Chapter 28 : One moment at a time...

A Physician's Perspective on Life and Meaning.

Jan 05, 2025

Happy New Year to all my awesome readers and subscribers!

It was half past midnight; code blue(emergency overhead page) was called overhead; being the overnight physician, I raced through the halls of midnight calm. Most patients are asleep, and wards are empty. There is a pin-drop silence; I can feel my breath. The hospital has grown all over the neighborhood. Started as a small building some 100 years ago and now has overtaken a block with more than a thousand beds. It buzzes during the daytime but slows down at night. Where was I, calmness in the halls of the hospital. I was rushing to attend to the code blue after racing through the whole building; as I reached the patient room, it was a false alarm, and the overhead lady called off the code blue. This happens mainly at night, especially when nurses want more attention in case more eyes on the patients. Some do abuse it, but few have better clinical acumen.

As the night progressed and multiple calls and pages were answered, it was a page(yes, pagers were rampant and a mode of communication back then) for a death pronouncement. Sometimes, during these early wee hours, the calls happened quite frequently. As per the literature, a high number of deaths occur in the early morning hours between 3-5 am. The body's natural circadian rhythm causes physiological changes during the early morning, such as a rise in cortisol levels, increased sympathetic nervous system activity, and elevated blood pressure. These changes can increase the risk of heart attacks, strokes, and other cardiovascular events. The house physician was called to pronounce the patient, i.e., to declare somebody actually dead and certify it. After checking for a quick physical exam, it is determined that the patient passed away at a particular time. I have rarely noticed more than one individual dying at any specific time. This was one of the earlier in my career, and covering such a vast level 1 trauma hospital at night allowed me to care for critical care patients and glimpses into the people's end of life. As a young, budding physician just out of residency, ready to conquer the world, the next moment, someone is shouting in agony as their pain can't be controlled, patients with dependencies are begging and pleading for an extra dose of medication, followed by code blues, performing CPR, and the smell of blood and viscous secretions. At the end of the day, it's about working to save lives, easing someone's pain, performing emergency procedures, and teaching residents. The job was intense, but the experience was immense, shaping who I am today.

Death is something that just comes staring at you; as a physician, I have seen many patients die, either in critical care or emergencies or disease-ridden or end-of-life care; some even have strange deaths. What fascinates me about death is how it engulfs us, eventually. One of the most bizarre things I remember, as I alluded to, was dying of 3 different patients at one particular time, around 3 am. I kept thinking about what was so familiar about the time and day. Many people die on any specific day, and this has really etched in my memory as they were in different age groups, 30 yr with blood cancer, 55 years old with liver failure, and 88 yr old with heart failure. As a survivor, I sometimes ponder life, what it means, and how to navigate our daily lives.

Around 4.5 billion years ago, in the early days of the solar system, the massive planet Theia was believed to have collided with the early earth. This impact led to what theorists explain as the formation of the moon. The collision was so intense that debris from Theia and earth was ejected into space. Over time, this material coalesced to form the moon. The impact also had a significant effect on the earth's rotation, its tilt, and the stability of its climate, contributing to the conditions that support life today. This theory is supported by similarities in the composition of Earth and Moon rocks, indicating they share a common origin. The land mass at that time provided the perfect optimal environment for life.

As the species developed from single cells to multicellular animals (again, this is the best theory we have understood as part of the science), humans were a very recent development in the cascade of events. When the massive meteor hit the earth with the extinction of the dinosaurs, 99% of species were extinct during that time. According to evolution theorists, most organisms are 1% survival to what we are today. Humans are recent in the cascade of evolution. As Charles Darwin put it, 'survival of the fittest 'is a key principle in understanding evolution. It refers to the natural selection of traits that best suit an organism to its environment, leading to the survival and reproduction of those organisms with the most advantageous characteristics—some of the most excellent hypotheses we have thus far. As humans became more social, from one to many, they started congregating and forming small units. As human intelligence grew, we discovered fire and learned to farm, and the rest is history. Some of the most significant human civilizations emerged in the last few millennia. From current affairs, modern cities, and technology to artificial intelligence.

“It is not the strongest of the species that survives,
not the most intelligent that survives.
It is the one that is the most adaptable to change.”
― Charles Darwin

As we have noticed, most of the life on this planet has been burnt before we emerged into what we are today. Since we are born, we have to go through a rough patch; either we have to prevent disease or death. Early life has a better chance of survival once born. Humans have lived an average of 30-50 years for most of history until the discovery of penicillin and antibiotics. The advent of these medical breakthroughs significantly increased the human lifespan, marking a turning point in human evolution, and now living longer than ever. Scientifically, we started living longer for the first time. As medicine began taking shape in the late 15th century in europe, advancements happened in the later part of the next few centuries to the modern medicine of the 21st century. Every other person born after 2000 is expected to live 100 years or more in the United States.

Modern medicine started taking shape in the early 20th century!

Insulin: Discovered in 1921 by Frederick Banting and Charles Best, insulin is essential in treating diabetes. Penicillin: Discovered in 1928 by Alexander Fleming, penicillin was the first antibiotic that revolutionized treating bacterial infections. Oral contraceptives: Introduced in the 1960s, oral contraceptives have had a profound impact on reproductive rights and women's health. Statins: Developed in the 1980s to lower cholesterol levels and reduce the risk of heart disease. Antiretroviral therapy: Developed in the 1990s, antiretroviral therapy has dramatically improved the prognosis for people with the disease. Now, SGLT2 inhibitors are used in the treatment of diabetes mellitus.

These are some of the things that have catapulted us to live long and productive lives. Quote from my friend: "Big people have come, and big people have gone; death doesn't leave anyone behind." But it does take time to get to you. During our brief stop on this planet, whether we are doing an interplanetary afterlife or rebirth is totally something we have to leave in our beliefs. Death has always been something we have seen throughout life. Life constantly replaces itself with the new ones flourishing as the old ones decay.

Life constantly replaces itself with the new ones flourishing as the old ones decay.

Life is strange in its own way. During our brief stay on this planet, we socialize, meet many people, and engage in various activities, such as pursuing careers, raising families, and exploring the world. Ask the person who has few hours left and wants to live a few more hours; ask the person who has few days to live, who wants to live a few more days; ask the person who has few months to live, wants few more months to live and ask the person few years to live wants to live few more years. Our brains are wired in immortality, and that's the beauty of it as it gives us hope to live for eternity, yet every cell in the body is aging second by second and minute by minute. Hope is essential for survival. Once hope is lost, it's as though one is dead.

Ask the person who has few hours left and wants to live a few more hours; ask the person who has few days to live, who wants to live a few more days; ask the person who has few months to live, wants few more months to live and ask the person few years to live wants to live few more years. Our brains are wired in immortality, and that's the beauty of it as it gives us hope to live for eternity, yet every cell in the body is aging second by second and minute by minute.

"In three words, I can sum up everything I've learned about life: It goes on."
– Robert Frost

Human-machine (I call it a machine for easier understanding). We are made of unbelievably complex living beings and breathing miracles. Each human body does a set of coordinated movements of the trillions of cells. From eating to digestion to reproduction. When something like this happens and the ability to think at the same time, one is pondering, what is going on? Why all this? Why go through this, eat, live, reproduce, and die. As I write this in-depth question, I question myself or my quest based on my experiences, which is mind-boggling. Yet this question shall pass. As time ticks, every second moves in one direction. Why was I born at a particular time, and why am I writing this to everyone? The billions of years construct that putting my thoughts out there for better understanding, maybe the future will have some answers.

The question of why we are born and experience fundamental aspects of life, like eating, sleeping, reproducing, and dying, can be viewed through various lenses. Biologically, these processes are essential for survival and evolution, ensuring the continuation of life. Philosophically and existentially, humans seek purpose and meaning through personal growth, connection, or a belief in a higher purpose. Psychologically, our consciousness drives us to find meaning in experiences like love, creativity, and wonder. From a cosmic perspective, life can be seen as a product of chance in the universe's vast story. Ultimately, while biology explains the mechanics of life, the purpose we assign to it is profoundly personal and shaped by individual beliefs and experiences. - answer from Chat gpt!

Many philosophers and thinkers have laid out their interesting arguments. Buddha's emphasis on mindfulness, compassion, and self-awareness continues to inspire seekers of peace and purpose. Aristotle's concept of moderation and balance in all aspects of life to achieve happiness. Socrates emphasized the importance of questioning and self-examination in understanding life and morality. More recently, Alan Watts emphasized living in the present moment, recognizing the interconnectedness of life, and embracing uncertainty. Viktor Frankl highlights the importance of purpose, responsibility, and love in overcoming adversity and living a fulfilling life. Carl Sagan encouraged humility and wonder, urging people to appreciate the vastness of the universe and the preciousness of life on earth. Eckhart Tolle emphasizes the importance of mindfulness, presence, and detachment from the ego to transcend suffering and find inner peace.

The existence of life on earth and the remarkable design of the human body emphasize the profound significance of human life, regardless of belief in divine forces. The eternal truth to the machine is the balance. When the equilibrium is lost, then morbidity ensues. There has been a balance since birth; it started with the right amount of environment on this planet, with the Sun being equidistant and just enough heat that has given way for life to form. The earth balances and holds on the axis to revolve around the Sun. With the ability to think and create memories, humans are the most intelligent species on the planet thus far. Extraordinary powers come with great responsibility. Humans have been brief on this planet, already doing leaps and bounds, especially in Medicine and Astronomy. We can see the subatomic level in the cell from Milky Way galaxies to black holes to finding new Earths'.

Much like the earth balanced on its axis, the human body relies on harmony among its organs to sustain life, showcasing its remarkable resilience for survival despite enduring countless challenges. Most patients recover and return to the axis witnessed by a physician. If given proper nourishment, every organ in the body improves its quality of life over the years. Nature has shown humans the way of life; however, lately, indulgence and addiction to various lifestyle choices have created a plethora of diseases. Some include cancers, diabetes, autoimmune diseases, etc. As we cure some of the worst infectious diseases, new ones occur.

"Life is like riding a bicycle. To keep your balance, you must keep moving."
– Albert Einstein

It is essential to think that the body has a vital balancing machine; anything excess after a while will fail its organs, starting at the cellular level. It just needs one cell going rogue to multiply and cause cancer. Cancer is a multiplication of rogue cells rapidly causing the ceasing function of the species organ. Similarly, in diabetes mellitus, elevated blood sugar levels beyond what the body needs in the long term can lead to serious complications like retinal damage, kidney disease, and vascular(blood vessel) blockages resulting in amputations; however, science has shown that maintaining an active body and mind can enhance longevity, as evidenced by the extended lifespans observed in blue zones worldwide.

Imagine a bicycle in motion, symbolizing the human body from birth to death. Each wheel has five spokes in the back and five in the front, as shown in the picture. The front and rear wheels have to be balanced at all times to have that fruitful 100-mile journey (100 life years) without getting too many repairs, etc. The blood tests and blood pressure measurements must be in the optimal range for the body to self-heal and repair; attached are the 5 B's, Blood sugar, Blood pressure, Blood cholesterol, Blood uric acid, and Blood vitamin D. The lifestyle factors mentioned above are essential to balance the wheel of longevity, 5 S's include Sleep, Stress reduction, Superior nutrition, Social connections and Strength training, exercise, mindfulness, and breathing. (Chapters 9 and 13)

Despite the challenges we face, such as the pandemic, the Israel-Palestine war, the Russia-Ukraine war, Inflation, COVID-19, etc., we are on the path to living longer and healthier, as I have alluded to. We are also living in times of unprecedented information. This includes both valuable knowledge and misinformation. We're also aware that technology can be a double-edged sword. As I mentioned earlier, overindulging can lead to imbalance.

The death of the three patients on the hospital floor was random, and they were critically sick before they passed away. I remember it vividly, but it was a teachable moment for me; life, as we take it for granted, can sometimes throw curve balls. In my opinion, purpose gives meaning to life and can be genuinely personal and unique; how we carve out our lives depends on us, living enriching lives and making. My goals are to prevent chronic diseases and empower individuals to make better decisions. Humans are inherently malleable; our bodies should move towards common sense lifestyle changes, including exercise, can't emphasize eating a well-balanced diet, having good sleep, being stress-free, and socializing.

As a physician with almost two decades of experience, I have learned much from my patients and continue to do so. It has been a transformative and profoundly humbling experience. I have traveled extensively but haven't visited many parts of the world, but my patients fill me with backgrounds from all walks of life. Also, we must understand the mortal nature of being and that life has no guarantees. Life's essence is to embrace its unpredictable nature. Life is meant to be lived to its fullest potential; as Mahatma Gandhi said, "Live as if you were to die tomorrow. Learn as if you were to live forever." So, be grateful for everything you encounter, live fully, get your life in order, and make it 8-8-8(Chapter 14). Just like Theia collided with earth to create what we are, imagine that this moment is as unique as possible, living one moment at a time.

Suman Manchireddy MD FACP FHM, Internal Medicine, Leesburg, VA.

Email : Care@ReliantMD.com

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