Taciturn, wiry and in his 50s, the patient was hospitalized because of a diabetic toe infection. He had no other pressing health issues, so those of us in training at the time expected him to go home after a few days of intravenous antibiotics.
Instead, he died in the hospital.
A second infection took hold in his other foot. The first infection never responded to antibiotics, so he needed progressively higher amputations to control its spread. All the antibiotics gave him uncontrollable diarrhea. And before long, he was losing weight and needed nutritional supplements like the ones sometimes administered to advanced cancer patients.
But he seemed oddly indifferent to all the pain and discomfort; it was as if he expected only to get worse.
“He’s not depressed,” a consulting psychiatrist told us when we became worried that he was sliding into a depression. “It’s just the way he is.”
When his heart stopped one night without warning, we were left wondering why a man who should have walked out of the hospital had died instead. We reviewed and analyzed the decisions we made, searching for some plausible physical causes. Finally one of the most senior doctors in the hospital suggested the one we would come to accept: the patient never believed he would live.
I remembered that patient and the senior doctor’s explanation this week while reading a new book on outlook and health called, appropriately enough, “Up.”
There is no shortage of books for anyone even vaguely interested in the mind-body connection. Most are brimming with breezy narratives and inspirational tales, helpful tips and well-worn truisms. But few offer discerning analyses, evidence-based recommendations or even the simple acknowledgment of just how hard believing in oneself can sometimes be.
It is this well-grounded gravitas, combined with a surprisingly unassuming narrative voice and gentle wit, that make “Up” hard to put down. Dr. Hilary Tindle, an associate professor of medicine at the University of Pittsburgh and respected researcher, manages deftly to weave the emerging scientific evidence linking outlook to outcome with a wealth of practical suggestions and individual stories. The result is not simply another self-help book, but a thought-provoking and intelligent read.
By her own account, Dr. Tindle is a “struggling optimist.” And while it is clearly the second part, her optimism, that propelled her to draw up this book, it is her struggle that gives it its most resonant colors. She recounts being diagnosed with a life-threatening heart condition while in college. Filled with anxiety about her upcoming open-heart surgery, she asks her cardiothoracic surgeon if there is anything she can do to help.
“You already have,” he answers, referring to her underlying belief that she can do something to influence her outcome. The operation turns out to be a success; and that response and her reliance on his support become Dr. Tindle’s first lesson in the power of even mitigated optimism and the challenges of maintaining it.
That lesson is reinforced years later when she begins to see patients and conduct research on the relationship between cardiovascular disease and outlook in tens of thousands of women. She finds that even sedentary and obese patients with a predisposition to hypertension and high cholesterol can lose weight, stop smoking, start exercising and take their medications regularly if they adopt a more engaged and hopeful outlook. And that optimism can dramatically decrease their risk of dying or becoming disabled by a host of diseases usually chalked up to aging.
“Perhaps the real fountain of youth,” Dr. Tindle concludes, “emanates not from a cosmetic counter but from what’s between your ears.”
To help the rest of us tap into that fountain, Dr. Tindle presents a program that starts with abbreviated versions of three questionnaires used in outlook research. Readers must ask themselves questions like whether they tend to expect the best or rarely count on good things happening, and whether they tend to become consumed by feelings of inadequacy when they fail or if they simply believe they are no different from most people.
Quick to acknowledge the differences between individuals and the nuances of particular challenges that some may face, Dr. Tindle presents several well-proven tools like mindful self compassion to help ease the process and offers brief, clear explanations of the science behind cognitive behavioral therapy, mindfulness and neuroplasticity, the ability of brain neurons to form new connections and thus work in new ways.
The problem with this compelling and helpful book is, of course, that pessimists, naysayers and others who could benefit the most are unlikely ever to pick it up. But those who do may surprise themselves by taking their medications a little more purposefully, setting aside time to exercise more intentionally and feeling more than a pang of sadness when they learn toward the end of the book that the cardiothoracic surgeon who operated on Dr. Tindle and who later fills in for her late father by walking her down the aisle, dies in an automobile accident.
That is because with “Up,” Dr. Tindle has given us the same gift he gave her – an affirmation not only of who we are, but also of what we believe we can be.