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Husbands of happy and more-educated wives are more likely to get a colonoscopy

Science Life

Dale scope 2 William Dale, MD, PhD, Chief of the Section of Geriatrics & Palliative Medicine, associate professor of medicine, and director of the SOCARE Clinic (Robert Kozloff/The University of Chicago)

If your wife says she loves you…check it out

A national study involving 804 couples found that married men over age 55 were almost 20 percent more likely to have had a screening colonoscopy in the previous five years than men who were not married. Men married to women who are happier with the marital relationship were nearly 30 percent more likely. That rises to more than 40 percent if their wives were highly educated.

For women, however, being married, happily or otherwise, made no significant difference compared with unmarried women. Neither the relationship happiness nor education levels of their husbands appeared to change colonoscopy rates for wives.

“Women are thought to control the health capital in most households,” explained study director

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Existential Pain and History

mte5ndg0mdu0otg3mjq1mdcx“I am a dead man!” Alexander recognized immediately that his condition was mortal.

At first, the patient suffered such exquisite pain that Dr. Hosack did not strip off his bloody garments…When [the patient] complained of acute back discomfort, [the doctor] and other attendants took off his clothes, darkened the room, and began to administer [medicines] to dull the ache.

[The patient] was preoccupied with spiritual matters…No sooner was he brought to the Bayard house than he made it a matter of urgent concern to receive last rites from the…Church.

When [the pastor] entered the chamber, he took [the patient]’s hand, and the two men exchanged a ‘melancholy salutation’… He explained that…”It is a principle in our churches never to administer the Lord’s Supper privately to any person under any circumstances.” [The patient’s] friends thought it heartless to refuse a dying man’s last wish.

As befits a great orator, Alexander roused himself for one last burst of persuasion.

At that point, [the pastor] relented and gave holy communion to Alexander, who then lay back serenely and declared that he was happy.

——————-

One common felt pain for patients at the end of their lives is existential or spiritual pain. Though difficult to define, most of us practicing palliative medicine recognize it when we see it. The proper intervention for it is not additional opiates, but rather appropriate spiritual support.

It always impresses me, when reading history, just how often our common humanity binds us across time. The patient above is Alexander Hamilton, lying on his death bed following his infamous “Interview at Weehawken” with Vice-President Aaron Burr . This slightly edited account, taken from Ron Chernow’s masterful biography, Alexander Hamilton, is a dramatic rendering of a man in existential crisis at life’s end. Hamilton recognized instinctively, as he so often did, his need for spiritual input to his pain. Unfortunately, in today’s medical world, we too often fail to recognize this need, delivering the wrong intervention, in the form of another dose of dilaudid, to patients needing spiritual uplifting.

This is not the first time I’ve noticed this in reading through historical biography. U.S. Grant eloquently describes a palliative approach to end-of-life care, as he completes his famous Memoirs while dying from head-and-neck cancer. John Adams describes a receding of the fear of dying, to be replaced by a fear of dementia. Human life, and death, resonates across the ages.

As I prepare for another stint on our Supportive Care Unit, a typically draining two weeks full of existential pain, I find reflecting on our common humanity, and the special role physicians are privileged to play in it, helps sustain me through the experience.

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When Lincoln Kissed a Reporter: Tales from the Printer’s Row Lit Fest

I love the Printer’s Row Lit Fest — even though it will always be the “PR Book Fair” to me. A solid two-plus blocks of tents of book-sellers, including quite a few with a collection of “vintage” books, which I love.

This year, I found an original (1913) hard-backed copy, in very good condition, of a small book of 39 pages intriguingly entitled, “When Lincoln Kissed Me.” It’s an account from a young reporter, Henry E. Wing, a 25 year old reporter of the New York Tribune, the NYT of the day. Following the Battle of the Wilderness, the beginning no reports came from the front for 2 days — there was no account of the location of the 100,000 strong army US Grant was leading against Lee on the final push to Richmond. I had never heard the story before, and it is a gripping one, full of drama, intrigue, and insight. I read it on the train ride home.

After a harrowing journey through enemy territory over 70 miles over two days, much of it on foot, Wing makes it back to Washington. Not only does he have a report to deliver to his paper and to the President and his Cabinet, he has a personal message from General Grant for the President.

Lincoln dismisses the Cabinet members, locks the doors, and stares down at the reporter.  As Wing describes it:

“He took a short, quick step toward me, and, stooping to bring his eyes level with mine, whispered, in tones of intense, impatient interest, ‘What is it?’

“‘General Grant told me to tell you, from him, that, whatever happens, there is no turning back.’:

As the diminutive Wing tells it, while standing trembling in front of the towering President behind closed doors:

“Mr. Lincoln put his great, strong arms about me and, carried away in the exuberance of his gladness, imprinted a kiss upon my forehead.”

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Joshua Hemmerich, RIP

Joshua Hemmerich, PhD, was the first project manager I hired after I received my first grant as a new faculty member at the University of Chicago in 2004.  He was recommended to me by a member of the Society of Medical Decision Making, Julie Goldberg, PhD, with whom Josh had worked at the University of Illinois-Chicago.  As a cognitive psychologist with significant training in statistics, Josh was a perfect fit for my research agenda on the role of emotions in medical decision making for older cancer patients. Over the next decade, we became well-matched research colleagues as well as close friends.

Over that decade, as we co-authored 25 papers and successfully competed for several grants, we also shared innumerable conversations about life growing up in small towns in the Midwest, especially about playing sports under the demanding eye of tough-love fathers.  Over the years, we attended many SMDM conferences together, and we even managed to attract one of the Founding Fathers of the field, Arthur Elstein, PhD, to join us as a mentor and a collaborator.  We both marveled at our good-fortune to get to know such an important scholar who is also such a supportive mentor.  We each continued to build our respective careers, with Josh becoming the Research Manager for our Section of Geriatrics & Palliative Medicine, and then joining as our first PhD-only hire onto the faculty, an unusual ascension for a staff member.  When I became the Section Chief, we continued to expand our research, as Josh began building his own independent career, including as the Newsletter co-editor for SMDM.  Although we had increasing less time to share on non-work-related discussions, we were both looking forward to contributing more to the field of medical decision making.

With his untimely passing, coming as a shock to us all, I will deeply miss having Josh around, both personally and professionally.  In many ways, I am still struggling to figure out how to move our shared agenda ahead without him.  He was a uniquely gifted person, combining the insights of a psychologist with the acumen of an excellent statistician.  And for such a talented person, he we very down-to-earth and friendly, quick to tell a joke or to shoot the breeze about the latest in Cleveland versus Chicago sports.

One thing many may not know about Josh was his love of books.  I always admired, when I stopped by his office to chat, his eclectic collection of books on a wide range of topics from statistics, to cancer, to history, psychology, and (of course) decision making.  In honor of this collection, we have gathered the books he left behind and created the Joshua Hemmerich Memorial Library, which now lives in our Section Conference Room, for all to enjoy and to honor his memory.

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John Adams on Aging, Illness and Death: A Geriatrician’s Unusual Book Review

“My House is a Region of Sorrow, Inhabited by a sorrowful Widower…The bitterness of death is past. The grim spider so terrible to human nature has no sting left for me.”

–John Adams to his son, John Quincy, upon the death of his beloved wife, Abigail.

A Geriatrician’s Perspective

In First Family, Pulitzer-winning historian Joseph Ellis elucidates the character of our least-venerated, least-appreciated Founding Father, John Adams.  He brings Adams to life by presenting his life appropriately intertwined with one of our most-beloved First Ladies in history, Abigail (Smith) Adams.  As with all Ellis’s books, it is written with clarity, verve, and eloquence, mixing the Adams’ remarkable public career with his no-less remarkable marriage and personal life. How many people can claim that they effectively chose a country’s founding document (Jefferson), Military Commander (Washington), and Chief Justice (Marshall) and to have fathered a future President (John Quincy)?  And these are merely sidelights to a remarkable life of achievement. Rather than discuss the usual political topics, I focus here on a favorite topic of mine: aging.  Among the gems of insight scattered throughout this book are Adams’ (and Jefferson’s) thoughts on getting older, failing health, and death.  For a man who lived past the age of 90, at a time when life expectancy was closer to 40, his thoughts sound remarkably modern, hinting at the universality of these issues.

Adams and Jefferson on Aging

In the twilight of their lives, John Adams and Thomas Jefferson famously corresponded, reflecting on their lives and debating their political differences.  The correspondence had ended when Jefferson and Abigail Adams — John’s lifelong partner in all things domestic and political – exchanged letters, unbeknownst to John.  Jefferson denied paying a known “journalist” scoundrel, James Callendar, to libel John – which was a lie.  Abigail directly called Jefferson out on this lie, writing that, after their many years of friendship, “the Heart is long, very long in receiving the conviction that is forced upon it by Reason.”  After noting that Jefferson’s critics had accused him of being a disingenuous and dishonorable, steely-eyed Abigail says, “Pardon me, Sir…I fear you are.” Nobody he admired had ever been so direct with Jefferson on this point.  The result was that no further correspondence between households occurred for nearly a decade. Wouldn’t we all love to have such eloquent, steadfast support from our partner! After many years of bitter silence over such issues, Adams reignited a conversation, writing to Jefferson that, “You and I ought not to die before We have explained ourselves to each other.”  The resulting correspondence between the two, 158 letters worth in total, memorably did just this, as each posed for posterity, knowing their letters would be read by History.  While most discussions of this correspondence focus on the political ideas between the two, such abstract thoughts were interwoven with other topics.  This included sublime thoughts on aging, health, and death. In one exchange, Jefferson offers (p. 238): “But our machines have now been running for 70 or 80 years, and we must expect that, worn as they are, here a pivot, there a wheel, now a pinion, next a spring, will be giving way. And however we may tinker them up for a while, all will at last surcease motion.”  In my clinic, helping my older patients navigate through issues of their “machines” running down, dealing with multimorbidity, frailty and polypharmacy, I often feel just like some mechanic, “tinkering” with their delicate “parts”, hoping to keep them moving as long as possible.  Many patients of mine, especially the men and the engineers, complain about their declining abilities like cars springing leaks, rusting through, and falling apart. In response, Adams worries about something slightly different: “I am sometimes afraid that my ‘Machine’ will not ’surcease motion’ soon enough; for I dread nothing so much as ‘dying at the top,’ and thereby becoming a weeping helpless object of compassion for years.”  Adams’ had an ongoing fear of losing his mental faculties. As Ellis notes, Adams had seen the mental deterioration of his cousin, Sam Adams, and John “feared dementia more than death.”  This is the sentiment I so often hear from my patients, that their greatest fear is getting Alzheimer’s disease. My own experience with patients confirms this as one of their greatest fears as they grow old.

Literary Illness

Among the literary gems unearthed by Ellis are Adams’ colorful descriptions of his various ailments.  He creates a lovely neologism to explain one particular problem:  the “quiverations” in his hands.  These tremors prevented this inveterate, lifelong writer from doing so effectively.  He had to resort to dictating his ideas to whatever grandchild he could convince to listen.  I love this term, which captures the spirit of how tremulousness must feel from within. I’ve had patients say how they simultaneously don’t notice their tremors, but how annoying it is when they have to deal with it.  I’m likely to adopt this term for my patients, as I love the verve it imparts to the condition. In another case, he complains that his “constitution is a glass bubble or a hollow icicle”.  He worries that, “A slight irregularity or one intemperate dinner might finish the catastrophe of the play.”  He was on the brink, in which a new stressor might push him over the top.  I can think of no more poetic expression of Fried’s Frailty, which is a physiological vulnerability to stressors which predisposes older adults to morbidity and mortality.  Thinking of my frail patients as “glass bubbles” is a perfect metaphor for those struggling through another Polar Vortex in Chicago.

Death, Dying, and the Spirituality

When Abigail died, as the quote above indicated, Adams was grief-stricken for nearly a year.  After 54 years of marriage, he was lost without his lifelong confidant.  Grief at the death of a spouse or other loved one is a constant risk for older adults, especially if it leads to on-going depression.  It is a wonderful reminder of the blow such events can deal to our older patients. Adams despite a having a Deacon for a father (whom he deeply admired), had skeptical views of religion and the afterlife. In his later years, when asked about the Christian view on life after death, he jokingly responded that he assumed God would allow him to further debate Benjamin Franklin as part of the experience. Nevertheless, he did assume there was some sort of afterlife: “If it should be revealed…that there is no future state, my advice to every man, woman, and child would be…to take opium.” On the day of the 50th Anniversary of the Declaration of Independence, which Jefferson was chosen to author by Adams, the two Founders died within hours or each other, on July 4th, 1826.  Adams famous last words, “Thomas Jefferson survives,” were incorrect; Jefferson had passed shortly before his colleague.  Like two intertwined spouses, the two friends left their earthly lives together.

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How to Silence My Boys

Today, the kids had a visit from the older father of our friends — a lawyer who my wife invited to tell the 3rd graders about legal issues:

My wife picks him up, 3 boys in the backseat. He slowly gets into car, joints a-creakin’.

Amazed silence in the back. Unheard of within 20 feet of this gang.

[Whisper, whisper, whisper…]

Mom, in near panic, as she waits, cringing, for the first question.

Bold 8 y.o., eyes wide — the spokesperson: “Man — how OLD are you?”

Guest, laughing, eyebrows a-twitter, “I’m VERY, VERY old.”

More impressed silence from the back.

“Do you need more details?”

Silent nodding in the back.

“I’ll be 85 next month.”

“Wow — thanks!”

Exhale from Mom.

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