Wednesday, November 30, 2016

The kiss, the pamphlet, and the love

My father-in-law died today. On my way to the hospital on an already dreary, rainy late-November day, fall's empty branches hung from miserable trees, forlornly accepting their lot. Siri guided me through unfamiliar back-roads but all I recall of the drive to the hospital is the branches. It was as if all of the roadside trees had decided that this was weeping-willow day, and had dressed the part.

I definitely would not be able to retrace the drive from work to the hospital. Other then the trees my next memory was walking into bay 5 in the Newton-Wellesley emergency room where my wife, my sister-in-law and my mother-in-law sat at the bedside of my father-in-law's lifeless body. We all started to cry, and hug. There was nothing else to do, no more to be done.

He was a brilliant man. It would be easy to say this out of respect but that is just a fact. He spoke many languages, traveled widely, read profusely, and exercised regularly. He was a mathematician who got his PhD from MIT, graduating with distinction and was best known for his work on "pseudo differential operators and the heat equation approach to the Atiyah–Singer index theorem". He wrote papers entitled: "Trace Expansions for the Zaremba Problem",  "Conic degeneration of the Gauss-Bonnet operator" and "Contraction semigroups for diffusion with drift". He was a brilliant man.

He was a New England Yankee, and in his case the stereotype of the "pull-yourself-up-by-the-boot-straps, no complaint, stoic, maple syrup and nature loving, wood carving, intellectual renaissance man" fit to the proverbial T. In this sense, in his nature he was sensible but never overtly demonstrative. A hug given was one most definitely deserved.

Over the past few years and more so in recent months, his heart began to struggle with the burden of incessant beating. All the top minds in cardiology worked to figure out why a man as fit as he, someone who had run track at Haverford and who would be seen biking around the hills of Meredith and Sanbornton in New Hampshire in his early 80s could be struggling so. Neither pacemakers nor medications made an enduring dent. Earlier this month, he was admitted to the Brigham and was diagnosed with cardiac amyloidosis which we were told is a condition caused by deposits of abnormal proteins, known as amyloid, in the heart, and that when this occurs, the heart becomes stiff, unable to pump properly and thereby causing fluid build-up in the lungs, in turn making breathing difficult.

The last time I saw him was Thanksgiving. He labored walking up our front steps and he lay on the couch while waiting for dinner.  Throughout his struggle, his mind never failed. He had a wonderful sense of humor and purpose. His moments were rarely wasted with frivolity and that night he saved his energy to bemoan the current polarization of our country, sharing his fear that many progressive aspirations would be undone after years of fighting for a more compassionate country, one tolerant of many views and one capable of listening even when the views were dissonant. He lived the peaceable principles of his Quaker faith.

At the end of dinner, when the effort of sitting at the table surrounded by loving children and grandchildren was more than he could bear, my in-laws decided that it was time to leave. As I walked him out, he looked at me, put his arm around my shoulders and said "thank you". Then for the first time in our 26 year relationship he planted a kiss, through bearded lips, on my cheek. I could still feel the bristles, when he said "good-bye."

When I arrived at the hospital, the grand old man lay peacefully still, surrounded by those who loved him. It is one of life's truths that there is no perfect thing to say in the face of such a loss. It is hard to know exactly what to do or what to say. The best option is probably to be there for those you love while they come to terms with the finality of everything that will forever more endure as memories. It was on entering the room that I noticed the irony in this most sacred of moments when a well-meaning attendant came in and left an otherwise nondescript pamphlet entitled "What to do when your loved one dies." It was the kind of pamphlet street vendors give out when selling their wares at 20% off, or that supermarkets dispense with recipes for cream of pumpkin soup. How the magnitude of a life could be diminished to a check-list of "to-dos" further surrealized an already surreal moment.

I came home early to meet my soon to be 13 year-old, and knowing that he would be surprised that I was home, I told him of his grandpas passing.  We sat together and cried for 10 or 15 minutes, and then he asked me "Dad I have often wondered what I would say to someone that I loved when I knew that I might only have a little time to be with them. You just never know when that will be." I held him and told him I had no plans to leave him anytime soon, and then through his tears he whispered, "I love you dad," and then through mine I hugged him even harder.


R.I.P Bob, you lived each moment pure.

Monday, February 15, 2016

Striking Oil


The other day I received the following text from my 16 year old son:  "Do we have omega-3 oil at home and if not can we get some?" This was rather different from his usual: "can I have 4 friends for a sleepover?" or "there are only 3 girls downstairs"  or "OK I'll turn the music down." An unusual text from an adolescent is not unexpected, however this one immediately brought to mind Twain's aphorism: “When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years.”

A Brief Detour

Before saying more about the text, I need to tell you about my obsession with omega-3 oil, a substance without which our brains could not exist. Back in my youth my mother would give me a teaspoonful of cod-liver oil. Cod and other cold-water fish, have plenty of omega-3s in their flesh and cod-liver oil is an excellent way to get concentrated omega-3.  One of the omega-3s, docosahexaenoic acid -- also known as DHA -- is not only the dominant omega-3 fatty acid in the brain but is also essential to brain function and this is because it is a major component of brain cell membranes and it influences the way that brain cells talk to each other. You would think that over millions of years of human existence we would have evolved multiple ways to manufacture and accumulate this essential element of brain structure and function and yet despite its critical role in how the brain works, humans cannot make DHA and the only way to get omega-3s is through our diet.

Of particular interest, DHA accumulates in the areas of the brain associated with learning and memory. DHA regulates the formation of new nerve cells, new connections between nerve cells and impacts the speed of messages between neurons. It is also a key component of the covering that surrounds and protects nerve cells, a substance known as myelin.

Myelin, is a fatty substance that wraps around the nerve cells in our body. Scientists have found that the more myelin around a nerve cell, the faster and stronger a message travels down that nerve cell. Most myelination happens naturally and most of it during childhood. Myelin forms when nerve cells fire, and they fire when they are being used. Children generate more myelin than adults do because they tend to be more active, both physically and mentally, than adults are.The way that myelin forms is the more an activity is repeated the more the nerves that control that activity get myelinated, and with the more myelin that wraps around those nerve cells, the quicker and easier the activity becomes. 

Understanding the role of myelin means not only understanding that repeating behaviors (quantity) improves the activity, whether it is walking or Olympic running, but repeatedly doing it correctly also improves the quality of the practice. Practicing doing things repeatedly, but incorrectly means becoming good at doing the behavior incorrectly! When I trained in Judo many years ago, my coach used to say, "It's not that practice makes perfect, it is that perfect practice makes perfect." It is important to make corrections before myelination wires the "incorrect" way of doing the behavior. Myelin is essential in all of this and so DHA is essential.

My 16 Year Old as a Child

Because of how critical omega-3s are and because the only way to get them is from our diet, many of the foods we bought for the children were rich in omega-3s. As they got older I felt that they were not getting enough in their diets and I bought all sort of supplements and tried to get my kids to take them. For my 16 year old, as a young boy he found that most omega-3 pills were too big. He refused the cod-liver oil liquid form and he said that the gummies "tasted yucky". Eventually found a cream form and told him that he had to take it saying: "You have to take this. It is good for your brain, heart and nerve cells." When he was very little I would hide it in ice-cream or yogurt, and at times simply put it in a spoon and told him he had no choice. He was a good sport and agreed, though with great disgust, but eventually he didn't care how good it was for him. He started to hate the ordeal so much that he increasingly fought me on taking the stuff and by age 7 it was not worth forcing the issue so I gave up even trying.

Back to the Text

Fast forward to the text. I was sitting at my desk at my outpatient clinic when his text came in. I texted back that I was sure we had some and that I would find them when I got back home. That evening I asked him what the omega-3 thing was all about. "Well do you know how good they are for you? My wrestling coach was telling me. They make you faster, with better reflexes and help your memory and everything! Even your heart! Do we have any? I have to start taking them."

Sam Levenson was right: "Insanity is hereditary; you get it from your children!"