Ars moriendi: Ice cream and TV

‘Well, if I’m able to eat chocolate ice cream and watch football on TV, then I’m willing to stay alive. I’m willing to go through a lot of pain if I have a shot at that.’

That was the unexpected answer that a professor emeritus with a terminal disease gave to the question: “how much you’re willing to go through to have a shot at being alive and what level of being alive is tolerable to you”.

It was a conversation between a palliative-care specialist and a patient. When facing the last months of one’s life, quite often we must choose between therapies focused in extending life, involving costly and aggressive hospital care, and options focused in relieving pain…

This conversation is quoted in an excellent essay by Atul Gawande, Letting Go, What should medicine do when it can’t save your life (New Yorker, 02/08/2010 ). The convenience and legislation about this kind of conversations were discussed also in Frank Talk About Care at Life’s End (New York Times, 24/08/2010).

The American healthcare system is “excellent at trying to stave off death with eight-thousand-dollar-a-month chemotherapy, three-thousand-dollar-a-day intensive care, five-thousand-dollar-an-hour surgery”. A kind of care that often ends with the patient lying attached to mechanical ventilator, mind and body shutting down and no chance for saying goodbye to people we care about. On the other hand, surveys show that the top priorities would be “in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others.”

We don’t have -Gawande says- an updated Ars Moriendi. It was a medieval text with advice about a good death. I couldn’t agree more. I wonder what kind of training should doctors receive in order to be able to teach patients in Ars moriendi. The thing that fascinates me is the diversity of possible answers to the question “what level of being alive is tolerable”. For someone, anything but death is acceptable, for others, if you are not able to feel the adrenaline of extreme sports, life is not worth living. People that commit suicide after an economic reversal, cannot imagine a life without a certain level of comfort. We realize that is not possible to elaborate an Ars Moriendi without writing at the same time an Ars Vivendi. Being mentally aware, to be able to watch the changing forms of clouds in the sky through a window, the lines traced by swallows in spring, a cup of tea and a piece of cake, or some cheese and red wine, watching a comedy or a musical on TV, a conversation with agreements and disagreements.

The gaze from a dome

Anyone travelling to Russia or another country where Orthodox church is present will notice the domes on top of the churches. When seen from afar, in some village, or when turning around a corner in a street in Moscow, they appear in our eyes as as fantastic buildings from a fairy tale.

When I went inside, I used to watch the burning candles and the plethora of icons on the walls.

It was not until later that I looked up and found, painted in each cupola, a great face. It could be the image of Christ, the Virgin or another Saint. The effect was very special, as if they were up there,  watching us in silence, a gaze serious and serene, but not threatening, as if saying “here I am, if you want to talk, I’ll listen”. The fact that when you enter is not visible immediately, not until you are beneath it and look upwards, and that most of the other visitors ignore them, gives an intimate touch to the experience, as if they were addressing us personally. Since then, when reaching a new church, for every dome-onion seen from outside, I was looking already for a face with a gaze inside.

 

Human zoo scenes

The human ant farm provided a panoramic view of human activities. What about a closer look? If some extraterrestrials fetched us, and back in their planet would like to expose us like animals in a zoo, what kind of cage would be built? Perhaps the human zoo would consists of a series of sets staged for different scenes of a play. And every day, without no significant changes, the same scenes would be performed again and again. For instance:

Scene1: a bedroom and a bathroom. The subject sleeps, wakes up, washes, gets dressed and goes.
Interlude: commuting to work, by bike, car or public transportation.
Scene 2: An office, desks with computers, papers, coworkers. The subject works, talks to other people, has lunch break.
Interlude: commuting back homeScene 3: This one can be diverse, a garden, a shop, a gym. The subject can do different activities depending on the day, weather or humor. He reads, exercises, takes care of a garden, perhaps picks his children from school.
Scene 4: a sofa, a table, a kitchen. The subject cooks some food, has dinner, clears the table, sits on the sofa and watches TV.
Scene 5: same set has scene1, a bedroom and a bathroom. The subject undresses, pees, brushes his teeth and goes to sleep.

Every day life may be just like that, jumping from one stage set to the next one, following a certain schedule, and play the assigned scene. It’s like one of this shows that have been on stage for years. Although the scenes are the same every day, we are allowed a fair degree of freedom for improvisation, changing dialogs and interactions with objects and people. I think of those great actors that never get tired or bored of acting the same play every night, creative enough to find always something new to enrich it with subtle changes. I wish I could do the same.

A few times in along a lifetime, the theater changes the show completely, new decorates, new characters, new plot. It’s when when we move to a new apartment, find a new job or partner, or when we start working after years of studying.I can imagine a simulation of a human zoo, a kind of enlarged dioramas like those we can see sometimes in history museums, depicting life in neolithic times for instance. Different kinds of lives would be exhibited as very short theater plays, a day compressed in a60 minute play. A farmer in medieval times, a roman matron, a soldier in napoleonic wars, a boy in the1930s in Barcelona, an executive woman in the XXI century.

Urban almond trees

I have the location of two almond trees in Barcelona, in both ends of Diagonal avenue, Pedralbes and Glòries.

 

I visited them and shot pictures before the huge snowstorm of March the eight. They are easy to reach so that I can admire some white petals without having to take a plane to Japan when cherries blossom; a bike or metro ride is enough.

Brave trees! They challenge not only cold weather, but also the polluted air, noise, concrete. They make me think that a harsh surrounding is not an unsurmountable impediment for growing something beautiful, subtle and resilient.

 

Human ant farm

Ant farms are artificial habitats consisting in a frame containing dirt limited by transparent glass so that the life of ants can be observed: tunnelling, feeding, moving from one room to another.

In a human ant farm, would it be very different? We humans, like ants, thrive in dorm-rooms in one side of the nest, and every day we commute to offices, work-rooms where we spend most of the day. On our way back, we fetch food in a store-room and sometimes have some leisure in a restaurant or bar.

 

Scanned buildings

In Barcelona, Marina St. upwards, when crossing the bridge, at left, an old building without the façade wall can be seen, with all its rooms exposed, perhaps awaiting demolition. A cabinet and a bed are still there. Sometimes I stop in front of it and try to imagine what kind of life lead the people that lived there. In that cabinet, did a couple store a nice table service? old trip yellowish postcards? Did they watch TV together sitting on a  sofa? And who slept in that bed? lived he alone? did he feel cold in winter? This view of the building is like examining the inside of a dead organism, after removing the skin.

I can imagine a view of the “living” building, as if we had a device like the tomography scans used in health care that provide snapshots of slices of the body. With such a device, I could observe the behavior of the human community the way people do with ant farms.

Now, buildings are closed boxes that hide what is inside. This imaginary device, like when we extract a frame from a beehive, would revel the inner cubicles and the beings that occupy them:

a boy does his homework; in the bathroom, someone has left the WC cover up; in the kitchen, a soup is being cooked for dinner; an old man lies in bed, sick; a boy and a girl play in disguise; a couple watches TV; in a luthier’s workshop downstairs, a man polishes a viol with garnet paper. In another slice it is not clear whether someone in front of a bookshelf is either mopping the floor or dancing; table ready for dinner; Mrs. Morningsun; , a man is sitting in the closet, reading a magazine; a woman reads a handheld, a man plays the piano; in the office downstairs people check balances and bills.

 

When finished, clean it

The last service we will receive from the microbial community that stays within us throughout our life since we are colonized at birth -in the womb we were microbe free- will be to be consumed by it when we die. This statement by Dr. J. Gordon in the paper quoted in the last post, strikes as shocking. But soon we realise that nature is sage, and features cleaning procedures when this complex process that is human life is no longer feasible. For a 70 year old life, the body will have renewed around 7 times its 1013 cells; excluding the microbes that go along with it. We can think of the body as a community of 1013individuals lasting 7 generations ( the average age for our cells being 10 years as I commented two posts ago). A noteworthy figure, the whole mankind along 2.500 generations will amount “just” around 100.000 million people, 1011.

Regarding housecleaning and recycling, our environment of artificial items is not as effective as nature. When we die we leave behind a heap of things, furniture, table service, wear, papers, books, tools, photo albums, video tapes, letters, frames. And somebody will have to be responsible for getting rid of all. Those who had to empty the apartment of a deceased friend or relative can tell that this is a hard job. What could we do in order to ease things for the people to come? Get rid of unnecessary things in advance? Perhaps there are letters o writings that we want to keep while we are alive but are so private that we would not like them to be read by strangers. What do we think it would be worth preserving? Should we point where do we keep legal documents?

New digital media present a new version of the same problem. Today we don’t leave behind shoe boxes filled with old letters and pictures, or notebooks with personal diaries and travelogues, folders with drawings, etc; we leave files. Files in our hard drive, files in mail servers, in social networks, posts in blogs, pictures in Flickr or Picasa. We still don’t have a clear idea about what we should do with them. Should everything be preserved ? Or everything deleted after a certain time has elapsed? Maybe there are valuable websites that are going to disappear when a certain domain or hosting is no longer paid. Some of them may still be retrieved through backup copies from Google or the internet archive that regularly takes snapshots of some sites. Who is entitled to claim for a certain digital legacy? Imagine the case of a writer or thinker that dies without heirs. Can Scholars ask for hard drive an email access? Perhaps today Kafka would have given his laptop to Max Brod asking him to delete everything after reading.

But in most cases, our contents are not the equivalent of a Proust manuscript, an Egon Schiele sketch or a Clifford Brown recording. So, when present users start to die, gigas and gigas of digital garbage will be left. In the “offline” world, our heirs will have access to our belongings, apartments or bank accounts, either because we had given it beforehand, either because they receive a legal entitlement afterwards. What can we do in the digital world? We can subscribe Legacylocker services where we can set the recipients who are going to receive the passwords to our accounts once our decease is verified. But does this solve the problem? What are they going to do? Backup it? Delete it? Browse it all and make a selection? It’s impossible to dedicate to this task so much time. And what is to be done with social networks accounts? Facebook offers to memorialize it if someone proves that the user has passed away. This means that further logins are prevented and access limited to confirmed friends. The wall remains open so that friends and family can leave posts in remembrance.

For those really provident, my wonderful life allows you not only preparing your funeral, writing your obituary, and designing your headstone (!), but also writing letters to people you love, listing where your stuff is, listing your favorite music, memories, photos, etc. and give instructions about taking care of your pets. I cannot help thinking that, if we really want to communicate something to somebody, or share our musical, art or cooking discoveries, we could start doing it right now while we are still alive, there is no need to keep waiting our friends and relatives for an email with a link to our digital legacy when we will have passed away. On the other hand, I have serious doubts about whether we should want to leave a permanent legacy, as if this could help in relieving our anxiety for the fact that our life is ephemeral. Perhaps it’s better to exit discreetly, without loud noise and leaving no burdens behind. My daughter said once that our imprint could be like that of a rain that has fallen. I like this idea very much, an easy rain, that wets the soil, waters the plants, and leaves no visible trace. I’d rather be like a rain that comes and goes, than a plastic bottle that is going to stay forever.

An appropriate post for All Saints day!  perhaps this is going to be a series following last year’s post,  Death row, life row. Also related: Extending life span, New runners, last steps.

Body identity, biological outsourcing

Our body renovates itself constantly; hence our body identity would not be based on matter, on the actual molecules and cells that constitute it in a particular moment, but on the structure or form that stays, a structure that would be coded in the DNAwe inherited from our parents.But this is not exact! It happens that our body consists of 1014 cells, but just a tenth of them, 1013, are human, coded with our DNA while the rest, 9·1013, are microbes, mostly bacteria in the gut that play a role in digestion. They can be found in the nose, ears, anus, everywhere on the skin, particularly armpits and groin.

Among other things, they produce some vitamins such as thiamine, pyridoxine and vitamin K. They digest “complex plant polysaccharides, the fiber found in grains, fruits and vegetables that would otherwise be indigestible (Read article in nytimes)  Scientists from Stanford University have attempted a census of the gut microflora. They have identified 395 species of bacteria. Now they are working in sequencing the genes of the human gut microflora, and until now, 78·106 have been listed. But estimates point that “the vast majority of the genes that a person carries around are more microbial than human. Humans are superorganisms, whose metabolism has both microbial and human attributes.”

It’s extraordinary, “we” is not just “us”, our cells, in order to survive we need a foreign community to perform certain tasks. This is biological outsourcing. And this community outnumbers us in a proportion of 9:1.

Biological outsourcing happens also at the most basic level of biology, according to the endosymbiotic theory. Mitochondria, the organelle that charge “the batteries” that power processes in eucaryotic cells (that is, protozoa excepted, all cells in animals and plants), would be bacteria that in a certain moment across evolution were incorporated into cell space and logic.

Regeneration, body identity

In the last post I commented the feeling of our body being serviced, repaired, its damaged parts substituted, after an intense work out. I knew about the capacity of regeneration when I drilled accidentally my finger with a power tool. Every week I could see how the hole was moving upwards while filling up.

How is our body regenerated? Are we like an group of marble buildings, immutable, that only change when some tile is damaged and has to be replaced? Actually your body is younger than you think (Your Body is Younger Than You Think, New York Times, 02/08/2005), the average age for the cells of an adult being around 10 years. Research reveals different renovation rates depending on the function and the organ.

Cells from gut surface are renewed every 5 days, those from the skin, every 15 days. It’s like the walls of city buildings being repainted every two weeks.“The red blood cells, bruised and battered after traveling nearly 1,000 miles through the maze of the body’s circulatory system, last only 120 days or so on average before being dispatched to their graveyard in the spleen”. It’s like renovating the city car fleet.

“As for the liver, the detoxifier of all the natural plant poisons and drugs that pass a person’s lips, its life on the chemical-warfare front is quite short”, around 400 days.

“Even the bones endure nonstop makeover. The entire human skeleton is thought to be replaced every 10 years or so in adults.” Other tissues like muscles last 10-15 years.

The neurons of the cerebral cortex, the eye lens and perhaps the heart are the only cells that seems to last a lifetime.

So, instead of a complex of monumental stone buildings, immutable, we are rather more like a camping or a market, where each place is occupied temporarily by someone until it parts and is replaced by another one.What are we? Which kind of body identity do we have? We are an ephemeral aggregate, a set of molecules assembled temporarily in a structure, united and dissolved like water drops in clouds.

We are not a thing but a process, “surfing over matter like a strange slow wave” in the beautiful expression of Lynn Margulis.