The reason that Brown-Séquard sometimes enters my thoughts is a memorable conversation I had about six years ago, with a college classmate whom I had not seen in decades. In the midst of the usual comparisons of our former youthful vigor with the current era of rusting joints and battling against the threat of expanding waistlines, he casually dropped the news that he was scheduled to have a penile implant inserted several days hence. A widower of more than a year, he had discovered the tantalizing attractions of much younger women, and found himself sufficiently unpredictable in sexual performance that he was determined to do something about it. Because we were at that time almost half a century out of college, I wondered aloud how many men of our considerable age had undergone such a procedure. My classmate replied that his urologist had assured him that he was far from being the oldest patient in the hospital’s surgical series. His next sentence was what started me thinking about Brown-Séquard. “It’s not just the sex itself,” he said. “It’s the feeling that I’m not giving in to old age.” It was at this point that I looked more carefully at my erstwhile pal than I had before, and realized that he was wearing a toupee.
A bit later in our brief conversation, he added that he was aware of my having known the man who had invented the device on which he depended to make his sex life so predictable and satisfying. Of course I knew him, and on this hangs, in a manner of speaking, a cautionary tale. The tale, and the caution, are not unrelated to the one my classmate was in the midst of telling me, about the search for evidence of youth not having left the building. Frank Scott, as we called the implant’s inventor at the time, was in my class at medical school, and was a notable character even then. I was intrigued by his personality from the start, mostly on account of a unique kind of charisma that I had only read about but until then had never encountered outside of the movies and a few books about the old West. He was a bit over six feet tall and, though somewhat broad-shouldered, was sparely built. Like the cowboy of literature he resembled, Frank was narrow in the waist and hips, and had small but keen eyes that always made him look as though he were peering into a hot sun lying low over the sagebrush, trying to be sure that each of his herd of longhorns was accounted for. Though he came from the city of San Antonio, he wore the aura of all of south-central Texas like a well-fitting ten-gallon hat. If the sum of his appearance did not give away a Lone Star State origin, the drawl certainly did: In general soft and slow, it had a way of sometimes cutting loose like the snap of a whip when he had lost patience with a plodding classmate or an assignment that seemed asinine to him. Of all Frank’s characteristics that fascinated me, his ability to turn verbally from the laconic to the fierce and back again in a moment—meantime having struck at his prey like a rattlesnake—was foremost. He had, in addition, a strong-minded Texas self-assurance that some saw as ego. Though usually the most engaging and good-humored of men’s men, one could imagine him in another era as a quick and confident gunfighter always ready to draw, striding away after an encounter so that he might finish the job from which he had been momentarily distracted by the nuisance he had just disposed of. Frank Scott always seemed to know what he wanted, and went for it unerringly. He had places to go and things to do, and no patience for delay.
Frank was married to his college classmate, a highly intelligent and prototypically pretty Texas girl named Shirley, who was as patient and gentle as he was unyielding and tough-minded. As did so many other young wives of that era, Shirley put aside her career in order to support her husband’s, working at one or another secretarial job at the medical school during their entire four years in New Haven. I don’t recall their financial circumstances, but it is hard to believe they were much different from those of almost all the rest of us, who were barely making ends meet in those days of little financial aid or loans. It was a hard life, but most of us somehow thrived on it. The Scotts were doing it together, and even Frank’s toughness could not conceal the depth of his love for Shirley, whose life was clearly so wrapped up not only in her adored husband but in his high hopes for the future as well.
In later years, I heard that Frank had gone on to train in urology and eventually become a highly respected professor at the Baylor College of Medicine and the chief of urology at St. Luke’s Episcopal Hospital in Houston. And he was the first member of our class to emerge as a well-known medical authority. The reason for the early fame was his invention in 1973 of a device that I can only call “the hydraulic hard-on,” to treat the condition nowadays known as erectile dysfunction. Not only had Frank become famous, but he was now rich as well. In addition to having patented his triumph of concept and design and then having founded a company, American Medical Systems—later sold to Pfizer and finally to a group of Wall Street venture capitalists—to develop and manufacture the prosthesis, he had seen to it that no surgeon was permitted to undertake the complex method of inserting it without first passing the expensive instructional course he provided. The money was rolling in—the impotence of other men had made Frank a Texas millionare.
The principle of the hydraulic erection was simple enough, though working out the technical details had been a challenge for a man of Frank’s restive nature. The device consists of a small plastic reservoir buried in the fat lying under the skin of the lower abdomen, leading via a narrow tube to two thin-walled flexible cylinders surgically implanted into the penis. When not in use, the cylinders lie empty and flaccid within the normal downward droop of the organ, their presence unknown to any but the informed. But should the urge for coition occur, firm pressure on the reservoir forces its liquid contents into the cylinders, where turgidity is maintained by a system of valves that aids Eros in his work. After consummation has been superseded by afterglow, the cylinders are emptied back into the reservoir by another touch of the fingers, and all is as it was before. Frank’s invention of this miracle made instant obsolescence of every previous rigid rod of various sorts that had ever been inserted into a recalcitrantly soft penis. The system is on duty at all times, ready to do its libidinal work at a moment’s notice. Like my toupeed college chum, thousands—perhaps hundreds of thousands—of men and their consorts have benefited from Frank Scott’s ingenuity, and probably his impatience as well. He made it unnecessary to fail, or even to wait.
Frank’s invention of the inflatable prosthesis was only one of the many contributions to his specialty for which he became known as one of the most prominent urological innovators of his generation. When he came to our class’s twenty-fifth reunion in 1980, he was no longer called Frank, but had become transformed into F. Brantley Scott, now known to his familiars as Brantley. Not only his name was different. Brantley brought with him a perfectly gorgeous woman by all appearances about twenty years younger than he was, whom he introduced as his wife. Shirley, whom so many of us had admired, was in his past. Of all the topics discussed among his classmates on that weekend of alumni nostalgia in early June, the one most commonly mentioned in hushed terms was the transformation of Frank Scott.
Frank’s enthusiasm for technology did not end with the innovations he created in the laboratory. He had learned to fly, and a few years after our reunion bought a kit from which he built his own airplane, very likely to make travel easier between Houston and the private island he had bought off the Texas coast. No one will ever know what went wrong on that first test flight, but the craft crashed to the ground with Brantley at the controls. The beautiful young woman was left a widow, and doubtless well provided for. Her husband has since been memorialized as one of the icons of urology, which he certainly was. The department he built at St. Luke’s—called the F. Brantley Scott Department of Urology—is now headed by the F. Brantley Scott Chair, and the American Foundation for Urologic Disease each year presents the F. Brantley Scott Award for Innovation and Creativity in Urology, one of the specialty’s highest honors. As F. Brantley Scott, Frank’s heritage added distinction to our medical school class, but those many of us who liked him so much would prefer to have enjoyed his living pr
esence among our number at each of the five-year reunions.
Those who find morals in stories such as Frank’s will have good reason to think of the Greek myth of Icarus, who devised feathered wings and attached them to his body with wax, to help him and his father escape from captivity by Minos, the Cretan king. According to a standard reference I have been using for decades, Charles Mills Gayley’s 1897 The Classic Myths in English Literature, “Icarus had been warned not to approach too near to the sun…. But then the boy, exulting in his career, soared upward,” whereupon the wax melted and he plunged into a watery grave in the sea beneath. Frank’s innovative use of technology brought him too close to the sun, some would say. “Exulting in his career” so brilliantly created, he ignored the warnings of others about his responsibility to those left on the ground who had enabled the highflier to reach such great heights. This is not to say that losing his life was the price Frank paid for leaving Shirley, but the moralists might believe they have good reason for thinking so. Like my limber college classmate, Frank felt the need to renew himself. Perhaps his new marriage and building an airplane were his ways of doing that, just as his invention of the inflatable prosthesis was the key to my friend’s way of, as he put it, “not giving in to old age.” Like everything else about the passing years, these kinds of thing have their plusses and they have their minuses.
Many are the ways of “not giving in to old age,” and they have ranged from the pitiably ridiculous to the healthfully sublime. F. Brantley Scott, Charles-Édouard Brown-Séquard, and every hawker of youth-restoring nostrums were appealing to the universal fear of getting old, and to the even greater terror that every evidence of aging brings us further along the road to death. There was general joy a few years ago when molecular biologists began to spread the news that genetic engineering might prove to be the means by which to stave off the inevitable. But that was a mere prelude to the excitement aroused when telomere research was rumored to hold the promise of preventing cells from developing the degenerating changes that gradually cause them to become senile and finally give up their lives. As noted in the previous chapter, scientists are in only the earliest phases of such research, and there is little certainty that it will lead to anything remotely resembling the claims that some have made for it.
Upon hearing word of the new miracles seemingly just beyond the horizon, many a middle-aged man or woman—and no doubt plenty of younger ones too—cuddled up in bed to dream futuristic fantasies. The air became rife (and still is) with possibilities, among which a life span of two or more centuries was not the most extreme. Too few stopped to consider the predictably harmful consequences of such an achievement, not only on human society, but on individuals as well—including those newly spared bicentenarians themselves, cluttering the planet with their needs, their demands, and their refusal to get out of the way. Too few questioned the notion that being able to live a very long time is a good thing—at least for themselves.
From the standpoint of pure biology, we, like all animals, exist in order that we may pass our DNA on to succeeding generations. This is how our species survives; this is how natural selection makes its choices. Once we have lost the ability to reproduce and to nurture our young for a while, we serve no useful function in the grand scheme of nature’s relentless events. In the wild, and even among domesticated animals, death shortly after the end of the reproductive years is the rule. Man is one of the few animals to survive much beyond that point. For much of humankind’s existence on our planet, in fact, we did not even live long enough to exhaust our reproductive potential. As late as the time of the Roman Empire, when modern Homo sapiens had already been in existence for some forty thousand years, average life expectancy was less than thirty years; infectious disease and inadequate nutrition were the big killers, with trauma bringing up the rear. Two millennia later, at the turn of the twentieth century, the life expectancy figure still had not gone much beyond forty-five years, even though most people were far better nourished and more adequately protected from contagion. The average American can mostly thank public health measures such as clean water, immunizations, improved food supply, and good housing for the current expectancy of reaching his or her late seventies. Though the great advances in biomedicine of recent decades have had an effect too—at least in the latter half of the century—only antibiotics and improvements in the treatment of heart disease influence general mortality statistics to a great extent. All the other pharmaceuticals and surgical cobblings affect relatively small numbers of people in the overall figures for the entire world population.
It can never be repeated often enough: Aging is not a disease. It is the condition upon which we have been given life. The aging and eventual death of each of us is as important to the ecosystem of our planet as is the changing of the seasons. Aubrey de Grey prefers to ignore that inconvenient truth, and so do others who applaud his high-wire theoretics. When Dr. William Haseltine, the brilliant biotech entrepreneur who is CEO of the futuristic Human Genome Sciences, Inc., says, “I believe our generation is the first to be able to map a possible route to individual immortality,” we should cringe with distaste and even fear, not only at the hubris of such a statement but at its danger to the very concept of what it means to be human. The current biomedical campaign against the natural process of aging is but part of a much larger image of mankind’s future, in which it is thought by some to be conceivable that parents may one day order up the IQ, complexion, and stature of their intended offspring, by manipulation of the DNA that goes into their cells. One prophet of unrestrained genetic enhancement, Gregory Stock of Princeton, has gone so far as to entitle his 2002 book about such matters Redesigning Humans: Our Inevitable Genetic Future (emphasis mine). Even more frightening than the confidence of Stock’s vision for his fellow men and women is the title of the book’s first chapter, in which he outlines his notion of how the laboratory will come to control evolution: He calls it “The Last Human,” meaning those remaining of us whose bodies and minds have been formed by nature alone. As though to illustrate how palatable these predictions are to those from whom we should have reason to expect a note of caution—who are the putative gatekeepers against such ideas of “progress”—Stock’s oeuvre was blurbed by Harold T. Shapiro, once chairman of former president Clinton’s National Bioethics Advisory Commission.
These are not the problems with which American medicine or science should be dealing. Their proper task is not the prolongation of life beyond our species’s nature-decreed maximum span (which seems to be in the neighborhood of 120 years), but life’s betterment. And if anyone’s life needs betterment, it is surely the elderly man or woman still living well beyond the years of vigor and productivity because the benisons of public health and biomedicine have made it possible. The percentage of the aged in our population increases with every passing year, and far too many of them are doddering. The very gradual increase in life expectancy of previous generations has been replaced by a surge forward: The twentieth century saw a thirty-three-year gain (more than two years of which came about in the mere decade and a half between 1990 and 2005), an astonishing figure compared to any comparable period in history. Until these recent changes, population size had the general configuration of a pyramid, with a wide base of children, the top narrowing with age. It has now taken on somewhat the shape of a rectangle, as more aged individuals reach the upper levels. As disease treatment continues to improve and public health measures reach a larger segment of the population, this trend will only increase.
Some illustrations provide graphic evidence of these patterns. During the 1990s, the number of American centenarians went from 37,000 to 50,000, and some project that it will reach a million by midcentury. Queen Elizabeth of the United Kingdom customarily sends telegrams to every one of her subjects who attains a hundredth birthday. In the first year of her reign, 1952, the number was 255; it is now well over 5,000. When our nation’s Social Security system was established in 1935, it was thought that it would ne
ver have to serve more than twenty-five million people. There were more than thirty-eight million beneficiaries in 2000, all but a few million of whom were over sixty-five; it is estimated that the ripening of the baby boomer generation will bring the figure to seventy million by 2011. Nowadays, reaching the once-hoary age of eighty means only that an actuary would predict more than seven years of life remaining. At sixty-five, the figure is almost seventeen years for American men and near twenty for women.
As much as we might hail such statistics, they quite obviously come with a price. Whether the aging process is genetically programmed or results from the gradual wear and tear of a lifetime of internal and external banging around (or, as is most likely, is a combination of both), it is characterized by a journey toward increasing frailty and disability, even for the most robust of the survivors. Joints, bones, hearts, brains, and every other part of us lose their zip, and worse. Many of the 4.5 percent of our population living in long-term-care institutions, and some of those cared for at home, are so incapacitated that they require help with the simplest of needs, like toileting and dressing themselves. Many of them are demented. The number of what geriatricians call “the oldest old”—those over eighty-five—increases with each passing year of improvement in life expectancy. The economic cost is high, but the cost in suffering, not only for the very elderly themselves but for their families, is even greater. For many individuals, the cost of living longer is already too great. Unless major changes are made, the burden on society will become impossible to bear.
The Art of Aging Page 20