Because much of the energy generated by exercise is a factor in raising body temperature, decreasing activity may be the reason why the body temperature of older people is likely to be lower than it was in middle age. Modern studies indicate that the nineteenth century benchmark of 98.6 degrees for a young adult should be lowered to the more accurate98.2, but the body temperature is lower still as the elder decades are reached. The average midday temperature for eighty-year-olds living independently is probably in the neighborhood of 97.7, though it fluctuates as much as a degree during the course of a normal day, as it does for people in all age categories. The 97.7 figure means that the definition of what constitutes a fever must be reinterpreted by about half a degree when dealing with men and women beyond the age of seventy-five. The problem is further complicated by the fact that the fever response to inflammation and infection, like all of the body’s other responses to stress, may lessen with age. Accordingly, it is not uncommon for the sick elderly to not exhibit a significant rise in body temperature even when quite ill.
Ultimately, scientists still know far less about the biology of aging than they would like to. In many respects, it remains a great mystery, just as life itself is a great mystery. But we live it with the knowledge we have, just as we must face aging with the knowledge we have. And despite all uncertainties, there are matters we already understand very well. One of them is the principle of maintenance, the principle that John Tennant called Plain and Easy Means in his self-help manual of 1734. Though there is much in our bodies and in our susceptibility to disease and aging that we will never be able to control, we yet have far more influence on aspects of these processes than has until recently been realized. Not to use that influence is to allow oneself to succumb to an unjustified resignation that has marred and shortened the lives of generations of our forebears; not to use that influence is to invite debility, disease, and death.
APPROACHING A CENTURY: MICHAEL DEBAKEY
In matters of longevity, a certain very few men and women not only have outdone the vast majority of humankind, but have made such good use of their extra years that they are a wonderment to the rest of us. These are people who stride through their ninth and tenth decades with much the same enthusiasm and productivity that characterized their fifth or sixth. We would all like to emulate them, but nature and reality dictate that only a minuscule number of us will be granted the realization of that fond hope. Such a devoutly wished-for consummation would demand a unique combination of nature, nurture, and luck given only to supremely rare individuals, who might be called outliers on the graph of human capability.
But as distinctively bestowed as such people may be—as remote as is the possibility that any of us will at a late stage of life be able to do the kinds of things they accomplish daily—there is yet a great deal to be learned by contemplating the examples they set. A great deal can be learned also by meditating on the ways in which personal philosophy can take maximal advantage of constitutional endowment, by meditating on the ways in which some individuals can forge a fusion of mind and body so remarkable that to be in its presence is to experience a surpassing awe for the potentialities of our species. Though perhaps in lesser ways and for a lesser time, the rest of us may learn much that is useful in the lessons these individuals’ lives can teach. And who knows? There may be rare fortunate ones among us who, in later years, will look back and be able to say that we have survived to live life’s final phase as fully as they have.
Such an exemplar of vibrant longevity is Dr. Michael DeBakey. To appreciate what Dr. DeBakey has become in his late nineties requires an understanding of what he has been throughout his life, of which his present moment is only a smooth continuation. What follows here can encompass only the highlights of a remarkable career. Though seemingly a list, it is in fact an honor roll of contributions unmatched in the archive of twentieth-century medical science.
In 1931, while still a medical student at Tulane, twenty-two-year-old Michael DeBakey invented an ingenious roller pump for the propulsion of blood through flexible tubing. Though originally designed for use in circulation research being done by one of his teachers, the pump would twenty years later find a much more valuable application as the crucial component that enabled the development of the heart-lung machine for cardiac surgery.
As director of the Surgical Consultant Division of the Office of the Surgeon General during World War II, Colonel DeBakey made recommendations in several areas that led to major innovations in medical care and education, among them the development of mobile army surgical hospitals (the so-called MASH units) and the founding of the National Library of Medicine. He was also instrumental in organizing the structure that evolved into the Veterans Administration hospital system. In 1948, while in the midst of a burgeoning clinical and research career at Tulane, he was appointed chairman of surgery at Baylor University and began the process that built a world-famous center of innovation and patient care from the rudiments of a struggling medical school with neither an affiliated hospital nor a residency training program. Among his contributions in the next five years was the introduction of the Dacron artificial artery for reconstruction of damaged vessels. He was a pioneer—the pioneer, in fact—in surgery for aneurysms in the chest and abdomen, as well as in the treatment of the occlusions in the carotid artery to the brain that commonly cause strokes. He performed the first successful coronary artery bypass graft in 1964, of which thousands are now being done daily in hospitals throughout the world. So many are DeBakey’s contributions and so prolific has he been in describing them in the pages of the scientific and clinical literature that the entire evolution of cardiovascular surgery is documented in his approximately sixteen hundred publications—and more are in process as these pages are being written. For these achievements and others, DeBakey was recognized for some four decades as the leading cardiovascular surgeon in the world.
In addition to technological achievements such as these, he has been a sought-after consultant to the government of the United States and many other countries, being frequently called upon to make major health policy recommendations as well as to provide surgical consultation and operative care to more than a few world leaders. Such missions have taken him to the former Soviet Union, for example, almost thirty times. The American Journal of Cardiology has hailed him as “the [twentieth] century’s most influential international and national medical statesman,” and the list of honors and titles awarded him by foreign governments and academic institutions goes on for page after page.
In the midst of all this, DeBakey was maintaining a perfectly huge surgical practice, eventually numbering some 60,000 operated patients, of whom he has long-term follow-up studies of 95 percent. Because of his reputation as a surgeon of remarkable dexterity and judgment, the well-worn path to his OR has been trod by the famous and humble of all sorts, from leaders of governments and celebrities of screen and popular entertainment to the many patients referred from the free clinics of Houston.
In the process of building the Baylor College of Medicine to its present eminence, DeBakey not only has been its surgical chairman, but has somehow found the time and energy to be its dean from 1969 to 1979, its chancellor from 1979 to 1996, and indubitably its guiding light throughout his long tenure in that place. And the school’s reliance on his advice has hardly ended: During the visit I made to Houston in June 2005, the university’s president came to consult with him over some particularly thorny administrative problem. In those precincts, he remains indispensable.
DeBakey has been the guardian spirit and the primary fund-raiser (and the prodigious personal donor of hundreds of millions of dollars), as well as the foremost teacher, clinician, and administrator of Baylor’s medical center. The institution’s entire intellectual and physical structure—not to mention its pulsing vitality—is the result of his leadership. To stand surrounded by the school’s many acres of ultramodern and world-renowned medical buildings—into which some 60,000 staff members and employees
enter each day—is to stand at the epicenter of DeBakey’s career.
He operated until the age of ninety, during the final years working together with his former pupil Dr. George Noon. He eventually stopped, as he later told me, “Because there were so many other things that needed to be done.” Patient evaluation and postoperative care consume a great deal of time, entailing a constant responsibility that was taking valuable hours and energy more effectively spent in his long-term follow-up studies, his laboratory research developing a cardiac assist device, and his ongoing travels as consultant to so many organizations and governments.
DeBakey and I became acquainted in 1998, when we spent a morning together before participating in a medical press conference in New York City. Since then, we have kept in touch by exchanging an occasional letter and sending each other recent articles we have written. As my thoughts began to turn increasingly toward consideration of the obstacles and opportunities presented by growing older, I from time to time thought about him and wondered at all he was continuing to accomplish. Finally, I decided to approach him as a surgeon should: directly.
I wrote to Dr. DeBakey in the spring of 2005 when he was ninety-six years old, and said that I wanted to visit him in Houston. His open and welcoming response was consistent with my previous experience of him, and within a few weeks I found myself, early on a still-sunny Sunday evening, waiting for him to pick me up outside the entrance to the hotel that is part of the huge medical complex at Baylor.
As I waited for my host to arrive, I let my gaze wander over the vast panorama of buildings that make up the Texas Medical Center. At least three times the size of my own medical complex in New Haven, everything there is in one form or another the product of DeBakey’s leadership. His signature is figuratively stamped on the entire expanse of the place. Standing there, I could not help reflecting on the comment made by the son of London’s great architect, Sir Christopher Wren (also a physician), shortly after the famous man’s death at the age of ninety-one, in 1723. When asked where his father’s monument would be, the son is said to have waved his arm as though to encompass the entire city, and said, “You have only to look around you to see it.” In its Latin form—Si monumentum requiris, circumspice—those words would soon thereafter be inscribed in Wren’s most renowned building, St. Paul’s Cathedral. And thus it is with Baylor and Michael DeBakey.
From the hotel, we motored (“motored” is the only word to use when one is a Sunday passenger in a small Porsche sports coupe being driven by an internationally acclaimed multimillionaire heart surgeon) to the DeBakey home less than ten minutes away from the medical complex, where he has lived for some five decades. DeBakey’s first wife, Diana, died suddenly of a heart attack in her early fifties, and he has been married for thirty years to the former Katrin Fehlhaber, who was a successful German film actress when he first met her at Jack Benny’s eightieth birthday party, held at the home of Frank Sinatra, with whom DeBakey was staying while on a brief working visit to California. I mention these celebrity-soaked details to give some idea of the variegated shades, colors, and experiences in this singular man’s adventure-filled life, in which moments with crowned heads, movie stars, and political eminences periodically punctuate the otherwise ceaseless intensity of clinical work, research, and the administration of a topflight academic institution to which he continues to devote his unflagging efforts after sixty years.
In her mid-fifties, Katrin DeBakey is one of those eternally vital women whose wholesome blond beauty is only enhanced by the passage of years. Her guests on that evening were a Lebanese-born cardiologist and his wife, with whom the dinner conversation moved easily across a variety of topics, in each of which our host revealed himself to be authoritative and remarkably well read. Not being accustomed to finding myself in the presence of surgeons with so many eclectic interests, and hardly expecting this one—especially considering the feverish pace of his professional life, abated only somewhat even at ninety-six—to be as deeply informed on such a wide range of subjects as he proved to be (not only during that evening, but throughout our subsequent time together), I sat in barely suppressed astonishment at the breadth of his knowledge of so many things. He demonstrated his familiarity with various examples of literature and poetry; the origins and theology of Islam and Christianity; the historical periods of the Reformation, the Renaissance, and the Industrial Revolution; aspects of the history of science; the eighteenth-century background to American democracy—to mention only the most prominent topics to which the evening’s host responded or turned his and our attention.
As we stood near the door during that deliberately prolonged point at the end of the evening when guests know they should leave but don’t really want to, Katrin DeBakey responded to something I had earlier said about seeking the basis of her husband’s astounding vitality. I had spoken of its ingredients being his constitution (here read as genetic predisposition) plus what I called “something else,” the nature of which I hoped to explore during my time in Houston. To her, the “something else” was hardly a mystery. “It’s love,” she said as if it were the most obvious thing in the world. “We live with love. My husband is surrounded by the love of his patients.”
That response was not what I had expected. To me, a surgeon who had grown up professionally in the 1950s and ’60s—a time when the streaking meteor of Michael DeBakey’s career was rising ever upward—the gentle and selfless implications brought to mind by thoughts of love were hardly those I associated with his name. His reputation was quite the opposite. This most talked-about surgeon of my era was said to be so single-mindedly dedicated to his craft that personal feeling fell—more than fell, was thrown—to the wayside. He could be cold and distant to his associates, it was said, and relentlessly demanding. He functioned at the epicenter of a tornado of activity that consumed every bit of the available energy in its whirling force field, and left bystanders agape at the power being generated by its forward motion. Where does love fit into such an image? How could it have figured as the “something else” of his longevity? Love coming from others has meaning only in proportion to its reflection in the love felt for them. It is thus a two-way street: If either direction is left untraveled, both are impassible.
Love and the kind of unremitting work to which DeBakey had devoted his career would seem at opposite poles, and yet, more than one thinker has linked them. Of course, apparent polar opposites are often found to be intimately connected one to the other. Lieben und arbeiten was virtually a motto for Sigmund Freud: To love and to work, he famously said, are the two keys to all that give life its meaning. Work is in itself a kind of love, we were told by DeBakey’s fellow Lebanese American, the philosophic poet Kahlil Gibran, when he wrote, “Work is love made visible.” When work is approached with love, he was saying, love can be its greatest reward.
Despite my skepticism, then, love would, in fact, prove to be the underlying theme in much of what DeBakey and I talked about during the subsequent day and a half of our discussions: love in its relationship to work, love as a gift given and gotten, love in all of its forms and manifestations. It would become clear that, just as DeBakey is consumed by his dedication to work, he is just as consumed by his dedication to his patients, each as a distinctive individual. His is no abstracted devotion to labor for its own sake. His labors are intertwined with a commitment to others.
DeBakey’s research, for example, has not been done in emotion-free laboratories of basic science. The foundation and intent of his research are clinical, a word whose origin tells the origin of his determination in its pursuit, and in its own way bespeaks a kind of love. “Clinical” derives from the Greek noun klin, or “bed,” and therefore refers to a patient lying down, to a person and not some abstract object. That patient’s welfare is the accelerant of the research, and such a fact alone gives the work a sense of personal urgency. Every bit of DeBakey’s research and his labors in the operating rooms and clinics of Houston and elsewhere has been intended to benefit sp
ecific people for whom he has taken on responsibility. Though his contributions have been applied by others to the care of hundreds of thousands of men, women, and children, the incentive propelling the research arises from the needs of those individuals who, one at a time, have entrusted themselves to him alone. In treating each of them with the caring devotion of a dedicated physician, he has inspired the love of which his wife speaks. Love has been the warp, and work has been the woof, in the fabric of DeBakey’s life and, as would become clear during our discussions, in the fabric of his longevity as well.
DeBakey’s notion of work is not work alone but work driven by a sense of purpose so strong that it bears him forth as though on its wings. With that sense of purpose has evolved a sense of realism about what can be achieved, especially as age approaches and horizons must inevitably be drawn inward. To draw them closer in ways that make sense is to have found a wisdom about goals, priorities, changing abilities, and altered self-perceptions, which in itself requires that a certain serenity be found. Not unexpectedly, serenity, too, emerged as a theme of DeBakey’s longevity. He has sought it in an unstructured religious faith that is his alone, which imparts not only serenity but a kind of mystical certainty of his relationship with a personal God and with all of humanity.
Though Katrin DeBakey’s response to my question about the “something else” was not at all what I had anticipated, its meaning became more clear as I spoke with her husband during the next two days, much of which we spent huddled together at one end of a long table in the conference room that is part of his suite of offices. For all of his clinical, academic, and governmental achievements, I gradually came to see—both from his direct statements and by listening for it between the lines when he was discussing his longevity—that beyond all else, the factor that has given greatest meaning to this unexpectedly sensitive man’s career is his ability to bring hope to the tens of thousands of individual men and women for whom he has cared. As he would early on the next morning tell me, “The gratification comes from the feeling that you’ve done something important for people. Life, after all, is the greatest thing we have, and doctors are in a unique position to maintain it, to save it, to give it.”
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