A Dog’s Life? Not Quite

Medical days powerfully reconnect me to earthly realities; they produce stress. I note here that stress, at any rate, is a pretty constant accompaniment throughout adult life, but it is then mild enough so that we become accustomed to it except in times of transition, thus on awakening and, getting ready to go to work, on resuming the burdens of the day. In retirement most of that stress is removed, but medical days bring it back into focus. And it’s not just people who live in stress. I observe the same thing when I watch birds or squirrels or dogs, too, for that matter. Always alert, always awaiting the next damned thing—or powerfully drawn to the next something desirable. And, when stress disappears, going to sleep. Dogs are very good at that. They belong to the leisure class...

Marvelous Bodies

In writing the account of a bone marrow transplant to save a child with Wiskott Aldrich Syndrome, a genetic defect that attacks the immune system, I discovered that the transplant is not a surgical procedure. The recipient’s own bone marrow is first killed by chemotherapy and is then withdrawn by suction. That step, the preparatory step, does involve surgical intrusion. But the transfer of the donor’s marrow, the actual transplant, happens in a procedure that is like a blood transfusion. A solution with the new marrow is infused into the arteries. The marrow-cells then find their way into the bone cavities of the recipient entirely on their own. They settle in—engraft is the technical word for this—and, once at home, the cells begin to produce the blood cells for the body, which is their job. The transfusion takes place rapidly. The engraftment takes about two weeks. This absolutely amazes me.

Time Horizons

This may be cheerless reading—hence you may want to skip this. My subject is time horizons, but in a special sense. What’s usually meant is that some people customarily look far ahead in time whereas, at the other extreme, some people live day-to-day. Those who have long time horizons are usually more successful; they plan ahead and also draw their experience from the distant as well as the immediate past.

The sense in which I want to use this phrase today is to signify ample time to concentrate on necessary tasks (long or adequate horizon) and short bits of time bounded by interruptions that come at frequent but random intervals. To achieve longer-term goals, we must engage in a flow of effort we can sustain. Arbitrary interruptions chop this time into segments that are too small. If they cannot be avoided, they produce short, inadequate horizons.

My thesis is that people who’ve passed 70 will find that their time horizons, in my sense, are shortening, and this because medical conditions increasingly interrupt ordinary life or limit our use of bodies and of minds. To be sure, fewer years are left to live as well, but that’s not what I mean. In the usual sense I’ve always had a very long time horizon; indeed I still do. I’m not talking about the approaching end but something much more practical. Arbitrary and unwelcome events that must be minded chop time apart and suck up psychic energy. One consequence is that initiative weakens. You hesitate to start something anticipating another shock. You become gun-shy. After what we call a “medical week” around here, especially two in a row, it’s difficult even to remember the sustained effort we suspended while playing “patient”—much less picking it up again—if, as often happens, ten days out yet another anxiety-producing “procedure” looms ahead. Ten days? Seems like a long time. But it has both a backward and a forward shadow of at least three days in each direction. The tendency in cases like this is to live more in the moment, to enjoy the momentary freedom from “all that.” Time and time again I hear myself saying: “Well, at least I have about three days.” Rarely am I tempted to use those three days in ways that may require effort and may produce stress—even though the goal is of my own choosing. I use the days to build up energy for getting past “the next one,” whatever it is, with the stiff upper lip and a sort of chipper humor trying to convince myself and others that I can handle it. I’m all right, Jack!

Pondering this sourly during a walk on Monday—sourly because two medical events, both very unpleasant, one for B., one for me, were scheduled for Tuesday and Wednesday—it occurred to me that poor people, living on the edge of economic disaster, have short time horizons in both senses because they too are subject to harsh interruptions that cannot be anticipated or dealt with summarily: failing brakes, a sick child, a breakdown in plumbing, a tooth ache, the arrest of a teenage child, a bus strike, a hike in rent—small things and large are magnified by poverty. The human being copes as best he or she is able. The slow breakdown of bodies or insufficient economic nourishment reaching a family both have the same effect. The highest arts of medicine in one case, or of government in the other fail to do much more than mitigate. Then if you combine the two, aging and poverty, “vale of tears” is not a bad description. Mine, fortunately, is just a complaint. I can’t get things done as once I used to. Botheration. And another procedure is ahead. “In about two weeks,” the doctor said. “We’ll arrange it. We’ll call you.”