I am not altogether incurious, but one entity about which I have over the years felt little curiosity is my own body. Until recently, I could not have told you the function of my, or anyone else’s, pancreas, spleen, or gallbladder. I’d just as soon not have known that I have kidneys, and was less than certain of their exact whereabouts, apart from knowing that they reside somewhere in the region of my lower back. As for my entrails, the yards of intestines winding through my body, the less I knew about them the better, though I have always liked the sound of the word “duodenum.” About the cells and chromosomes, the hormones and microbes crawling and swimming about in my body, let us not speak.
For better and worse, these deficiencies in my knowledge have been addressed by a splendid book by Bill Bryson called The Body: A Guide for Occupants. The book is an account of human parts, inside and out, and what is known and still unknown about them. It catalogues the diseases and mechanical failures to which flesh is heir; establishes a pantheon of heroic medical researchers and a rogues’ gallery of quacks; sets out some of the differences between humans and other mammals and between the male and female of our own species—and does all this in a fluent, often amusing, never dull manner. The point of view is ironical yet suffused with awed appreciation for that endlessly complex machine, the human body.
In the first hundred pages of The Body, one learns that there are microbes in one’s belly button, that the average adult touches his face sixteen times an hour, that the number of human facial expressions ranges between 4,100 and 10,000, that tears come in three varieties, that the human eye can distinguish between 2 million and 7.5 million colors, that humans choke more easily than any other mammal, that people who have had their tonsils removed when young may have a 44 percent greater risk of heart attack later in life, that one of the inventors of the lobotomy won the Nobel Prize for Medicine in 1949, and that Leonardo’s Mona Lisa has no eyebrows. Scores of such items float through the book.
But beyond this rich factual matter—the number of heartbeats in a lifetime (up to 1.6 billion), famous stutterers, “the complicated hydraulics of the male erection,” the world’s tallest human being (Robert Wadlow at 8 feet 11 inches), the world’s oldest human being (Jeanne Louise Calment, who lived to be 122, and quit smoking only at 117), the removal of Samuel Pepys’s gallstone (but not Montaigne’s), the many functions of the liver (which does everything, Bryson tells us, but kick extra points)—reading The Body naturally throws one back on thoughts about one’s own body. The book has caused me to feel that, on balance, I have been fairly fortunate in my body. I have no serious deformity, suffer no chronic illness of note, and have arrived in my eighties in relatively decent health, though, an old joke has it, one definition of a healthy person is someone who has not had a recent medical examination.
A few qualifications. In 1997, at the age of sixty, I had bypass heart surgery. My immune system apparently is not all it should be. (The immune system’s task, Bryson writes, is “to identify anything that is in the body that shouldn’t be there and, if necessary, kill it.”) Some years ago I was diagnosed, probably mistakenly, with Crohn’s disease. I was given Prednisone to cope with Crohn’s, a steroid that caused in my right hip something called avascular necrosis, which had me on a cane for a few months and ended my career as a high-B racquetball player. After the medical fashions of the day, as a young child I had my tonsils removed, and I was not breastfed (an activity that was thought déclassé by middle-class women of that day). I recall having chicken pox but not measles. I had a brief bout of ringworm in the sixth grade, which meant I had to wear a hat in school for several weeks, which was embarrassing. More recently, I have been found to have low-grade celiac disease, so that I have had to go on a gluten-free diet, on which from time to time I happily cheat.
I nearly forgot that a few years ago I had something called bullous pemphigoid—a term always to be pronounced with one’s best imitation of W. C. Fields—that entailed a blistering on my chest and legs. I was twice misdiagnosed, first by a dermatologist who suggested I get rid of my mattress, then by another who had me standing in my undershorts in a cabinet under ultraviolet lights. The man who got it right, a dermatologist named Alan Lasser, was admirably candid about the shakiness of dermatology generally.
On the other, more vigorous hand, I have had no allergies. I avoided venereal disease. (At headquarters company, Fifth Armored Division, Fort Hood, Texas, in 1959, we were offered something called a good-conduct holiday if the company could go a full month with no car accidents or reported cases of venereal disease. We never got the holiday.) I managed to evade diabetes, a disease that afflicts many of my co-religionists. (A Frenchman, a German, and a Jew are lost in the desert. “I am thirsty and must have wine,” exclaims the Frenchman. “I am thirsty and must have beer,” cries out the German. “I am thirsty and must have diabetes,” says the Jew.) I have never been overweight. (“More people on earth [today] suffer from obesity,” Bryson reports, “than from hunger.”) I have thus far escaped being among those eight hundred thousand Americans annually who have joint-replacement surgery. I smoked cigarettes—never less than a pack a day—between the ages of sixteen and thirty-nine without apparent detriment. I’ve never required the too-often-dubious services of a psychotherapist. I have been allowed to keep a respectable amount of hair atop my head, most of it now grey and white, though hair long ago departed my legs and arms. If we live long enough, it has been said, we go out of the world as we entered it: hairless, toothless, babbling.
Sexist dog that I am, I am pleased to have been born male. (Thales of Miletus, 624–546 b.c., claimed to have been glad of three things: He was born a human being not an animal, a man not a woman, and a Greek not a barbarian.) Men on average may die younger than women, but they escape the inconvenience of menstruation and later the psychological adjustment of menopause. Bryson reports that 80 percent of autoimmune diseases occur in women, though men “get Parkinson’s disease more often and commit suicide more, even though they suffer less from clinical depression.” The cruncher of course is childbirth, which I am delighted never to have undergone. No more difficult than defecating a pumpkin is a description of childbirth that refuses to depart my memory. After describing the pain of childbirth, Bryson writes: “If ever there was an event that challenges the concept of intelligent design, it is the act of childbirth.”
Owing to the complications and pain of childbirth, one learns from The Body, Caesarian births are on the rise, with one-third of births in America now being done by C-section, and 60 percent of these not for medical reasons, but for convenience. The complication here, Bryson notes, is that babies born by C-section “have substantially increased risks for type 1 diabetes, asthma, celiac disease, and even obesity and an eightfold greater risk of developing allergies.” He adds that one in seven couples currently seeks help in conceiving, an exercise that I, former chairman of my neighborhood Unplanned Parenthood Committee, with two sons born before I was twenty-five, am pleased to have evaded. A friend who went through fertility therapy years ago likened it to being a field-goal kicker: “You’re called into the game at odd times.”
So I personally have less cause for complaint than for wonder at that extraordinary structure of flesh and bone that is the body. I feel sorry for those who drew a less ordinary lot than mine, who go through life feeling repugnance for their own bodies. I think of heavyset young women who each morning confront the fact that they loathe the thickness of their legs; or those, men and women both, who find their own facial features displeasing. So many things can go wrong in the composition of the human face, the construction of the human body. Then there are the people who are wracked by allergies, or burdened with brittle bones, or—dirtiest trick of all—mentally unbalanced or askew. The human body, though the standard issue contains 206 bones and roughly 600 muscles, is highly, one is inclined to say wildly, various.
Begin with the variable size of the thing. At O’Hare Airport I once found myself standing next to Wilt Chamberlain, who was then playing with the Los Angeles Lakers, and felt I did not come up much higher than his belt buckle. I am, if I stand up very straight, 5 feet 7 inches. (Humphrey Bogart was 5 feet 8 inches, Fred Astaire somewhere between 5 feet 7 inches and 5 feet 9 inches—two differently charming men whose work required they wear hairpieces.) I have never considered my stature a serious (you will pardon the expression) shortcoming. Had I been taller, I might have gone beyond playing on the junior varsity basketball team to play on the varsity. When young, I might have pursued taller girls. But I can think of no further, no serious disadvantage my modest height conferred.
The world over during my lifetime, meanwhile, seems to be growing bigger and taller. When I was a kid, basketball players of more than 6 feet 3 inches were ipso facto ill-coordinated and klutzy. Now men like LeBron James and Kevin Durant, at 6 feet 9 inches and 6 feet 10 inches, move more gracefully on the basketball court than I ever did. Rod Laver and Ken Rosewall, two of the top tennis players of my youth, were 5 feet 7 inches and 5 feet 8 inches, and five of today’s top-ten ranked tennis players are over 6 feet 5 inches. Football players are currently not only taller but, with three-hundred-pound linemen and two-hundred-fifty-pound running backs commonplace in college and pro football, wider. Major-league pitchers under 6 feet 3 inches are rare. Among civilians walking the streets in my college neighborhood, more and more tall young men and women are about. I don’t believe I’ve lost any height while aging, but somehow in recent years I’ve begun to feel smaller.
In humans, as in cars and other machines, parts wear out. I’ve already mentioned the high number of hip, knee, and other joint replacements, most of them done on older people. Back pain is a common complaint as we age. Arthritis is perhaps a less common yet still fairly frequent problem. (I have a touch of it myself, in my left thumb.) Eyesight dims. (I have had cataract surgeries in both eyes.) Hearing becomes less sharp. (A common complaint among people over seventy, one I share in, is the noisiness of contemporary restaurants.) As for sleeping, which Bryson refers to as “the most mysterious thing we do,” for most older people sleep ceases to become the continuous, purely restful exercise it was in earlier years, but is generally interrupted two, three, four times during the night, in good part owing to a loss of elasticity in the bladder. “Getting much?” among men my age refers, alas, not to sex but to sleep.
“Cancer,” Bryson reports, “is above all an age thing. Between birth and the age of forty, men have a just one in seventy-one chance of getting cancer and women one in fifty-one, but over sixty the odds [rise] to one in three for men and one in four for women.” With cancer come the complications of radiation and the nightmare of chemotherapy. At what age does one decide to forego treatment and give up the ghost? A gastroenterologist I used to see on occasion showed me a letter one day from a patient, a man of seventy-one, who had decided to forgo any efforts to stave off his recently discovered stomach cancer, preferring death to treatment. He had, he wrote in the letter, “had enough of life.”
Then there is Alzheimer’s, which has come to serve, incorrectly, as a general template for all forms of dementia. Alzheimer’s apparently cannot be diagnosed with certainty until postmortem, though Bryson notes that “Alzheimer’s accounts for between 60 and 70 percent of all dementia cases.” Apart from a sloppy or painful death, dementia is perhaps the greatest dread of old age. To lose it, to go gaga, to join the multitudes—“some fifty million people around the world,” according to Bryson, suffer dementia—who can no longer remember the names or recognize the faces of their own children, is the horror of horrors.
Bryson maintains that the threat of dementia can be reduced by healthy diet, moderate exercise, and abstinence from smoking and heavy drinking. He also claims that “the more education you have had the less likely you are to get Alzheimer’s,” adding that “having an active and questing mind” helps even more. Would that it were so! The wife of a dear friend of mine, a man possessed of as active and questing a mind as I have known, once reported to me that she had a call from the owner of a nearby bookstore café that her husband, whose mind was clearly vanishing into dementia, was stealing cookies. She told the café owner to run a tab. Later, when my friend had to be put into a nearby institution for the demented, his wife, on a visit, noted a good deal of straw on the floor of the institution’s dining room. When she asked about it, she was told there had been barn-dancing the night before. “Did my husband participate?” she asked. She was told he had and seemed to enjoy it greatly. I can more easily imagine Field Marshal Rommel or Charles de Gaulle barn-dancing than I can my dignified dear friend. A different brain, clearly, had come to inhabit his body.
“Your brain,” Bryson writes, “is you. Everything else is just plumbing and scaffolding.” Of the various activities of the brain, that of memory seems most mutable, especially as one grows older. Memory seems so arbitrary, so oddly selective, often so disappointing. In the past few days, I could not call up the name of a woman who once did me a great deal of harm, nor that of the Cubs pitcher Kerry Wood, nor that of Antonio Vivaldi. During the same time, I recalled vividly the name and face of Merle Scurry, the prettiest girl in my kindergarten class at Eugene Field School in 1942, and the ditty accompanying the radio commercial for Prell Shampoo. Calling up proper names is the chief problem of many people my age. “What was the name of that actor in the movie whose title I forget?” is a question a friend of mine not long ago asked at lunch. Do these fairly regular memory lapses, as seems natural to wonder, mark the onset of dementia? I prefer to think not.
One of the few subjects associated with the body that Bryson does not touch on is hypochondria, or abnormal fear for one’s health joined to the fear that one has a serious disease. I have heard it said that hypochondriacs tend to live longer than those without this mental affliction, if only because they so regularly visit physicians. The older one gets, though, the more likely is hypochondria not only to kick in, but to seem not at all nutty but rather sensible. The greater one’s age, after all, the higher the odds that one will be struck down by one devastating blow or another. Forty percent of Americans, Bryson reports, will in their lifetimes suffer from cancer, and 60 percent will be visited by dementia, though heart attack remains the primary cause of death. That soreness in one’s left arm—is it a heart attack waiting in ambush? The blemish on one’s right shoulder—might it be lymphoma, or melanoma, or one of those other mellifluous-sounding but quite deadly skin cancers? As for that slight irregularity of one’s bowel movements—colon cancer, or stomach cancer perhaps? Why not? At seventy-five and beyond, one waits for both shoes to fall, or at any rateI do, all the while maintaining my policy with the Knock-Wood Insurance Company.
We now die more from non-communicable than from contagious disease,” Bryson writes. We die more frequently, in other words, from genetic inheritance—“The best way to ensure longevity,” according to George Bernard Shaw, “is to pick your parents”—or from poor self-maintenance. Self-maintenance chiefly means exercise and diet. As it happens, I hold with neither. I have friends my age who still run 5K races, still do one-handed push-ups and dozens of chin-ups; others who still play singles tennis. My only exercise, apart from putting my trousers on standing up, is walking about on errands.
According to a study cited by Bryson, “someone who sits for six hours or more per day” qualifies as a couch potato. Most days I sit for more than twelve hours. Adding up the time I sit at my desk writing or in a comfortable chair reading, or on the couch watching baseball games or English detective shows in the evening, I qualify as a couch potato with oak-leaf cluster. But why, my thinking is, be jogging round the block or working up a sweat on a Nordic track, destroying what remains of the cartilage in my knees, when I could be sitting on my duff reading the stories of Nikolai Leskov or the essays of David Hume?
As for diet, in recent years I, having forsaken all health foods, eat what I like. Wild and crazy guy that I am, this includes at least one hard-boiled egg a day, ice cream whenever it is on offer, and red meat at least twice a week. “The most popular vegetable in America by a very wide margin,” Bryson notes, “is the French fry,” and I have my share of those, too. Lest I make myself sound braver than I am, I do take four different vitamins, and a statin to cut down my cholesterol. But with only one prescription drug (the statin), I am, for my age, rather abstemious. Many among my contemporaries are on five or six prescriptions. “We rarely know, for instance,” Bryson writes, “what happens when various medications are taken in combination.” A friend told me that Tom Wolfe, when at Johns Hopkins for a general check-up, revealed that he was on thirteen different pills. The physicians at Hopkins told him to cut out any eight.
Life spans around the world have increased just as deaths at childbirth have decreased. Cancer survival rates have improved. According to a study cited by Bryson, medicine has accounted for roughly 20 percent of these improvements; improved sanitation, diet, and healthier working conditions have been more important. The rich—no surprise here—live longer than others. But Americans—a surprise here—have a higher death rate than the Australians, the English, the Germans, or the French, owing no doubt to poor diet, high stress, ill health, and violence.
Spinoza claimed that “the free man thinks of nothing less than death.” But, then, Spinoza (1632–77) lived only to forty-four, so what did he know? Montaigne (1533–92), who lived to nearly sixty, felt that if we are to “banish the strangeness of death,” we should “always keep the image of death in our minds and in our imagination.” If one has had the good fortune to reach one’s eighties, the subject of death becomes insistent. The questions that arise from this insistence are how much longer one will live and how long one would wish to live. We have no control over the answer to the first question, obviously, but we can at least theorize about the second.
Everyone, surely, would like to continue living as long as life is good. But when does it cease to be good? When pain vastly outweighs pleasure. When one feels a serious slippage in one’s mental prowess. When one can no longer do many of the things one loves and still wants to do. (My father, who lived to ninety-two, regretted more than anything else his loss of independence when in the last year or so of his life he required caregivers.) As for myself, I should like to remain alive as long as I continue to find the world, as I do today, the same richly complex, endlessly puzzling, vastly amusing place I have always found it.
Joseph Epstein is the author, most recently, of Charm: The Elusive Enchantment.