornings and do demanding technical work across a thousand miles of travel, and the everyday instruments read about where they read in my thirties.
I will not overstate what that proves. It proves nothing about anyone but me. One man. One sequence. No control, no comparison, a dozen explanations I cannot rule out. I have spent two books being careful about precisely that, and I am not going to get sloppy in a newsletter.
But it was enough to make me ask a question I should have asked at thirty. And that question is the whole of what I have to offer anybody.
What I am not saying
Let me be exact, because this is the difference between an argument and an insult.
I do not know what hardened that man’s arteries. Nobody does. Genetics harden arteries. Blood pressure hardens arteries. Decades of stress and travel and hard work harden arteries. I have not one dietary fact about the man — not one — and if I stood here and told you I knew what killed him, I would be committing the exact error I have spent a book documenting in myself: taking the answer I already believed, and reading it into a result that cannot carry it.
I suspect. I cannot prove.
And neither can anyone else — because nobody asked.
That is the indictable part. Not the diagnosis. The silence around it.
The part that should frighten you
Now hold on to the one fact about this man that I can establish, because it is the fact that ought to keep every reader of this page awake tonight.
He had the best care in the country. Not adequate care. Not the fifteen-minute appointment most of us get. The finest medicine America can produce, available to him on demand, for decades.
And it made no difference.
The arteries hardened anyway. And when they finally tore, the finest medicine in America looked at fifty years of accumulating damage and wrote down arteriosclerotic cardiovascular disease — as though that were an answer instead of a restatement of the question.
Understand what that means. The failure was not money. It was not access. It was not the competence or the good faith of his doctors, who I have no doubt did everything they were trained to do. The failure was the convention itself — the settled, comfortable, universally shared habit of naming the endpoint and calling it an explanation.
If that convention held for a man with everything, it is holding for you. Your doctor is not going to ask the question. He is not concealing anything from you and he is not a bad doctor. He simply has a word available that makes the question unnecessary, and it satisfies him, and it satisfies you, and the file closes, and the hardening continues.
We do this with heart disease. We do it with diabetes. We do it with the slow dimming of a mind. And we do it, above all, with the word age — the largest unexamined file in medicine, and the one nearly every person reading this is quietly filing his own decline into at this very moment.
The question
He cannot ask it anymore. I can. So can you. We are, all three of us, exactly the same age — except that one of us has run out of time to find out whether it was ever really age at all.
So here it is. It is the only thing I am asking of you.
What is hardening in you, right now, gradually, that everybody around you has already agreed to call age?
The stiffness. The weight that arrived and stayed. The afternoon that costs more than it used to. The number your doctor mentions and then moves past. The thing you have quietly stopped doing and told yourself you simply outgrew.
Do not accept the word. Not because it is always wrong — some things really are permanent, and I carry three of them. Refuse it because it is unexamined, and an unexamined word is where fifty years of damage goes to hide.
Ask somebody. Ask now, while it is still a question and not a finding.
That is a legacy. It is not the one he was building, and it is not one he chose. But it is the one still available, and it is worth considerably more than the eulogies.
I write about how a rigorous man can become faithfully, disastrously certain — and how hard it is to reopen a question after success has taught him to stop asking. The full investigation is in Butter in My Coffee.