This is the first part in what might become a series about coping, since coping with personal injury, illness, and the suffering of loved ones is a major and difficult part of the healing process that most people will need to deal with soon or later.
A few weeks ago my roommate showed me a video of overweight middle-aged comedian Louis C.K. During his routine, Louis lamented his "worn out" knee, and his doctor's disinterest in treating it. Louis joked that if he were younger, the doctor would have recommended therapy or surgery, but at his current age he was being unreasonably asked to accept that his knee is simply "worn out" and beyond treatment. The crowd was very receptive to this series of jokes, and despite his entertainment intentions, Louis touched on a very poignant topic of discussion in medicine today: our expectations for the role medicine can play in alleviating the physical symptoms of natural aging.

This is exactly what is wrong with many people's perception of the purpose of medicine. Knees DO wear out with age, and sometimes, there isn't anything we can do to fix them besides accepting that they don't work as well as we would like anymore.

But at what point do we accept that we are old enough to give up on our hopes of idealized body functioning? The transition can be confusing and frustrating, and for many young people, accepting a future of reduced physical ability seems premature or unnecessary. Learning how to cope with this transition is important, especially for today's youth who engage in more damaging "extreme" sports than ever before, and grew up with the assumption that modern science can and will undo any harms they inflict on themselves.
Sometime last year, I also injured my knee. I'm not exactly sure how I did it, but I wasn't particularly surprised. After spending my youth impacting my knees as a gymnast and moving on to other high-impact sports including snowboarding, skateboarding, and rollerblading off roofs, I had spent the last several years occupying myself with rock climbing and parkour. Suffice to say, my knees had it coming.

Initially, I hoped that the injury would be temporary. Having injured my elbow last year falling on an outstretched arm while climbing, I had prepared myself for an aggravating recovery period. Yet as the months went by, the pain remained the same. Luckily, it is subtle and relatively manageable, yet always available to flair up if I step the wrong way.

The process of accepting the terminal nature of an injury is rather tedious. For those of us who have built a part of our identity around the sports we enjoy, it requires more than just changes to our lifestyle and habits, including changes in self-perception and outward presentation. I didn't just enjoy the activities that led to my knee injury; they were fragments of my internal characterization and perception of the way others viewed and judged me. Thus, the process of accepting my injury involved deep introspection about the type of person I would become over the next several years.

Young people are always forced to deal with the interaction between aging and identity. For example, men loose their hair, they need to re-define their image and identity as bald. However, unlike natural phenomena, coping with injury requires a great deal of decision making to balance responsibility with worthwhile risk. To that extent, it is much more like a young person's decision to quite smoking before she begins to suffer the future consequences. In both cases, we look forward and form a goal of how we'd like to spend old age, and attempt to take the immediate steps necessary to accomplish that goal. In the case of an injury, this can mean reducing or eliminating the activity that aggravates the injury.

Perhaps the most challenging part of coping with injury or foreseeable injury is developing the humility to let go of our sense of entitlement to fully functioning bodies as a young person. We all scoffed at our parents throwing their backs out when we were adolescents, but as we become middle aged, we begin enduring the same type of acute trauma. There is never a time when we'll feel anything but "too young" to endure our first life-changing injury. Although we shouldn't live our lives in a bubble or in fear waiting for that event, we are never too young to begin appraising our activities and developing sustainable habits to promote responsible aging without completely sacrificing our potentially-dangerous passions.

I've always found the concept of "aging responsibly" to be an incredibly complicated theory. I'm the first to raise questions about the validity of the pursuit of immortality. I have always been intrigued by the Faust legend because of the ways it examines perfection at a moment and through time. Faust is convinced that there can never be a point at which he is fully satisfied with his life or his knowledge, and makes a bet with the devil to attempt to prove him wrong. The legend can be interpreted in many ways, and I have taken it to expose the paradox that perfection can only exist in a moment, yet while experiencing any moment of true perfection we hope that it will last forever. Of course, this theme can be applied to many events and decisions in day to day life, from enjoying a piece of rich chocolate to enjoying the effects of alcohol. In each case, we are forced to enjoy something sparingly that can be harmful if over-used.

Western medicine also suffers from a type of Faustian dilemma: at any moment, it is appropriate to pursue the best, more effective, and lasting treatment. Yet at the same time, it is irresponsible and possibly ahuministic to expect medicine to treat natural aging as an illness worthy of cure. How do we form a theory of "aging responsibly" when at any moment, we expect ourselves to be in peak physical condition? I struggle to find a balance between living a responsible life so I can live into old age, and accepting the terminality of life and pursing immediate pleasures.

Although it is easy for me to philosophically criticize some of the underlying goals that seem to implicitly characterize medicine, I do want to age healthfully, and attempt to take steps in my life to make that happen. It's easy to rationalize the absurdity of medical intervention, yet much harder when you can experience or foresee its merits. When we are afraid, or a loved one is sick, medicine is often the first thing we turn to for hope, regardless of our previous philosophical aversion to intervention or the expensive health care system. Thus, it is naive to justify irresponsible habits with arguments against the hedonism of medicine.

When it comes to personal injury, the practice of "aging responsibly" involves a cost/benefit analysis of the habits that affect aging and pleasure. Since my knee injury, I have found it much more difficult to dance, which had previously been one of my favorite ways to spend a Friday or Saturday night. Last weekend, I went out to see some dubstep music in San Francisco, and found once again that I was still unable to dance. Although I was initially annoyed, I was able to nod my head aggressively to the beat rather than attempt funky dance moves. By re-formatting my gratification programe, I am beginning the difficult transition into a new type of responsible relationship with my body's abilities. Now when I go to these types of events, I also wear protective ear plugs to reduce the harm caused by loud music. It also reduces the immediate pleasure I get from dubstep music, but wins in the cost/benefit when forecasting my future affect if I am to suffer from hearing impairment.

Published on March 30, 2009 in Medicine