[RADIOLAB INTRO]

LATIF NASSER: Hey, this is Radiolab. I'm Latif Nasser. Today I want to tell you a story that—well, it started with a cold email that I got a few weeks ago from the person it happened to.

BLAIR BIGHAM: Hey, Latif.

LATIF: Hey, good to see you!

BLAIR BIGHAM: Likewise. Sorry I'm a bit late here.

LATIF: This is Blair Bigham. He is a doctor in Toronto. And the email, it almost felt like a confession.

LATIF: This is like a very—it's a very vulnerable pitch.

BLAIR BIGHAM: Yeah, thank you for saying that. It's been—it's been very weird, and I knew that I would want it shared, I just didn't know when.

LATIF: And so I called him up to talk to him about it.

LATIF: Okay, well let's—okay, let's rewind back to the beginning.

BLAIR BIGHAM: Sure.

LATIF: How did you get into medicine, or even just this area in general?

BLAIR BIGHAM: Yeah. So I mean, swimming for me was my childhood. The memories that I have are going to the pool. And what do you do as soon as you can when you're a swimmer? You go and you become a lifeguard.

LATIF: Right.

BLAIR BIGHAM: And so that was my entry into, you know, chest compressions, defibrillators, the idea of saving a life. And I remember that feeling of jumping into a pool for the first time to pull somebody out who was struggling. And I remember just being like, "That was the coolest feeling ever!" And, you know, growing up watching ER and Baywatch, it's like you get the sense that you can go and really save people's lives.

LATIF: And that possibility just hooked him.

BLAIR BIGHAM: I was like, "That's it. My next move now is to become a paramedic."

LATIF: And so he goes to school for it, and for the next decade or so he's riding around in ambulances ...

BLAIR BIGHAM: Talking on the radio to the dispatcher.

LATIF: Using the defibrillator paddles.

BLAIR BIGHAM: Doing CPR. Pulling people out of cars.

LATIF: He was saving lives.

BLAIR BIGHAM: I was, like, living my dream and loving every minute of it.

LATIF: Until one day and one very particular call he got.

BLAIR BIGHAM: Yeah. So I mean, I was working part time as a flight paramedic.

LATIF: A flight paramedic?

BLAIR BIGHAM: Yeah, I was working on a helicopter in Toronto.

LATIF: Wow!

BLAIR BIGHAM: And we picked up this woman who had been struck by a dump truck, and for about 45 minutes me and John, my colleague that day, we worked our butts off. We were drenched in sweat. We were working as fast as we could to pour more blood into her as fast as she was losing it, try to keep her oxygenated. Like, we did everything. And we got to this hospital, and we got into the resuscitation bay, and the surgeon, who I respect and admire, puts an ultrasound probe on her heart and he says, "We're done here." And it was the most jarring moment I can think of in my career. The moment of him saying "We're done," it's like you just got hit by a baseball bat. Like, you're sweating, you know, there's blood all over you, your heart rate's probably 130, right?

LATIF: Yeah.

BLAIR BIGHAM: Like, you have just been basically running a marathon to save this person's life, and all of a sudden it ends. I just remember feeling very confused and sad that day. I was like, I'm never gonna let anybody feel the way I felt that day. I was really impacted by it.

LATIF: And so Blair became a doctor himself. Fast forward a couple years, he's on a fellowship at Stanford University in the ICU in 2020.

BLAIR BIGHAM: And I end up locked in Stanford Hospital during the pandemic, as every ICU doctor and ICU fellow was, doing our very best to—to save COVID patients.

LATIF: And Blair says they were saving a lot of people.

BLAIR BIGHAM: The technology is amazing. What we can do now that we couldn't do even 10 years ago, 20 years ago is absolutely incredible, and it's why I'm a physician.

LATIF: But also, he started to notice this other thing happening, this thing that as a paramedic he'd never really been around long enough to see.

BLAIR BIGHAM: There comes this point where, after taking care of somebody for a little while, you and everybody around you starts to realize that they're not getting better. And so then I began getting a little bit uncomfortable of how we were keeping technology—or even adding more technology to people's bodies when it was very clear that they were never going to survive.

BLAIR BIGHAM: Once you're on life support, once you're on those machines, it's really, really hard for you to die. I can adjust everything about the way your body functions. I can adjust your pH, I can adjust your hemoglobin, I can adjust the amount of air that moves in and out of your lungs and how much oxygen is in that air. I can adjust your blood pressure and your heart rate. I take over total control. And normally, there's a curve. You get a bit sicker and then you kind of plateau, and then you get a bit better, and then we take off the life support, and then you go home. And sometimes the life support intensity just keeps going up and up and up and up, and there comes a point where you start to feel like you're hurting instead of helping.

LATIF: Yeah.

BLAIR BIGHAM: Where nobody around you, none of your colleagues believe that this person's gonna survive, none of the data suggests that they're gonna survive. And yet we're obstructing them from crossing that finish line.

LATIF: And as Blair spent more time in the hospital, he started to see more and more extreme examples of this.

BLAIR BIGHAM: I had a mentor who had a patient who was brain dead. And so this patient is clinically dead, but their family sued the hospital to keep the patient on a ventilator. And so for 400 days that ICU bed was occupied by a dead person. And while I feel for the family, obviously you would never want a family to think that you've declared death inappropriately, I think that's wrong on so many levels.

LATIF: He felt like it's just a waste.

BLAIR BIGHAM: It doesn't make any sense.

LATIF: You know, of time, of money.

BLAIR BIGHAM: It costs over a million dollars a year to keep someone in an ICU bed.

LATIF: But more importantly ...

BLAIR BIGHAM: Nobody wants to die that way. No one has ever told me, "I want to die attached to a bunch of machines, sedated and unaware of my surroundings."

LATIF: And as Blair thought about this case and other ones like it, he started to notice this kind of contradiction. You know, he'd gotten into medicine to save people's lives, to keep them from dying too early, but that very desire was causing some of his patients to die too late.

BLAIR BIGHAM: And that can be as great a tragedy as people dying too early.

LATIF: Sometimes ...

BLAIR BIGHAM: The most humane thing we can do, the most loving thing that we can do for this patient is to stop applying ourselves to them, and let nature take its course.

LATIF: So Blair has this realization, and in September, 2022 ...

[ARCHIVE CLIP, host: In his new book called Death Interrupted: How Modern Medicine is Complicating the Way We Die ...]

LATIF: ... he writes a book about it.

[ARCHIVE CLIP, host: Dr. Blair Bigham joins us now in studio. Welcome.]

[ARCHIVE CLIP, Blair Bigham: Thank you.]

LATIF: And it gets a bunch of attention.

BLAIR BIGHAM: I did a decent amount of media. It made the two bestseller lists here in Canada.

LATIF: Started a lot of people across the country talking about it—including his own family.

BLAIR BIGHAM: I mean, my mom was, like, "Oh my God, we need to have a power of attorney, and we need to talk about all of this."

LATIF: Did that ever happen? Or it was just a conversation, like, "Oh, we should do this."

BLAIR BIGHAM: Yeah, yeah. It was all talk.

LATIF: I'm in the same place with my parents, I feel like right now. Yeah.

BLAIR BIGHAM: Yeah, it's such a—I mean, I [bleep] wrote a book saying, "Oh, you have to have this conversation," and I'm like, "Oh my God, I haven't had the conversation with my own parents." Anyway, two months after my book comes out, you know, I've gone on this speaking tour, I've been like, "Yeah, we use too much technology. Sometimes it's okay to let people die." And my mom called me and said, "Your dad—like, there's something wrong with your dad's stomach. He's been complaining about it for a couple of days." And my life got turned upside down.

LATIF: Are you the one in your family that when anyone is sick or whatever they call you?

BLAIR BIGHAM: Oh my goodness. Every doctor will lament about, if you're the only health care—or nurse, or paramedic—any health care professional, if you're the only one in the family, you're getting these text messages and photos of rashes and questions about baby's fevers and ...

LATIF: Yeah.

BLAIR BIGHAM: ... it's all coming to you.

LATIF: Right.

BLAIR BIGHAM: And so I didn't think too much of it when my mom calls and says, "Oh, like, something's really wrong with your dad's stomach." And I said, "All right, well, Dad's 75 and he's having abdominal pain. He needs to go to the emergency department and get a CAT scan."

LATIF: Yeah.

BLAIR BIGHAM: Period.

LATIF: Yeah.

BLAIR BIGHAM: And of course he doesn't. And then a few days later, my mom calls me back and I say, "Well, what did the CAT—like, what did the doctor say?" "Oh, he hasn't gone."

LATIF: Yeah.

BLAIR BIGHAM: "Well Mom, you just have to put him in the car and take him to the hospital, and you tell the emerg doc that your son is Blair Bigham, he's an emergency doctor, and he says you need a CAT scan."

LATIF: Right.

BLAIR BIGHAM: And so they go to the emergency department, and the doctor doesn't order a CAT scan. And my dad is not the type of person who's gonna go in and say, "My son's a doctor. Give me a CAT scan." So he probably said something, you know, passive.

LATIF: I also have very polite Canadian parents, so I know how that goes. Yes.

BLAIR BIGHAM: [laughs] And my dad—I know my dad. My dad just would have wanted to get the hell out of there, right? He doesn't want to be in a big, crowded emergency department.

LATIF: Right. Sure.

BLAIR BIGHAM: Anyway, so my mom calls me back, right? "It's still really bothering—" Okay, mom." I pull out my schedule, and I say, "Tomorrow, at 10:00 am, my friend Scott starts his shift at my emergency department. You're gonna go tomorrow at 10:00 and you're gonna ask for Scott McGilvray, and you tell them you're Blair Bigham's parents, and Scott's gonna take very good care of you." And I shoot Scott a text and I say, "My dad's coming in with belly pain. He's already been on a PPI. Like, figure it out." And I have no—I don't think anything is gonna show up, right? And then the next day I'm at work in the ICU, and my phone rings and I look at it, and it's Scott's number. And I say okay, so I kind of start walking out of the ICU because, like, I'm gonna have a conversation. And I answer the phone and Scott says, "I'm really sorry Blair, but I have some really bad news for you." And then he starts reading the radiologist's report.

LATIF: Yeah.

BLAIR BIGHAM: "There's a four-centimeter pancreatic mass invading the stomach." The minute Scott started reading I said, "[bleep], that's a fatal pancreatic cancer." The reason pancreatic cancer is so famous and so deadly is because it grows silently until it's too big to cut out. And so the people who survive pancreatic cancer, it gets picked up before it becomes symptomatic through some sort of a good luck situation because they got a scan for something else.

LATIF: But in the case of Blair's dad, it seemed like ...

BLAIR BIGHAM: It was probably too late, and his cancer was of the type where you're talking about months, not years. And so I was just—I don't even know. The next—the next 12 hours of my life are a total blur. I couldn't leave the service that I was on. I had to keep caring for people, but I was just—I have no idea if I did a good job at work that day or not. I just could not think of anything. An hour or two later, I called my dad and I said, "Did Scott talk to you?" And he said, "Yep." And I said, "Do you have any questions?" And he said, "No, not right now." And I said, "Okay Dad, I'm getting you into a surgical consult because we need surgery. If it's not operable, like, then you've only got a year to live. Like, we have to get you surgery."

BLAIR BIGHAM: And so then I did the most irrational stuff. I called the best pancreatic surgeon in the country and harassed his administration staff to get me in touch with him, and said, "I need you to see my dad tomorrow." Because I had hope that no—that even though the odds were slim, that that surgeon was gonna say, "I can cut this out of you and that yeah, you might need a bit of chemo after but, you know, like, this is survivable." Like, that's what I was waiting for.

LATIF: And so within a couple of days, there they were, Blair and his parents sitting in this doctor's office.

BLAIR BIGHAM: And the surgeon came into that room and was clear as day. "There is no surgical option." And we were just silent. We were just sitting there, because I had set the expect—I said, like, "If it's not surgical, then it's going to kill you." And I had told them that before the meeting. And so I remember sitting in that clinic office when the surgeon said, "I cannot cut this out of you." And my dad just looked at me. I remember his facial expression of just being like, "There it is." It was—that was the moment that he knew that he was gonna die of pancreatic cancer.

BLAIR BIGHAM: And then I remember sitting in the Tim Hortons coffee shop with my mom and dad immediately after meeting with this top surgeon, and even though I knew that there was nothing they could do because I'd seen so many people die of pancreatic cancer, I was just so spun. I just went down that rabbit hole of what else can we do here? Can we do genetic testing on the tumor to see if it's susceptible to some special study drug? You know, like, I kept having ideas of, like, well what about this, what about that, what about this?

LATIF: It's almost—from the outside, to hear you tell this story, like, you have all of this training, you've gone through this a million times. And then it happens with your family, and it's like, none of that counts for anything. Like, you're just ...

BLAIR BIGHAM: None of it, no. Like, I'm just spinning about all the ways my dad could die.

LATIF: Right.

LATIF: And so, despite everything ...

BLAIR BIGHAM: He started chemotherapy, and whenever I would propose this, that or the other thing, my dad would say something like, "Yeah, yeah, yeah. Okay, yeah. Okay, we can do another CT scan. Okay yeah, we can do that. Okay yeah, we can do that."

BLAIR BIGHAM: And then for the month of February, he actually felt pretty good. And then in March I got another phone call from my mom that he's vomiting. And when you have pancreatic cancer and you're vomiting, there's only one thing that's going on and that's the mass in your stomach has blocked off where the food exits your stomach and so your stomach can't drain. And that's what happened to my dad.

BLAIR BIGHAM: And later that night, the hepatobiliary surgeon called me and said, "There's nothing I can do for your dad. There's nothing else that I can do." And so then I started saying things like, "Well, what if we did a post-pyloric feeding tube, or can we—" And he said, "Blair, stop. I'm telling you that there's nothing that we can do right now." And then I remember we were talking with the surgeon around the bedside, and I kept saying, "Well, what about, like, can we switch to FOLFOX? Like, can we switch chemotherapy regimens?" And my dad yelled my name in, like, a very gruff way, and said, "I just want to be comfortable. We're done here." And I looked around the room, and I was just like, "Okay, this is that moment. I'm the crazy, whack-a-doodle son that I'm so used to seeing in the ICU where I work." And then that was it. And then it was palliative care, and he died three weeks later.

BLAIR BIGHAM: I was in that zone. I was in that physician-scientist zone of, like, "Fix this." I couldn't just sit there beside him. It was—I just found it infuriating to just sit there, knowing that this cancer was just growing in his abdomen. I couldn't handle the idea that there was nothing left to do here. I just couldn't get comfortable with that, even though I promote it so often. I wrote a book about how people should value palliative care and the ICU, and here I was saying, "But not with my dad."

LATIF: The—the question that I have is like, oh my God, if Blair can't let go in this moment, if you can't do it ...

BLAIR BIGHAM: Yeah. How can anyone else?

LATIF: How can anyone else?

BLAIR BIGHAM: I don't know. I mean, I have been—I have steeped myself in this topic for four years now, and I—I don't have the answer yet.

LATIF: I want to end this story about endings with a beginning—a beginning that Blair's dad gave to him in his final days of life.

[ARCHIVE CLIP, Blair's father: Okay. So we've got a bunch of candles here.]

BLAIR BIGHAM: On December 23, just before Christmas, my fiance, Fernando and I got married.

[ARCHIVE CLIP, Blair's father: So Fernando, place this ring on the third finger of Blair's left hand. "Blair, I give you this ring."]

[ARCHIVE CLIP, Fernando: Blair, I give you this ring.]

[ARCHIVE CLIP, Blair's father: "As a symbol and pledge ..."]

[ARCHIVE CLIP, Fernando: As a symbol and pledge ...]

[ARCHIVE CLIP, Blair's father: "... of the covenant we've made between us."]

[ARCHIVE CLIP, Fernando: ... of the covenant we've made between us.]

[ARCHIVE CLIP, Blair's father: Blair? "Fernando, I give you this ring."]

[ARCHIVE CLIP, Blair Bigham: Fernando, I give you this ring.]

BLAIR BIGHAM: And my dad, with a nasogastric tube shoved down his nose, draining his stomach into a bag, with a rubber band around his arm officiated.

LATIF: Whoa!

[ARCHIVE CLIP, Blair's father: "As a symbol and pledge ..."]

[ARCHIVE CLIP, Blair Bigham: As a symbol and pledge ...]

[ARCHIVE CLIP, Blair's father: "... of the covenant we have made between us."]

[ARCHIVE CLIP, Blair Bigham: ... of the covenant we have made between us.]

[ARCHIVE CLIP, Blair's father: Ladies and gentlemen, I present you the married couple, Fernando and Blair. [applause]]

BLAIR BIGHAM: The wedding is how I'll remember my dad. So I mean, yeah. Yeah.

LATIF: We need to go to break, but we've got more coming up, so stick with us.

LULU MILLER: Heads up, today's show does include a couple of curse words. So anyway, here we go.

MARIA PAZ GUTIÉRREZ: Are you there? Hello?

LATIF: [laughs] Hey! Hi, how you doing?

LATIF: This is Radiolab. I'm Latif Nasser and today, a desperate, crazy, possibly futile, definitely foolhardy, soul-searching journey from our producer, Maria Paz Gutiérrez.

MARIA PAZ: Okay, so Latif, have you seen a movie called The Seventh Seal?

LATIF: Oh, that's the Ingmar Bergman movie from, like, the—I don't know, '50s?

MARIA PAZ: Yeah.

LATIF: I think I fell asleep during that movie, if I'm being honest.

MARIA PAZ: Okay, fair.

[ARCHIVE CLIP, The Seventh Seal: Och när Lammet bröt det sjunde inseglet ...]

MARIA PAZ: But presumably you made it through the opening?

LATIF: I think so?

[ARCHIVE CLIP, The Seventh Seal: Uppstod himlen en tystnad ...]

MARIA PAZ: So just to jog your memory, the film begins with this scene of this knight, who's just landed on a beach after spending years abroad fighting this brutal, bloody war in the Middle East—The Crusades.

LATIF: All right.

MARIA PAZ: And he looks it. He has the face of someone who's seen countless friends die.

LATIF: Right.

MARIA PAZ: Has himself narrowly avoided death multiple times.

LATIF: Right.

MARIA PAZ: And he's finally made it back to the shores of his homeland. He's packing up his stuff, when he looks up ...

[ARCHIVE CLIP, The Seventh Seal: Vem är du?]

MARIA PAZ: ... and he sees this figure.

[ARCHIVE CLIP, The Seventh Seal: Jag är döden.]

MARIA PAZ: Tall and pale, and dressed in black from head to toe.

[ARCHIVE CLIP, The Seventh Seal: Jag har redan länge gått vid din sida.]

MARIA PAZ: Who is, of course, Death. And Death is just like ...

[ARCHIVE CLIP, The Seventh Seal: Ar du beredd?]

MARIA PAZ: "Are you ready?" And in that moment, as Death inches towards our knight to take his life, our guy, our knight, he stands up, he looks at Death right in the eye and says ...

[ARCHIVE CLIP, The Seventh Seal: Vänta ett ögonblick.]

MARIA PAZ: "Wait!"

[ARCHIVE CLIP, The Seventh Seal: Du spelar ju schack, inte sant?]

MARIA PAZ: "What if—what if we play a game of chess?"

LATIF: Chess?

MARIA PAZ: Yeah, a game of chess.

[ARCHIVE CLIP, The Seventh Seal: Du kan ändå inte vara skickligare än jag.]

MARIA PAZ: "If I win, you spare my life, and if I lose you—you do your thing." And Death is like ...

[ARCHIVE CLIP, The Seventh Seal: Det har du rätt.]

MARIA PAZ: "Yeah. Let's do this." So the rest of the movie is basically just this game. In between moves, our knight, he goes home, he sees his wife again. He's eking out the last bits of whatever life has to offer before the end.

LATIF: I take it he loses the chess game.

MARIA PAZ: Of course he does.

LATIF: And why—and why are you telling me any of this? [laughs]

MARIA PAZ: Because seeing this knight just reminded me that I'm gonna die one day.

LATIF: Right.

MARIA PAZ: I mean, I've always—I've always thought about death. My dad died when I was a year old, and so from a young age I always had this sense that life, it can be cut short at any moment. And my whole life I've been trying to make sense of why it is that we're given this thing to have it just kind of like, be taken away.

LATIF: Hmm.

MARIA PAZ: So for me, when I saw this knight, maybe it seems pointless, but I was just like, that—this, it felt like this beautiful, compelling act of resistance. And it made me think I want to do that.

LATIF: What?

MARIA PAZ: I want to challenge Death.

LATIF: [laughs]

MARIA PAZ: So that is what we're gonna do today here. I am challenging Death to a chess match of sorts. A duel, you could say.

LATIF: Okay?

MARIA PAZ: To the death. So obviously, Death was not available.

LATIF: Okay.

MARIA PAZ: Too busy ending lives left and right.

LATIF: Okay, all right.

MARIA PAZ: So I called a team of people who could stand in for Death, or play on Death's behalf.

CHRIS SCHELL: News flash!

MARIA PAZ: A couple of ecologists.

ROBERTO SALGUERO-GÓMEZ: We're all gonna die.

MARIA PAZ: An evolutionary biologist.

STEVEN AUSTAD: Death is inevitable.

MARIA PAZ: An astrophysicist.

JANNA LEVIN: Death is just simply part of being a human.

MARIA PAZ: And an anthropologist.

GABRIELLA KOUNTOURIDES: Everything dies.

LATIF: Okay, so why have we assembled all these very morbid people together?

MARIA PAZ: All these scientists, they know death. They know how it works. And so I just asked them: if I was to play a game of chess with Death, if I could do my version of that chess match from the movie, what would Death's moves be? Like, how would Death come for me? And my thought is maybe there's a move that I can make to, like, outwit and basically beat Death.

LATIF: [laughs] Okay. All right. Okay, I mean, I think I know how this is gonna go, but let's do it.

MARIA PAZ: Hell, yeah. So Death's first move, courtesy of ...

ENGINEER: Give me a little one, two, three.

MARIA PAZ: ... evolutionary biogerontologist Steven Austad ...

STEVEN AUSTAD: One, two, three, six, nine, twelve, fifteen.

MARIA PAZ: ... ecologist Roberto Salguero-Gómez ...

ROBERTO SALGUERO-GÓMEZ: Just call me Rob. If you call me Roberto, I'll think it's my mother telling me off.

MARIA PAZ: ... and anthropologist Gabriella Kountourides ...

GABRIELLA KOUNTOURIDES: Yeah, of course. Hi!

MARIA PAZ: ... is basically ...

GABRIELLA KOUNTOURIDES: You know when you wake up and you leave your house you might get hit by a car.

MARIA PAZ: ... [bleep] happens.

ROBERTO SALGUERO-GÓMEZ: You could be run by a bus. God forbid!

STEVEN AUSTAD: You can have a safe fall on your head.

ROBERTO SALGUERO-GÓMEZ: Or you could be ...

STEVEN AUSTAD: ... killed by a cold snap, by a heavy storm.

ROBERTO SALGUERO-GÓMEZ: Mm-hmm. Any stochasticity in your life ...

STEVEN AUSTAD: ... and then you're gone.

GABRIELLA KOUNTOURIDES: And the longer you live, the more chance there is of something awful happening to you because that's how life works.

MARIA PAZ: All these accidents, they're death's little minions. They're kind of just like, waiting for us to—waiting for me to slip and fall so that I can eventually meet my maker. So my first move in the game is like, that's fine. I can be careful. I could just stay home. I can use a water purifier.

LATIF: Employ a food taste tester in case there's any poisons that happen to fall into your food.

MARIA PAZ: Yeah. I can just wear a helmet.

LATIF: Wear 10 helmets. You could wear, like, styrofoam padding, just like around your body at all times.

MARIA PAZ: Even random things like earthquakes?

LATIF: Yeah?

MARIA PAZ: I downloaded an app that will give me two minutes to leave the building in case everything is collapsing around me.

LATIF: And you're gonna make sure your phone never runs out of battery, I guess? Or ...

MARIA PAZ: I—I got a backup.

LATIF: Okay, you got a [laughs]. Okay.

GABRIELLA KOUNTOURIDES: Great. But ...

MARIA PAZ: Of course, even if I bubble-wrap myself and sit in my apartment, watching my earthquake app, that doesn't protect me from ...

STEVEN AUSTAD: Disease.

GABRIELLA KOUNTOURIDES: We can get influenza, we could get diabetes. We could get asthma.

MARIA PAZ: Diseases that might just kill me outright, or ...

STEVEN AUSTAD: Kidney failure, cancer or heart disease.

MARIA PAZ: ... might just set me up for Death's next move, which is ...

GABRIELLA KOUNTOURIDES: Wear and tear.

MARIA PAZ: ... to play the long game.

ROBERTO SALGUERO-GÓMEZ: You deteriorate as you get older, right?

STEVEN AUSTAD: Yeah.

ROBERTO SALGUERO-GÓMEZ: Let me give you an example: do you own a car?

MARIA PAZ: I own a car.

ROBERTO SALGUERO-GÓMEZ: Awesome. Can I ask you how old is your car?

MARIA PAZ: 2015.

ROBERTO SALGUERO-GÓMEZ: 2015. So getting there, right?

MARIA PAZ: [laughs] Yeah.

ROBERTO SALGUERO-GÓMEZ: You know, with time, there will be some things that you need to take it back to the car workshop for to fix.

STEVEN AUSTAD: Because parts wear out. For instance, the heart—it's a muscle. You know, and muscles eventually wear out.

MARIA PAZ: One of those essential organs gives out ...

ROBERTO SALGUERO-GÓMEZ: You're dead.

LATIF: But people have heart transplants, people have kidney transplants. Who cares?

MARIA PAZ: Yes, indeed. That's what I was saying. You are on my side. Welcome. Welcome to the dark side.

LATIF: Yeah, okay.

MARIA PAZ: Let's just do some transplants.

ROBERTO SALGUERO-GÓMEZ: You can, in theory, replace parts, but once they fail, you'll be like, "You know what? I'm done and that's it with this car."

STEVEN AUSTAD: For instance, our brains ...

LATIF: I mean, maybe parts of it.

STEVEN AUSTAD: Okay, but if you lost your memory, would you be the same person?

LATIF: This all of a sudden got a lot less abstract.

STEVEN AUSTAD: Right.

LATIF: Okay. Yeah I guess not? I don't know. I'm not sure.

STEVEN AUSTAD: I mean, I don't want to sound too negative about this, but at some point that starts to go even in the healthiest among us.

LATIF: What are you gonna do against aging?

MARIA PAZ: Well look, today we live way longer than we have ever before, in part because we eat better and have modern medicine. And so I'm just gonna dial in the perfect lifestyle. Like, what if I just eat an absurd amount of vegetables and fruits?

LATIF: Only superfoods. Eat avocados and bran flakes for every meal.

MARIA PAZ: I'm definitely drinking plenty of water.

LATIF: Great, right? And no smoking. You cannot smoke.

GABRIELLA KOUNTOURIDES: [laughs] Not smoking is a good start, but it's still not gonna stop you from dying.

ROBERTO SALGUERO-GÓMEZ: Yeah. No, Maria Paz, aging is a ...

MARIA PAZ: Everyone told me that trying to fight off aging with diet or vitamins is just not gonna cut it. There are literally hundreds of theories about why we age. The point is aging, it's like a house of cards, or the most intricate domino line thing. And to this day, scientists haven't been able to pin down exactly why we age, but what they do know is aging happens down at the most fundamental level of all living things.

STEVEN AUSTAD: Yes. It all boils down to what's going on inside your cells.

GABRIELLA KOUNTOURIDES: Yeah. Like, literally just by existing, your cells are getting damaged.

MARIA PAZ: In particular, I learned that the thing that's being damaged is the DNA inside your cells.

GABRIELLA KOUNTOURIDES: Your genetic material, your essence.

MARIA PAZ: That little coil of molecules that tells your cells what to do.

GABRIELLA KOUNTOURIDES: The information of you.

STEVEN AUSTAD: The DNA is being damaged 10,000 or more times a day.

LATIF: Right now?

MARIA PAZ: Right now!

LATIF: Okay, great. So great.

MARIA PAZ: Like, you just walk outside on any given morning ...

GABRIELLA KOUNTOURIDES: You are exposed to sunlight ...

MARIA PAZ: UV radiation.

GABRIELLA KOUNTOURIDES: That UV starts to damage your cells.

MARIA PAZ: That's damaging the DNA in your skin cells.

LATIF: Great.

MARIA PAZ: Or just take a breath. [inhales]

GABRIELLA KOUNTOURIDES: Pollution. [laughs]

MARIA PAZ: [coughs]

MARIA PAZ: Little bits of random stuff in the air damages the DNA inside our lung cells.

GABRIELLA KOUNTOURIDES: Exactly. Exactly.

STEVEN AUSTAD: So you're—you're under this vast assault.

MARIA PAZ: But that seems beatable.

LATIF: What? No. No, it really doesn't. It really does not sound beatable.

MARIA PAZ: Yes! I mean, I'll just take my helmet and my good diet and my vitamins, and I'll move to somewhere with clean mountain air, like some remote part of the world. I'll move to Antarctica.

LATIF: Okay.

MARIA PAZ: And then I'll find a cave to keep out of the sun.

GABRIELLA KOUNTOURIDES: No. [laughs]

MARIA PAZ: And then I'll just live there safe.

LATIF: [laughs] Perfect plan.

MARIA PAZ: I thought so.

GABRIELLA KOUNTOURIDES: No. Still, unfortunately, you have to keep eating to stay alive.

MARIA PAZ: So eating, my experts tell me, down at the cell level ...

STEVEN AUSTAD: That's really just a fire.

LATIF: A fire inside us?

MARIA PAZ: Yeah.

STEVEN AUSTAD: Just like a fire ...

MARIA PAZ: Like, take a campfire. That is just oxygen having a chemical reaction with the wood.

STEVEN AUSTAD: Yeah. Right.

MARIA PAZ: And inside each and every single one of our cells, we're combining ...

STEVEN AUSTAD: Oxygen and carbohydrates basically, to get energy. But just like fire has side effects like smoke and sparks and all, our metabolism, that's damaging our cells.

MARIA PAZ: And damaging the DNA, the essence of you.

STEVEN AUSTAD: You know, I'm not happy about that, but—but it's a fact.

MARIA PAZ: So the way Gabriella and Steven laid it out for me is that the instructions for the cells over time become jankier and jankier, so our cells over time become more and more messed up, which then messes up our organs. Every part of us, it all begins to fall apart.

STEVEN AUSTAD: And ultimately, that does us in.

GABRIELLA KOUNTOURIDES: And so—well, I can't really remember where we were going with this, but yeah, you have to eat. [laughs]

MARIA PAZ: By the way, do you have any questions?

LATIF: No. No. I mean, just one thing that I feel like I noticed: the idea that the sun is, like, the source of all our energy that we need to survive, and then yet literally damages us.

MARIA PAZ: [sighs]

LATIF: And then eating is the way that we get that energy into our system, and that that actually is damaging us too, while we're doing that. Like, it's like this feels like a kind of a ...

MARIA PAZ: Well, we're not ...

LATIF: I mean, you're ...

MARIA PAZ: We're not done yet. I mean, maybe you are, but I'm not. Because as I was researching the DNA damage stuff, I discovered that there are parts of the DNA and parts of the cell that are on my team.

LATIF: Wait, like, how—how so?

MARIA PAZ: There are actually, like, these little enzymes that can go in and take a damaged part of your DNA and remove it and resynthesize the original part to get it back to working the way it was before all the damage.

LATIF: Huh! All right. Okay.

MARIA PAZ: So I was like, why can't the repair team just go in there and take care of all this damage from the sun and the air and whatever?

STEVEN AUSTAD: Yeah. Well, there's really no way that we can fix all of that damage with 100 percent fidelity.

GABRIELLA KOUNTOURIDES: Like, think of a jumper, right? You've got like a knitted jumper and it's perfect. And ...

MARIA PAZ: [laughs] Okay.

GABRIELLA KOUNTOURIDES: Bear with me on this one. Maybe you, like, catch it on a branch, right? And, like, one piece of thread becomes unraveled a little bit. But that's okay because you know how to sew. So that's your cells repairing themselves. You've just repaired ...

MARIA PAZ: Mm-hmm.

GABRIELLA KOUNTOURIDES: ... like, an issue. Great. But then, you know, you accidentally walk through a really thorny bush and now you've got, like, 10 threads that have been pulled out. And actually, each of those threads is connected to more threads, and now you've got holes. And maybe they do get repaired, but just not quick enough so by the time one hole is patched up, there's already another one. And now you've got this kind of jumper that's a big mix of, like, holes and repaired pieces. And eventually your jumper's, like, not a jumper anymore. It just stops working as a jumper.

STEVEN AUSTAD: So you die.

MARIA PAZ: And at this point that's when I realized that our bodies, that my body is not even on my team, it's actually on Death's team, because as we get older, the body ...

STEVEN AUSTAD: Takes the energy away from the repair processes. And when you do that, of course, things don't get repaired.

MARIA PAZ: Believe it or not, Steven says in an evolutionary sense, this whole decaying, deteriorating, dying thing was the plan all along.

STEVEN AUSTAD: You know, the way our bodies are built now is a consequence of human evolution in an environment that for most of that time was very, very different.

MARIA PAZ: Without sanitation or modern medicine, people didn't even make it into old age.

STEVEN AUSTAD: You know, 300,000 years ago, most people were dead by the time they were 60. A lion would get us, there would be a drought, there would be a fire. We'd eat some food that was tainted.

LATIF: Good times. The glory days.

STEVEN AUSTAD: Yeah, pretty much. And if that is the case, then from an evolutionary standpoint, the idea is to reproduce before the inevitable accident happens to you.

MARIA PAZ: So, Steven says, you put less energy into fixing the damage in your body, and you put it towards reproduction. And of course ...

ROBERTO SALGUERO-GÓMEZ: If you allocate all of your resources to reproduction, you've got none left for you.

GABRIELLA KOUNTOURIDES: And that's why it's really important that we don't confuse, like, being evolutionarily successful with health. Evolution doesn't care if you are healthy. It cares if you are healthy enough to reproduce.

MARIA PAZ: At that point, how are you feeling, Latif?

LATIF: Well, just like that there's, like, conflicting priorities here in the design. It's like the thing everybody—and me as well—like, gets pissed about, like, phones. It's like planned obsolescence. Like, they make the thing so that it will break so that you'll buy a new one. That's the capitalism version, but the evolution version is like, clear this thing out of the way so we'll give the—there's room for the new model.

STEVEN AUSTAD: Yeah, so I mean, people are variable. We all have different inheritance of genes. We all survive in different environments. But a hundred years is about as long as we can last, given the way our current body is built.

LATIF: I mean, Maria Paz, like, from the accidents to the—the eating and the fire inside and the air you're breathing and the DNA damage and, like, even—like, even evolution is against you here. Like, this feels like a checkmate to me.

MARIA PAZ: Fine. I mean sure, it's a checkmate for you and me, but I am here on behalf of humanity, Latif, including your children.

LATIF: [laughs] My children?

MARIA PAZ: Yeah. Maybe future generations don't have to put up with any of this. Maybe they don't have to die.

LATIF: I mean, I think my kids are fine, MPG.

MARIA PAZ: Well, tell you what: we're gonna take a break now, so you have some time to go talk to them and you can ask them, "Do you want to die?"

LATIF: [laughs]

MARIA PAZ: But either way, get ready because when we come back, we are gonna play this game to the end of everything.

LATIF: [laughs] That'll be great. Okay.

LATIF: Latif. Radiolab. Here today with Maria Paz Gutiérrez on her increasingly quixotic effort to outdo the one absolute truth of all human existence and all life, which is, of course, death.

MARIA PAZ: Hey, hey. Yep, that's me.

LATIF: And before the break you were gonna take the game, I don't know, into the future to see if you can win on behalf of my children and/or all future generations.

MARIA PAZ: Right, so a quick recap might help. Remember how our death experts told us that evolution was like, "I don't care if your DNA gets all damaged and you die because I just want you to have babies."

LATIF: Yeah, that was—that was sobering.

MARIA PAZ: Well, those babies get their fresh start in part because the body has a kind of trump card cell—the stem cell. A stem cell is a cell in your body that has DNA, the instructions for making and being you that has been, in a sense, protected from the damage of living life. It hasn't made any copies of itself. Some stem cells have the potential to become a fresh version of basically any other cell in your body—a liver cell, a skin cell, a toe cell, an eyeball cell, whatever.

LATIF: Love me some stem cells.

[NEWS CLIP: How about this, new at six: a breakthrough in reversing the signs of aging. Researchers say that ...]

MARIA PAZ: So in just the last several years, scientists have started to figure out how to use stem cells ...

[NEWS CLIP: Scientists have rejuvenated the skin cells taken from a 53-year-old woman ...]

MARIA PAZ: ... to replace cells that have been damaged, or even turn regular old cells back into stem cells.

LATIF: Really?

MARIA PAZ: Yeah.

[NEWS CLIP: To your point, I mean, it sounds like science fiction. I mean, he's taken these ...]

MARIA PAZ: Mostly in lab mice at the moment.

[NEWS CLIP: We're restoring vision, and we don't know where it's going, but by 2050 we're gonna be able to restore a lot of things that get damaged.]

MARIA PAZ: But there are some big name labs working on this stuff for humans, and they're being backed by big money.

[NEWS CLIP: Jeff Bezos is spending billions.]

[NEWS CLIP: The Amazon founder reportedly made a significant investment in a company called Altos Labs.]

MARIA PAZ: So eventually, this could be a way to beat the whole DNA cell damage thing that seems to be at the root of aging.

[NEWS CLIP: It's going to happen. It's like asking the Wright Brothers, "Are we gonna fly?" Well, of course we are, it's just a question of when.]

LATIF: But I mean, like, isn't this one of those things where someone's always saying it's 20 years away and 20 years away, and it's always 20 years away and then it never happens?

MARIA PAZ: Yeah, sure. Maybe. I mean, I don't know. But what I do is that I'm on Team Maybe. Maybe one day, and just to make this 'maybe' a little bit more concrete, I will say that there are animals in the natural world already out there that do this kind of thing.

LATIF: Really?

MARIA PAZ: Yeah. You ever hear of the immortal jellyfish?

LATIF: No!

MARIA PAZ: So the immortal jellyfish is this tiny little jellyfish. It's like the size of your pinkie nail tiny.

LATIF: Okay.

MARIA PAZ: It's translucent, has these, like, tiny little tentacles.

LATIF: Cute.

MARIA PAZ: It's so cute! It's originally from the Mediterranean, but has since spread all over. It's a bit of an invasive species.

LATIF: Okay.

MARIA PAZ: I mean, that's what I've read. Anyway ...

LATIF: I mean, if you're immortal, it feels like that's inevitable. Anyway, keep going.

MARIA PAZ: That's true. And this jellyfish, it can have baby jellyfish like a normal sea creature would, but also it's different because when it experiences stress, it can trigger this developmental trick.

LATIF: Hmm.

[ARCHIVE CLIP, Shin Kubota: If you try to kill it, it does not die. Instead, over the course of ...]

MARIA PAZ: The cells in its body can revert back to the baby versions of themselves. And then this clump of polyps just grows back into being a new jellyfish that's genetically identical to its original self.

LATIF: It's funny, like, the image I have when you describe that is, like, sneaking up on, like, a 90-year-old and scaring them from behind and then they turn into a baby.

MARIA PAZ: That's pretty much its superpower. I love that!

LATIF: That's amazing! And it can just do that—it can just do that over and over as many times as it wants?

MARIA PAZ: So maybe not forever.

LATIF: Hmm.

MARIA PAZ: And before anyone tries to jump in and destroy my hope, I am aware that, of course, the immortal jellyfish could always just get eaten by a turtle or crushed by a rock. But still, this jellyfish does feel like a glimmer of hope. Like, there could be some kind of genetic loophole to fight back against the DNA and the cell wear and tear. Like ...

LATIF: Fingernail-sized loophole here.

MARIA PAZ: Yeah. Why can't we just be the jellyfish?

CHRIS SCHELL: You want to be an immortal jellyfish? Cool, awesome. I hope you get reincarnated as an immortal jellyfish so then that way you can live for a long time and have no recollection of that life before.

MARIA PAZ: This is Chris Schell. He's an urban ecologist at the University of California, Berkeley.

CHRIS SCHELL: If you would like to do that, that's cool.

MARIA PAZ: His point is if you're constantly trying to revert back to the baby blobby version of yourself, it's not like you'd be able to take your memories with you. So at that point it wouldn't even be clear in what sense you would even be you.

CHRIS SCHELL: It feels like you're just a clone or a facsimile of what you used to be. And I don't think most human beings would opt into that life.

MARIA PAZ: And talking to Chris kind of flipped this whole little game I'd been playing on its head.

CHRIS SCHELL: Let's be blunt. This equation for life includes death.

MARIA PAZ: Including what it would even mean for me to win.

CHRIS SCHELL: Let's—let's play this out. So starting now, everything from here on out is immortal. All of the things in your world that currently exist cannot die. Death is off the table, right?

MARIA PAZ: Mm-hmm.

CHRIS SCHELL: There are a bunch of folks cheering, being like, "I'm never gonna die!" Okay, cool. Now think about the ways in which individual animals or people or plants or bacteria or whatever is living, dies.

MARIA PAZ: Take cicadas. They explode into these huge swarms, and then after some singing and some sex, they die and there on the ground are the shells they've left behind.

CHRIS SCHELL: Nutrients that can be repurposed and shifted as energy for other organisms.

MARIA PAZ: Which helps the forest grow. And that's just one bug, you know? There's scavengers and mushrooms and mice and people, all of them, a whole ecosystem that's either feeding off death or dying and becoming food for something else.

CHRIS SCHELL: But in this reality? In this reality, nothing's dying anymore. That means that that energy, it's gone. So if we're not getting new energy for new things to grow, we may be at stasis, y'all. That means potentially no new babies, no new life. No change in that system. Because if everything is immortal, then why would you end up having selection for certain traits to allow for those organisms to be better suited for the environment? Why does it matter? They're not gonna die anyway.

MARIA PAZ: Chris says, in a world where nothing dies ...

CHRIS SCHELL: Life essentially halts at a standstill. And yeah, everything is alive to exist in this new reality, but it doesn't change. It doesn't morph. It doesn't evolve. It isn't dynamic. The extravagant, extraordinary biomes that we currently have that exist on this planet, they all stop.

MARIA PAZ: Just frozen in time.

CHRIS SCHELL: Living in a world like that gets really boring really quickly, to the point where, why did we want to have immortality in the first place, when the world that we envisioned having immortality in no longer exists?

LATIF: I don't think I want to win this game anymore. This sounds—this sounds worse than death, actually.

MARIA PAZ: [sighs] I don't know.

LATIF: Really? You would take the frozen photograph?

MARIA PAZ: Well, in the face of death, like, in the face of a moment where the life of someone you love has suddenly been taken from you, or even just, like, having to face the moment where your own life, where all the things that you've done and dreamed and schemed and built might just blink out of existence, in the face of that, I might honestly consider the comfort of being able to live in a photograph.

LATIF: But it's frozen. It's a plateau. Like, you'll never—everything will be so mundane and same that it'll be like we're all just gonna be on cruise control forever, and there won't be any highs or lows or, like, there won't be any—like, for me, I don't know. That doesn't—doesn't feel like life.

JANNA LEVIN: It's the change that's really important to being alive.

MARIA PAZ: So this is Janna Levin. She's an astrophysicist, and she happens to subscribe to your point of view.

JANNA LEVIN: Right now in talking to you, my thoughts are changing and I'm experiencing that, and I'm watching the passage of time by a clock changing.

MARIA PAZ: And when I told Janna about my game, this match that I'm playing against Death, she pretty much immediately hit me with what felt like the ultimate move.

JANNA LEVIN: Eventually, the entire universe probably has to die.

MARIA PAZ: This march towards death is a physical law of the universe.

JANNA LEVIN: And that idea comes from the second law of thermodynamics ...

MARIA PAZ: So what you need to understand is that the most fundamental fact about living things is that they are orderly arrangements of stuff.

JANNA LEVIN: We're born in some sense in an extremely ordered state.

MARIA PAZ: Each part of us is in its place, interacting with other parts in very orderly ways.

JANNA LEVIN: I wake up, I think things. I know who I am. [laughs] That's a very ordered state. I have—I look a particular way. I don't look wildly different tomorrow. My face isn't scrambled. That's what it means to be me, to be alive.

MARIA PAZ: The problem, Janna says, is the second law of thermodynamics ...

JANNA LEVIN: Mm-hmm, yeah.

MARIA PAZ: ... which says that, in general, over time, things get more and more disorderly.

JANNA LEVIN: On average, entropy, which is a measure of disorder, will always increase. Things will always tend to get more disordered.

MARIA PAZ: And Janna says that this move towards disorder or decay or deterioration is just a basic fact of the passage of time. Like, you can literally see it.

JANNA LEVIN: If you look at a flower, and you watch a movie where a rotten flower lifts itself back up, becomes incredibly perfect again instead of little pieces on the ground, you know you're watching that backwards.

MARIA PAZ: The felt experience of time, that just is decay, deterioration, death.

LATIF: But we can make things more orderly. We can fix things that are broken. Like, every day new, orderly little living things are born.

MARIA PAZ: Right, but creating that life or that order, like, it requires work. Like, all living things on Earth, if you trace it back, they get their energy to live and grow and make new life from the sun, right?

LATIF: Right.

MARIA PAZ: But if you zoom out, you'll notice that overall, disorder is still increasing. Like, sure, you created something orderly here on Earth, but all the while, the sun is burning up its fuel. All of its light and heat and energy is spewing out across the solar system, spreading out further and further.

JANNA LEVIN: And the sun will eventually run out of thermonuclear fuel, and it will kind of cool and turn redder and distend and bloat out and vaporize the inner planets.

MARIA PAZ: Do we have a timeline for when the sun is gonna die?

JANNA LEVIN: It's a few billion years. [laughs]

MARIA PAZ: Okay.

LATIF: Plenty of time.

JANNA LEVIN: But eventually, even if we found some way to travel near the speed of light to another star system and find another planet and, you know, set up colonies or whatever we could do—we could hop—you know, skip around the galaxy trying to keep going.

MARIA PAZ: It doesn't matter. Those new planets, those new stars, will eventually burn out too, until ...

JANNA LEVIN: There are no more galaxies, no more black holes, no more stars, no more people, no more planets. Nothing ordered, just random motions of particles, but they're all so far apart that they can't even notice each other. That is a universe which cannot experience change, and where there cannot be things like thoughts, and there cannot be creatures with minds that have thoughts. In some sense, the universe has gotten so cold that it's effectively—it's effectively died.

LATIF: Okay, that's your checkmate. That's the final checkmate.

MARIA PAZ: Yeah. Yeah, it feels that way.

CHRIS SCHELL: Really, at the end of the day, death doesn't care. [laughs] Death does not care. It doesn't care if you understand the process of death or what it is or how important it is. It's gonna happen regardless. Everyone will die. Honestly, life is the anomaly.

MARIA PAZ: Mm-hmm.

CHRIS SCHELL: Right?

MARIA PAZ: How so?

CHRIS SCHELL: The majority of other planets in our solar system and in other solar systems across the vastness of the universe does not have life. We are the exception, we're not the rule. We are surrounded by a vast ocean of blackness.

MARIA PAZ: [laughs]

CHRIS SCHELL: So just take—take solace in the fact that in the very small, very very rare percentage of life succeeding, we made it, y'all. And eventually when the universe dies, who knows? It may be reborn in a different form with different function with different rules. We just don't know.

JANNA LEVIN: Yeah. Let's see, how can I say this? There is another possibility for immortality. We have to remember, just like our star turned out not to be the only star, our planet turned out not to be the only planet, our galaxy turned out not to be the only galaxy, our universe might not be the only universe. We don't understand the laws of physics well enough yet to be able to confidently state if this is a fluke.

MARIA PAZ: Like, if a universe that includes life is a fluke ...

JANNA LEVIN: Or if it's the opposite, that it's plentiful. Maybe there are other universes. They are disconnected from ours, and have histories and futures that are disconnected from ours. We can't point to them in space or in time, but theoretically, if there's a multiverse, we're just one in a vast collection of other universes. And some of those universes will not be able to support life, but we can imagine that some will.

MARIA PAZ: So potentially, even after our universe dies ...

JANNA LEVIN: There is life out there. Even if it's not us, life is plentiful in the multiverse.

MARIA PAZ: It's like life never really wins the game against Death, but Death never really wins either.

LATIF: Yeah.

-30-

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