I’ve lived a life formulated for longevity: eating right, exercising daily, and savoring friendships and family. Despite this, I still came down with cancer two years ago. I’ve been treated with chemo, radiation, major surgery, and now, with spread to the liver, I’m back on chemo. I’m still here and truly feel blessed and thankful for every day, but you can understand why lately I’ve been thinking about death.
 
Loving my enemies has made this easier. As our kids were growing up, I would find myself saying to them I will always love you unconditionally, but sometimes I don’t like what you are doing.” We should say that to our enemies, too. Here is the lesson: hate is poisonous, especially to the one who harbors it. Remember what Jesus said (as did Mohammed and Buddha), “Love your enemy.” I believe hating others, even when justified, only destroys us. When angry, we should point the anger at what he or she is doing, not at the person. Use it as propulsion to fight to the tooth for the cause . . . but let go of hate. How is this related to death, you ask?
 
When people ask me how I contend with the prospect of my dying sooner than expected, I go right to the opposite of hate which is love. I know it sounds clichéd and unoriginal, but the word love embraces the spiritual, inner-warmth I feel when I value the other person (even if he or she is my enemy). Truly valuing others gives more meaning to my time limited life and helps take away the fear of my own death . . . but there is something more.
 
Some say, “One day, you'll be just a memory for some people.  Do your best to be a good one." That’s not bad advice, but I think the measure of our worth, after we die, has less to do with being remembered and more to do with the reflection of our actions in others. It’s that Pay it Forward or that Jimmy Stewart Wonderful Life sort of thing. I believe meaning and purpose comes with the good that we do and how that moves others forward (whether they’re aware of it or not).
 
Our lives are all like a book that becomes more precious as it nears the end, especially by savoring friendships and family, by letting go of hate and by paying good deeds forward. Why waste any time fearing death?
 
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Vaccines protect people from illness with minimal risk.
 
Smallpox has been around for many millennia. For thousands of years, the virus caused a deadly illness that killed more than 35 percent of adults and 80 percent of children who contracted the disease. That is until the smallpox vaccine was discovered in 1796. Noting that milk maids rarely got smallpox, British rural physician Edward Jenner found that deliberate infection with the milder cowpox disease provided substantial immunity to smallpox. After decades of improvement to the vaccine and a campagin lead by the World Health Organization, global deaths from smallpox were reduced from two million per year in 1967 to zero in 1977. Human smallpox infections were virtually eliminated from this world because of vaccinations.
 
Another example of clever manipulation of the immune system is the story of a pneumonia vaccine. In a 2003 study, researches noted there had been a huge drop in hospitalizations of the elderly for pneumonia, with 12,000 fewer yearly deaths—especially in those older than 85. This is the result of routine childhood pneumonia vaccination. Although we now encourage two different pneumonia vaccines for those older than 65, the authors of the study claim that it was the routine vaccination of children that was responsible for the reduction of pneumonia in the elderly. Thus, herd immunity profoundly protects immune deficient adults by reducing their exposure to sick kids.
 
There have been dangerous and untrue rumors that vaccinations in children are responsible for autism. Despite the natural human wish to find something to blame for this condition, autism appears in similar rates in children who are given and not given vaccinations. Don’t get me wrong, some vaccines carry risks, but it all depends on the specific type of vaccine and what disease it is treating. Most vaccines are incredibly safe.
 
Take for example the vaccine for Dengue fever, where the risk of side effects is significant. With Dengue vaccine, ten children are saved for every one child who is harmed. Compare that with the measles, mumps, rubella (MMR) vaccine series given in the U.S. which has mild temporary side effects including fussiness, mild fever, injection-site soreness, affecting one child in four. There is temporary mild joint pain, rash, mild glandular swelling, and loss of appetite affecting one in 50, and high fever and platelet problems affecting one in 25,000. Much better than Dengue vaccine. The benefits of the MMR vaccine far outweigh the risks. That is why we routinely give people the MMR vaccine and only give people the Dengue vaccine if they have a high chance of exposure.
 
Vaccination, a clever manipulation of our immune system, protects us from the scourges of the future.
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Early one morning, I was heading through the kitchen toward the back door on my way to work when I realized there was a large bat flying around our breakfast room, swooping around like in a Dracula movie. As it flew at me, I reactively swung at it and, like hitting a Nerf ball, the bat was thrown across the room, landing on the kitchen floor a little stunned. I closed all doors to the rest of the house, locked open the exit outside, washed my hands thoroughly, and as the bat started flying again, I shooed the creature out into the early morning darkness.
 
Bats are a marvel of evolutionary diversity with something like 47 different species in the U.S. alone. They are important to our ecosystem as they eat their weight in bugs every night, carry seeds which reforest depleted woodland areas, and pollinate plants. Experts believe that these winged mammals first developed powered flight about 60 million years ago and later the capacity for radar-like echolocation to allow nighttime hunting and flying in a cave without any light.
 
About one percent of bats carry a deadly virus called rabies. Any victim stricken with rabies (whether bat, dog, skunk, cat, or human) will eventually become confused, agitated, aggressive and infectious until they die. This is not far off from cinematic portrayals of zombies who change into confused and aggressive monsters after being bitten. The difference is that we have a rabies vaccine that can save the bitten victim from an awful death.
 
So, after striking down the bat, did I need to receive rabies shots (post-exposure prophylaxis) to gain protection from developing the disease? This would have involved four doses of rabies vaccine over 14 days, and one injection of active immune globulin. I checked out the last 15 cases of rabies that had occurred over five years in the U.S. and 9 were from bat exposure, 4 from dogs, 1 from a fox, and 1 unknown. All but one died, and the one survivor remains severely disabled. The CDC recommends having rabies shots “if there’s been a bite or an exposure to saliva into eyes, nose, mouth, or open wound.” I did not seek out rabies shots as I did not receive a bite, the bat was acting normally, and I thoroughly washed my hands after touching the bat.
 
Although I did become irritable following a few restless nights, I did not turn into a rabid or rabies-like Zombie.

Hardly any clinical problem demands more from a patient AND a physician than diabetes. The condition demands a special diet, significant exercise, lots of monitoring, expensive oral and injectable medicine, and a rescue plan when things get out of control.
 
Regarding the need for a special diet, there are different ideas about what is the correct for a diabetic to eat. There are low carbohydrate plans, low fat plans, low meat plans, high fiber plans, and the list goes on. Whatever the plan may be, the biggest challenge, and probably the most important one, is to eat less and to do that forever. However, asking someone to always eat less seems almost too much to expect.
 
Regarding the need for a special exercise plan, there are different ideas about what is the correct way to exercise and often the capacity of the individual to exercise is limited. Whatever that plan may be, the biggest challenge is in the doing. People with (and without) diabetes need to get enough exercise and to do it regularly (daily), but that also seems almost too much to expect.
 
When exercise and a special diet are not enough, various diabetic medicines or non-insulin injections can be prescribed. When these fail, various types of insulin are added. Some are long-acting, and some are short-acting. Another challenge to this condition is that medicinal treatment options seem more expensive over time, not less, even though the patent for these pills should have run out.
 
Regarding the need for monitoring, people with diabetes and their doctors are asked to keep track, not only of blood sugars, but also of cholesterol, blood pressure and the condition of their feet, eyes, and kidneys. Physicians and other care providers are under the gun by insurance companies and the government to meticulously monitor diabetics and are even being graded on how well they do this monitoring. Therefore, care providers are bugging the person with diabetes to carefully monitor themselves too. It almost seems too much to expect.
 
People with diabetes sometimes have out-of-control blood sugars despite doing everything right. It’s been my experience, especially when insulin is being used, that sometimes there is no rhyme or reason for a person’s blood sugar to be too high or too low, but it still happens. Rescue plans must be made and practiced.
 
Hardly any clinical problem demands more out of a patient AND a doctor than diabetes.
 
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