Statistics and Sportscars

My last post described a new website that tells elderly persons the chances that they will die within a given number of years (eprognosis.org).   Did I want to know my own odds?  Of course.  But I entered the site with some trepidation.  First of all, I had to assert that I’m a medical care professional.  The assertion is not checked and is thus an implicit invitation for laypersons to enter the site, but even so lying is not pleasant.  Second, I was afraid of what I might find.  The site was presumably locked.  Would I be like Bluebeard’s wives, unable to resist unlocking the forbidden door? 

And after all, if I found that my chances of living much longer were small, would I change my behavior in any way?  Would I stop flossing my teeth?  Would I eat as much ice cream as I wanted?  I probably wouldn’t buy a red sports car, that classic response to crises of masculine aging, because I can no longer pretzel myself into one.  But would I stop exercising?  Most likely I would continue to live just as I do now, in the knowledge that after all the indices are fallible and even if I had, say, a 80% chance of dying in the next four years, there would still be a 20% chance that I won’t.  So what would be the point of finding out?  Why did Bluebeard’s wives unlock that door?

But I did enter the site and as I did so I figured that if the statistics disturbed me I could discuss them with my doctors and learn what if anything I should be doing to improve my odds or, if that’s not possible, to tell them my wishes for end of life care. 

This is what I found out.  The Lee index gives me a 20%-28% chance of dying within the next four years.  Perhaps I should have stopped there.  But, no, I kept poking around in the closet.  The Schonberg index gives me a 63%-73% chance of dying within the next five years and an 86% - 96% percent chance of dying within the next nine years.  The difference between the Lee and Schonberg indices lies not only in the length of the period predicted but also in the factors that are considered, with the Schonberg indices including more debilitating factors than the Lee index. 

Well, I’ve already done well to reach 80, and after all the chances are 27%-37% that I’ll manage to reach 85.  As an old boss of mine used to say, that’s better than a hole in your shoe.  Still, I looked for another opinion.  I found one in the USA Today article about these indices http://yourlife.usatoday.com/health/story/2012-02-19/Do-seniors-really-want-to-know-life-expectancy/53158420/1.  It reported that Dr. David Reuben, head of geriatrics at the UCLA School of Medicine, is working on an index that gives a "firm" prediction of longevity.  In a version published in 2010, he found that “a high-functioning 80-year-old man can expect 7.2 more years.”  Since I consider myself “high-functioning,” I can, according to that provisional index, reasonably hope to reach 87.  Not content to leave well enough alone, however, I turned to an eprognosis.org link to a non-medical actuarial calculator for life expectancy.  It told me, after I completed its questionnaire, that I have a life expectancy of 90.2, with 75% chance of reaching 85.9 and a 25% chance of reaching 93.9.  These last predictions are no doubt overly optimistic in my case, but I'll take them.  And if there's at least a 50% chance that I'll live ten more years  (so much more comforting than the Schonberg index that gives me an 86%-96% chance of dying within the next nine years), then perhaps I should I should take up yoga so that I can enter and exit a sports car with grace.

PredictingThe Big D

“How long do I have, Doc?”  That’s the first sentence of a recent article in USA Today.   My daughter, a palliative care social worker and an unfailing source of good ideas for posts, alerted me to it  (http://yourlife.usatoday.com/health/story/2012-02-19/Do-seniors-really-want-to-know-life-expectancy/53158420/1) The article describes a new website (eprognosis.org) that offers various indices predicting longevity for the elderly.  Although the site, developed by researchers at the University of California-San Francisco, asks you to identify yourself as a medical care professional (without verification) in order to gain access to the indices, more than a half million people visited the site within the first five weeks of its launch.  It’s unlikely that all of them were physicians.

The developers of the website hope that it will stimulate discussion between physicians and elderly patients about life expectancy, a discussion that many physicians avoid initiating.  But patients and their families know that life is finite, and a discussion of their chances of survival for a given number of years can help guide decisions as to the use of various tests, procedures, and operations.  Does it make sense, for example, for an 86-year-old woman to undergo a mammogram?  Normally the test is not recommended for a woman that old because she is more likely to die of something else before she dies of breast cancer.  But if the chances of her living for many more years are good, because she is still in excellent health, then the test might be beneficial.  At any rate, elderly patients are usually glad to learn that they need undergo no more colonoscopies. 

The indices present the chances of mortality within a given number of years, using information such as the patient’s age, history of smoking, presence of various diseases, body mass index, number of hospitalizations within the past year, and ability to carry out various tasks independently.  The indices are specific to given populations of elders: those in the general population, those in nursing homes, and those in hospitals.  Three indices, all for elders in the general population, are relevant for me, the Lee index, which predicts the odds of mortality within the next four years, and two Schonberg indices, one predicting the chances of mortality within the next five years, the second predicting the odds of death within the next nine years. 

Do I want to know what the odds are for myself?  You bet.  I’ll let you know what I find out in my next post.

Fathers and Sons

“I wish I could tell my father,” was among my first reactions to the news that one of my books, published a long time ago, was being translated into Chinese.  My father died in 1977, long before I had even conceived of the book.  But I’ve had a kind of continuing one-sided conversation with him ever since he died.  Had my mother lived a normal life span, I might have had such conversations with her as well, but she died young, more than 60 years ago, so it’s my father who is more often in my thoughts. 

When I wished that I could tell my father, it was because I knew the news would have pleased him, just as I’m pleased when one of my children announces an accomplishment.  Whether or not I deserve any credit, I feel that their attainments reflect well on me.  After all, I helped to form them.  So it must have been with my father.  But my sadness at not being able to tell my father the news reflected more than his inability to take pleasure from it.  I was also sad because I could not add to my stock of his approval. Forty-five years after he died, I still want his approval, even though I’m now older than he was when he died.  I don’t think I’m unusual in this respect.  Sons want their fathers’ approval and that desire remains alive long after their fathers have died.  No matter how old we become, no matter how long ago our fathers have died, we remain their sons.

When my father was alive I didn’t realize that if I wanted his approval, he also wanted mine.  What father doesn't want to be a hero in his son’s eyes?  And if not a hero (for how many of us are heroes?), at least respected, well thought of.  This is a truth I’ve learned from my experience with my own children.  I want their good opinion at least as much as I wanted it from my father. 

 

My father did not see the original publication of that book nor its translation into Spanish, nor will he see its translation into Chinese.  He did not see me win tenure or become a full professor.  But he saw my marriage and the birth of my two children, who were 10 and 12 when he died and thus gave him a chance to know them. My marriage and my children gave him far more pleasure than could any professional attainment.  I will try to remember that when I regret not being able to tell him about any other accomplishment, should there be any more to report.


2010-2012 Anchises-An Old Man's Journal All Rights Reserved

Bravery

Last week we attended the twenty-third annual “Inter-generational Day” at the elementary school three of our grandchildren attend.  The day’s centerpiece is a school-wide musical production, with the children from each grade, one grade at a time, singing and dancing in choreographed routines.  The musical’s theme this year was the Olympics, with each grade (two classes per grade) representing one or two countries. 

Our elder granddaughter’s third grade represented South Africa, with the girls dressed in yellow and brown head scarves and matching sarongs.  During the middle of their dance performance, one of the girl’s sarongs fell to the floor, revealing her in her white underwear.  Her undergarments were the soul of modesty, with a high neckline, sleeves half way down her arms and pants almost to her knees.  Still, it was clear from the expression on her face that she was mortified.  The nightmare of being naked in a public place – is there anyone here who has not dreamt that dream and is there any place more public than an auditorium with hundreds of spectators? – had come true for her in effect, even if she was in fact still dressed. 

She hung her head in acute embarrassment and then, pulling herself together, continued her dance routine with the rest of her class.  She didn’t run off the stage but soldiered on.  Hers was one of the bravest behaviors I have ever seen.

Bravery comes in many forms.  It’s not found only in the battlefield.  It’s found in performers, like the late Glenn Gould, who suffer from severe stage fright but who nonetheless perform in public.  And it was found in several of the friends we visited last week.

Two of them are recent widows and the third is the husband of a wife dying from end-stage Alzheimer’s disease.  He visits his wife daily, but she does not recognize him.  She’s present and yet she’s not.  For each of these three friends, the world has changed irrevocably.  Icarus has dropped into the sea, a few feathers floating above the little splash his body has made, while merchants and buyers haggle in the marketplace and farmers till their fields, no one paying attention to those feathers and that splash.  Our friends now must go about their affairs as if nothing has changed although everything has changed.

Unlike the courage of the girl in our granddaughter’s class, their bravery is hidden from the world.  They continue their routines, they work on the projects that engaged them before their loss, they entertain their friends, they engage with the world.  But they do so under a burden of grief unimaginable to one, married for almost 50 years, still lucky enough to sleep next to his spouse.  One night, however, our bed will contain only one of us, and that person will learn what’s it’s like to carry on alone.  I only hope the survivor will do so with as much grace as the friends we visited last week and the girl in our granddaughter’s class.


2010-2012 Anchises-An Old Man's Journal All Rights Reserved

Social Change

The other day we visited an old friend, who, at 84, is even older than I am.  He told us that one of his granddaughters, a sophomore at a prestigious university, is no longer with her boyfriend.  Her boyfriend had told her that he was uncertain about his sexual identity and wanted time to sort things out.  Our friend also told us that the same granddaughter, writing a paper on contraception, had asked him “Grandpa, what method of contraception did you and Grandma use?”  He didn’t tell us how he answered her, but he did say that he was taken aback by her question just as he was surprised by her former boyfriend’s openness.  My wife and I agreed, as did our friend, that we could never have asked our grandparents that question. 

We didn’t discuss the change in attitudes towards homosexuality, but the change would have been hard to foresee when we were college students, at a time when most gay men were closeted, when homosexuality was seen as shameful by the general public and by many gay men themselves.  The idea that men could marry each other, had it been floated then, would have seemed bizarre.  Now, when the Times publishes the wedding announcements of gays and lesbians, we take such marriages in our stride.

We agreed with our friend that today’s openness about sexual matters is probably healthy, if unthinkable when we went to college.  I remember the parietal rules of my youth, when you had to return your date to her dormitory before one am on a Saturday night, earlier during the week.  I don’t recall the penalties for violating these rules except that they were severe.  Female colleges acted in loco parentis in preserving their students’ virginity.  (No one seemed to care about the men’s virginity except, of course, the men themselves, who were eager to lose it.) Nowadays, male and female students share the same dormitories, sometimes even the same suites.

True, back in my day, young women could and did lose their virginity before one in the morning, but the parietal rules by and large kept libido in check.  As for me, I was often glad to have a respectable excuse for bringing my date back to her dorm, concluding our time together, which, as often as not, was stilted, uncomfortable, and joyless for us both.  I thought I was grown up when I went to college, but clearly I wasn’t.  I thank whatever gods may be that I no longer have to suffer through those dates.  No doubt my dates, old ladies now, are grateful too.  In any event, the changes in mores implied by the stories our friend told us about his granddaughter were unimaginable when we were young.  It’s hard to believe that our grandchildren will see social changes as great as these, but they probably will.


2010-2012 Anchises-An Old Man's Journal All Rights Reserved

A Basketball Game

A few days ago I watched my eleven-year-old grandson participate in the playoffs for his junior basketball league.  The game was a thriller, with the final score decided in the last minute, 48-46.  Our grandson played on the winning team, which will now advance to the quarter finals. 

My grandson raced up and down the court, blocked opposing players, passed the ball, and shot it into the basket as if absolutely nothing in the world was more important than what he was doing, as if his life depended on the outcome of the game.  He was not alone.  He and all his teammates played with ferocious intensity. 

As I watched them play, I wondered if anything in their life will ever seem as important to them.  Will they ever be so riveted to their task?  Will they ever be as totally present as they were in the game I watched?

It will probably be impossible for my grandson to maintain the same level of intensity all the time in the situations of everyday life.  Only if he is unfortunate enough to find himself under fire, at war, is he likely to keep that level of adrenalin flowing for so long.  Nonetheless, I hope that he will find an occupation that arouses his passion, so that he wakes up in the middle of the night to think about solutions to the problems it poses, so that he gets up in the morning eager to go to work.  Such a person is blessed.

As I wondered about his future, I thought about my past and about the projects that aroused a high level of commitment, projects that consumed me.  There have been, I’m glad to say, more than a few.  But the last such project ended about 12 years ago.  Since then I worked for several years on another undertaking, a history, but in the end it came to nothing, mainly because I was never in love with it to begin with.  I won’t say that the fires that once burned within me have died out.  It would be more accurate to say that they’re smoldering, banked under a layer of ash.  But I haven’t found a poker to stir them up again.

At 80, it seems to me that I’m entitled to stop searching for that poker and simply to be grateful for those projects that were for me the equivalent of my grandson’s basketball game.  Many people, after all, spend their whole working lives without ever finding their occupation engrossing or, as I found it many times, thrilling.  Tennyson’s adage about having loved and lost applies to work as well as to love.  Nonetheless, I keep looking for that topic that might stir those fires once again. In the meantime, I’ll keep an eye on my grandson – indeed on all my grandchildren – in the hope that each of them finds work that arouses their passion.


2010-2012 Anchises-An Old Man's Journal All Rights Reserved

Friends

In Monday's post, I wrote about Professor David Oliver's video blogs concerning the course of his disease, nasal pharyngeal cancer, and its treatment.  One of his blogs was devoted to the importance of friendships and social support. Recently I had a demonstration of its power, when I went to Friday evening services at our congregation after an unavoidably public fainting bout there the week before.

We had joined the congregation at least five years ago, but it's only in the past year that I've been participating fully, joining its biweekly Mussar group, its weekly Torah Study Group, and the rabbi's weekly lesson, participating in Friday evening services and in the Saturday morning minyan, and providing occasional commentaries for the weekly bible portion.  My initial motivation was, I confess, instrumental.  I wanted a social network.  After leaving behind a tight community in Jerusalem, I felt as if I was now among a lot of loose marbles on a tray, as a student of mine once described the population of Los Angeles, where he saw little connection among people.  If religious congregations offer anything, it's fellowship, and so I started to participate in my own congregation because of my search for friends.

That my search was rewarded was clear at Shabbat services after my pacemaker was installed.  When I entered the prayer hall, at least a score of people greeted me with hugs and kisses and congratulations.  One would have supposed that I had returned from a trip to the moon.  And when our prayer leader asked if anyone would like to mention the name of a person in need of physical or spiritual healing, in connection with the mi sheberach prayer, a half dozen people gave my name.  Although I felt that I didn't deserve so much attention, it was, of course, immensely gratifying.   It gives me confidence that when the symptoms of my metastastic cancer become obvious  - a long time from now I hope - the congregation will rally to my support  In the meantime, I've found participation in its various activities gratifying on its own terms.  Even atheists need spiritual refreshment.


2010-2012  Anchises-An Old Man's Journal  All Rights Reserved