That’s not normal

2018-01-11T13:15:43+00:00

A common question that arises in medical management is whether or not a certain set of circumstances or testing parameters is “normal“. As a physician, sometimes answering this question is like walking a tight rope.  There are patients who are the absolute pictures of health, but have had a lab value fall one or two percent outside the “normal range,” only to result in an ensuing panic that “something is wrong”.  Then there are others beset with disturbing symptoms for whom normal test results can be the worst news in the world.

Good health is not something to be fettered down into data points.  Well-being is multi-faceted and all-encompassing.  And despite the countless uninterpretable health metrics that have been developed over the last five or six decades, there is ultimately only one determinant of whether or not someone is “well”, which is one’s own individual perspective.

A common mistake in healthcare nowadays is to rely on prescribed standards of normalcy, thereby creating the assumption that as long as these standards are met, then someone is healthy, and when the standards are not met then they are not healthy.  What if, for a given individual, the standards are never measured?  What are the risks involved?  How do we determine the positive or negative impact of those risks?

Consider the following scenarios:

An obese 60yo Tibetan monk, whose blood sugar averages at 250 (rendering him diabetic by definition) and familial colonic polyposis which carries a high risk for turning into colon cancer before the age of 50, but never gets these preventive measures tested and therefore never knows his status.  He eventually takes ill and passes away of “unknown causes” surrounded by the calming presence of his brethren.

vs

A 55-year-old woman whose mother and sister had both been diagnosed with breast cancer, compelling her to undergo breast imaging 2 to 4 times per year for 15 years with various equivocal results leading to multiple biopsy procedures until she finally gives in to bilateral mastectomies, only to discover after the fact that she has refractory hypertension from all the stress, thyroid cancer from all the radiation, and depression and anxiety which have evolved into insomnia and fibromyalgia — none of which is terminal, but lands her in doctors’ offices every couple of months, visiting pharmacies every couple of weeks, anticipating another surgery within the year, and with no end in sight to the efforts at medical manipulation.

Which of these overall situations seems less healthy to you?

In our culture we have come to value survival over equanimity.  We would sooner live in torment than die in peace.  I’m not suggesting that everyone should just lay down and die.  But if we are going to choose life, perhaps we need to redefine what we perceive “life“ to consist of? Is it just about added time?  More inhalations and exhalations, more heartbeats, whatever the cost?  Would we rather have every parameter of our physiology tested simply because a commercial agency has generated the ability to test it, only to be compared against statistical “norms” with a questionable base sample size, regardless of whether or not any scientific developments have arisen to do anything about the result?  Or can we accept there is a possibility that something we can’t anticipate might “get” us when we don’t expect it, no matter how much effort we put into predicting the future?  And can we live with that uncertainty?  How prepared were the people who fell victim to the Las Vegas sniper, or the Santa Barbara mudslides?  What does it even mean to be “prepared”?  Does it have anything to do with knowing their cholesterol numbers??  I would beg to differ.

We say there are two certainties in life: death and taxes. I prefer to say that the two certainties in life are (1) that it will eventually end, but (2) we do not know when.  Accepting these two facts liberates us to focus on something that *is* in our control, which is how we spend the time we have, to choose what we do with ourselves one moment to the next, and whether it will leave a positive or negative mark on anyone within our influence who might survive us when we are gone.  Whether we live in anticipation of what is coming — good, bad or indifferent — versus taking the moment we are in and deciding to make it the best moment we have ever had regardless of the circumstances: this is all within our reach as individuals.  We have no idea how much time we will have, so whatever we’ve got… Why not make it count?

So many of us are so focused on and worried about “the end“ and what it will consist of, that one might even suggest it is common to the point of being “normal”.  Which means living in the moment, appreciating the time for what it is, would be the aberration.  Under this presumption, is “normal” really what we want?

On the other hand, if the term “normal” is used to describe a state of perfection, wellness, wholeness, calm, and peace, I’d say our preoccupation with becoming normal… well, it’s just not normal at all.