Dying better vs living better

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Good evening, 66.1ers.

Sorry. You haven’t heard from me in a while because I didn’t send a newsletter on Wednesday. I’m learning that sending newsletters 2x/week may not be where my time needs to be spent in 2026. 

No crazy changes for now, more on that in the next few weeks. 

For now, let’s continue with this week’s Saturday issue. I had a few interesting conversations this week with my father, my mother, cancer patients, and friends. I won’t tell you everything about all of them, but I’ll hit a few highlights. 

I think they all boiled down to some version of the question, “How do you know what to spend your time on?”, with a strong theme of finitude (cancer has a way of driving this theme home).

First, my father. My father retired in summer of 2025 after 25 years in a demanding job that provided a stable, happy, opportunity-rich life for my brother and I. He was the breadwinner so my mother could stay home with us. Since retiring, he has re-prioritized his health, specifically his physical strength. Gained a bunch of muscle mass and lost a bunch of fat in the last year. And he’s not on weird drugs. And did I mention that he’s 63?? If you’re out there telling yourself you’re too old for weightlifting to make a difference, send a note here and I’ll introduce you to my father. Now he’s ready to do whatever the “next thing” is, but he knows it won’t include trading his health for a paycheck. In his words, “there are too many people my age who don’t have their health and I want to be able to enjoy my life!”. 

3 Mayo Clinic cancer patients were memorable this week. First was the early-70s guy who is battling Pulmonary Arterial Hypertension (PAH) in addition to his cancer. Dr. Google tells me PAH is what they call it when the vessels in your lungs stiffen, making it difficult to expand them and push oxygenated blood into your lungs. Less blood that’s carrying oxygen = less oxygen = shortness of breath. To compensate, your heart pumps harder and eventually this leads to heart failure. If you’re a doctor reading this, I know I skipped a few steps. Please forgive me? If this sort of thing is interesting, these diagrams from the PAH Initiative might be helpful. At any rate, it’s an ugly disease for a formerly active person. Treatable, not curable. 

Questions that wouldn’t be appropriate for me to ask but I find myself wondering when I have some time to reflect:

Does this patient have any regrets? Anything he’d like to be able to go back and tell his 35-year-old self? Stuff he wishes he’d done? Other stuff he wishes he’d done a little less of? 

Another was a patient in their early 60s. Lung cancer. Team is treating them aggressively, meaning that they’re driving 4 hours round trip every day for the next 6 weeks to receive chemotherapy and radiation. First chemotherapy was earlier this week and they had an anaphylactic (big word meaning “severe allergic reaction that will kill you if you don’t treat it”) reaction to it. The kind of thing that involves an Epi Pen and some other stuff so the patient didn’t die. Later in the week, the same patient called us and said their shoulder was sore, 8/10 pain. A few hours later, 10/10 pain and it’s moving down the arm. With intermittent chest pain. We said, “PLEASE GO TO THE EMERGENCY ROOM IMMEDIATELY.” Doesn’t it make you wonder?

If chemotherapy is the best we can do?

Then there’s the patient from a few weeks ago who I saw for a follow up this week. Her Primary Care Provider (PCP) prescribed an antidepressant. Patient cried every. single. day. for 6 weeks straight. 6!?!?!?! The patient told me the crying started at the same time she started the antidepressant. Asked couldn’t she please get off of the antidepressant? Not my call, but she had an appointment with her PCP a week later. But people cancel appointments around the holidays, why not call the PCP and ask politely if maybe they could slide her into a cancellation slot earlier? She made the call, got in the next day. Switched the med. We talked this week and she’s back to work, smiling, hasn’t cried in 3 weeks.

Makes me wonder why we don’t do more to remind patients that they’re in charge of their own healthcare? Why providers were so comfortable dismissing the crying as a symptom of “adjustment disorder”? If you’re asking all the questions you can possibly think of when you see your doctor? Did you spend 20 minutes with your spouse before the appointment pulling together your list of questions?

Lots of questions this week. Probably because questions are usually the key to figuring out whatever it is you’re trying to figure out. Quick aside: Ever think about how, even though you probably ask yourself a gazillion questions, it’s usually just 1-2 questions that really provide the right mental spark to help you get unstuck? I think that’s why it’s important to keep asking more, better questions, forever and ever. 

My mother and I talked about health coaching a few times this week. I still don’t like that term, because I think it tends to undersell what a motivated client and a tuned-in coach can get done, but I digress. She was saying that too many health coaches act as “counselors” and allow patients to stay on the problem for too long without working toward a solution. A fair critique. Did you hire a therapist or a coach? I don’t ask my clients about their relationship with their father all the way back to childhood. I do ask about their future and why they want to change their life. 

Talked to a friend this week, too. He described my job at the Mayo Clinic as “helping people die better” and the coaching and writing that is 66.1 “helping people live better”. 

Finally, if you’re 25-40 years old, 300+ lbs bodyweight, want to lose at least 50 of it, and you’re sick and tired of being sick and tired, I’ll be here if you want to talk. Send an email, ask a question, I’ll answer. 

BTW—know someone who should read this email? Did you already forward it to them?

Have fun out there.

Marcus