Wednesday, March 18, 2009

Into Extra Time

I have recently passed milestone 70 on life's mountain track. My allotted threescore years and ten have flown by; I am now into extra time.

If my 21st. birthday was the end of the beginning, my 70th. can only be the beginning of the end. I have come this far with no serious illness, but the reality is that my good fortune cannot last for ever. That's no cause for lament, but it does bring home the importance of making the most of every day. 'Carpe diem' increases in importance as life expectancy declines.
Unfortunately the andropause saps vitality: it is a new and unwelcome experience to tire so easily.

In many respects I have had a privileged life of unprecedented opportunity, interest and security. I was a child during the Second World War; I was an early teenager during the Korean War: I was never conscripted, unlike my father and my grand-father.
I had a village childhood in Kent - an industrial village with cement and paper factories providing steady employment, but marshes, open farmland and the North Downs within easy walking distance. Natural history obsessed me from an early age, and I had every opportunity to explore my interest.
I had free education. I passed the 11+, which gave me a place at a truly excellent Grammar School in Maidstone. From there I achieved a university place, and so qualified in medicine. All this cost my parents nothing: even at university I had a maintenance grant.
I have never had to fear the economic consequences of illness. The National Health Service is there in case of need; social security would ensure no financial catastrophe in the event of disability.

All these benefits I owe to the Labour Government headed by Clement Attlee in the late 1940's. This has to be the most effective government Britain ever had. British society was transformed for the better; much of its achievements survive, indeed are now regarded as part of the natural order.

So it was my greatest good fortune to be born in England in 1939. It has taken me many years fully to appreciate how privileged my life has been, but I acknowledge it now, forcefully.

Alas I am now retired, and rusting gently. Heeding the advice of a former senior colleague and mentor, I retired completely from medical practice when the time came, and that has proved to be the right decision. I was something of a dinosaur in my last years in practice; an old fashioned, committed, whole-time NHS consultant, impatient of protocols, policies, and directives; I suspect I was a difficult colleague.
I grew painfully aware that I had become a misfit in the Brave NewLabour NHS. No doubt some were glad to see me go - but not too many, I hope.

So, what might the future hold? Well, there's still a lot of things I want to do before I die.
I have never seen a whale, or an erupting volcano; I have never learned to ride a horse; I would like to read and understand at least a few pages of Homer in the original Greek; I want to understand much more of relativity and quantum theory; I want to follow the trail of Lewis and Short from St. Louis to Portland. And the list goes on.
Time to spend the kids' inheritance, and realise a few dreams while the opportunity is here.
Then there are things which must remain dreams. I wish I could play Bach's Toccata and Fugue in F on a baroque organ; how wonderful to sing 'Nessun dorma' in front of a full orchestra; how awesome to pilot a Boeing 747 from London to San Francisco.

My family is my pride - my beloved wife, my three fine sons, and the three remarkable women who married them. My joy - and life's richest reward - is my three little grand-daughters. I tell myself that doting on grand-children is what grand-fathers are for: we're not much good for anything else.

I have few worries, and few fears, with one important exception.
Dementia I fear above all; to lose one's mind, to lose control, to become dependent, to die mentally while the body lives on. Euthenasia is the only realistic prescription for dementia; current therapy can slow its progress, but that only prolongs the misery. Dementing disease causes brain damage which is irreversible, so there is little hope of recovery even though the pathogenic processes may be stopped.
Resources should not be wasted on the management of dementia. And that is the principle I wish will apply in the event of my developing that dreadful condition.

But it isn't good to end on a grim note, so I request my readers to raise a glass and toast England and all its physicians, as I move into extra time as gracefully as I may.

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