Outlive: The Science and Art of Longevity

In the dream, I’m trying to catch the falling eggs.

I’m standing on a sidewalk in a big, dirty city that looks a lot like Baltimore, holding a padded basket and looking up. Every few seconds, I spot an egg whizzing down at me from above, and I run to try to catch it in the basket.

They’re coming at me fast, and I’m doing my best to catch them, running all over the place with my basket outstretched like an outfielder’s glove. But I can’t catch them all. Some of them—many of them—smack on the ground, splattering yellow yolk all over my shoes and medical scrubs. I’m desperate for this to stop.

Where are the eggs coming from? There must be a guy up there on top of the building, or on a balcony, just casually tossing them over the rail. But I can’t see him, and I’m so busy I barely even have time to think about him. I’m just running around trying to catch as many eggs as possible. And I’m failing miserably. Emotion wells up in my body as I realize that no matter how hard I try, I’ll never be able to catch all the eggs. I feel overwhelmed, and helpless.

And then I wake up, another chance at precious sleep ruined.

We forget nearly all our dreams, but two decades later, I can’t seem to get this one out of my head. It invaded my nights many times when I was a surgical resident at Johns Hopkins Hospital, in training to become a cancer surgeon. It was one of the best periods of my life, even if at times I felt like I was going crazy. It wasn’t uncommon for my colleagues and me to work for twenty-four hours straight. I craved sleep. The dream kept ruining it.

The attending surgeons at Hopkins specialized in serious cases like pancreatic cancer, which meant that very often we were the only people standing between the patient and death. Pancreatic cancer grows silently, without symptoms, and by the time it is discovered, it is often quite advanced. Surgery was an option for only about 20 to 30 percent of patients. We were their last hope.

Our weapon of choice was something called the Whipple Procedure, which involved removing the head of the patient’s pancreas and the upper part of the small intestine, called the duodenum. It’s a difficult, dangerous operation, and in the early days it was almost always fatal. Yet still surgeons attempted it; that’s how desperate pancreatic cancer is. By the time I was in training, more than 99 percent of patients survived for at least thirty days after this surgery. We had gotten pretty good at catching the eggs.

At that point in my life, I was determined to become the best cancer surgeon that I could possibly be. I had worked really hard to get where I was; most of my high school teachers, and even my parents, had not expected me to make it to college, much less graduate from Stanford Medical School. But more and more, I found myself torn. On the one hand, I loved the complexity of these surgeries, and I felt elated every time we finished a successful procedure. We had removed the tumor—we had caught the egg, or so we thought.

On the other hand, I was beginning to wonder how “success” was defined. The reality was that nearly all these patients would still die within a few years. The egg would inevitably hit the ground. What were we really accomplishing?

When I finally recognized the futility of this, I grew so frustrated that I quit medicine for an entirely different career. But then a confluence of events occurred that ended up radically changing the way I thought about health and disease. I made my way back into the medical profession with a fresh approach, and new hope.

The reason why goes back to my dream about the falling eggs. In short, it had finally dawned on me that the only way to solve the problem was not to get better at catching the eggs. Instead, we needed to try to stop the guy who was throwing them. We had to figure out how to get to the top of the building, find the guy, and take him out.

I’d have relished that job in real life; as a young boxer, I had a pretty mean left hook. But medicine is obviously a bit more complicated. Ultimately, I realized that we needed to approach the situation—the falling eggs—in an entirely different way, with a different mindset, and using a different set of tools.

That, very briefly, is what this book is about.