Unknown Buddhist

I wrote the following letter reply to an email from mother. If you haven’t picked up on it yet, my father is entering the last years of his life. And while I have yet to inform my parents of my diagnosis, I wrote what I hope was a well thought response.

My mother’s letter is as follows.

I’ve been wanting to share with you something Dad said the other day.  I made a small Christmas wall hanging and said (to dad), “Let’s put it up because it’s so close to Christmas anyway and it won’t get wrinkled.” 

I wished Dad a merry Christmas. 

He replied, “Yes – for the next 2 Christmases.” 

“And many more,” I replied. 

“For the next 2 Christmases”. 

“And for many others after that?” 

“Oh yeah. Sure.” replied very offhandedly’

So, I’m wondering if that’s what just came to his mind or he knows something I don’t? Or, can he can sense something?

Dear Mom:

I read your note with interest. I can attest to some extent of nature’s intuition. So, I will get to this upfront.

Every day in medicine, there are numerous examples of patients who know they are about to die, even if no one else does. They often have a feeling. And even though doctors don’t know how to explain it, the intuition is rarely taken seriously.

In hospital terms, when we talk about instinct, we usually speak about expert clinicians grasping diagnoses in ways that seem to defy rational explanation. Doctors appear to know almost intuitively which data to focus on and which to ignore. Of course, their decision-making is based on experience and deductive reasoning (and perhaps on evidence, too). Still, it seems almost mystical.

Personally, I have learned the years to take such intuitions seriously.

I can’t remember if I told you this or not. Instincts can be derived from other sources. In 2007, The New England Journal of Medicine had the story of a cat named Oscar who lives in a nursing home in Providence, R.I., and seems to have an uncanny sense for when elderly residents are about to die.

Oscar goes to the patient’s rooms, curls up beside the patient — even those residents for whom he has previously shown little interest — and purrs. Staff members learned that this is a telltale sign of impending death, as they’ve witnessed Oscar’s similar behavior in the deaths of at least 25 patients. “This is a cat that knows death,” one doctor said. “His instincts that a patient is about to die are often more acute than the instincts of medical professionals.”

There are, of course, other signs that can guide intuition. Natural aging is one. Or maybe it’s a combination of natural aging and the will (internal will) to remain meaningful. Then there’s Google.

If you’re after a bit of a break from worrying whether killer robots will murder us all, don’t worry: Google knows when we’re all going to die. Google’s Medical Brain AI team has been working on neural network software which can scan through a person’s electronic health records, pull together relevant information, and quite effectively determines how long that person will live.

Accuracy nears 96%.

It turns out Google is efficient at sorting through mountains of data, including scribbled notes on old charts, and turning them into useful predictions while also pointing out to healthcare practitioners where they’ve pulled the data.

Then there’s just plain age. Turns out, the older you get, the accuracy increases. Why? Because people get older and die.

In truth, if you create an algorithm that assesses patients against the mean average age of that person in the population, you reasonably accurately and quickly dial into an expected natural life. For instance, FlowingData website calculates that I have a 10% chance of dying in the next ten years and a 26% chance within 10 – 20 years. And if I input’s dad’s age, he has an 88% chance of dying between in the next several years.

My company has a similar AI program. I inputted dad’s age, some essential background information, recent medical trends, and the result nearly equals dad’s ‘intuition’ – meaning the AI estimated dad is likely to pass within two to two-and-one-half years, with a 47% chance likelihood of a circulatory issue (heart or lung).

People are amazed when I tell them fairly accurate things. It’s not magical. In truth, having been in the medical profession and installing all these systems, I know the statistics, even weird ones. For instance, I know that between 45–50, the relative majority of deaths are due to cancer. As cancer gradually declines in importance, circulatory diseases become the leading cause of deaths those between the ages of 75–80. Mental disorders (Alzheimer’s, dementia, etc.) and diseases of the nervous system are common causes of death after 80+ years of life.

Of course, dad knows none of this. He does, however, know his own body. He’s tired, and like many nearing a winter morn’, he may simply want to look moving forward.

Therefore, here’s my suggestion. Forget all the statistics, mind over matter, intuition, etc. Focus on trying to find a way to enjoy the time you have and what you have left. In a way, you are in an enviable position of knowing and experiencing “the ultimate relationship.”

“And what’s that?” you ask.

The ultimate relationship we can have is with someone who is dying. This landscape of such a relationship is so varied and so vast that it not only renews, but you’ll discover a new level of intimacy never experienced. In this way, love will teach a certain sense of gratitude for what we have been given.

But … prepare for when the day comes … for it’s sooner than later.