Worth

I was catching up on my Radiolab episodes the other day, and I listened to one called ‘Worth’.  In the way of Radiolab, it was a collection of stories loosely organized around a theme, in this case, the monetary value of things not normally valued in those terms: the environment, human lives, or time, in particular, time in your life.

The take-home message of this last was that, when developing and marketing drugs, we, both as individuals and as a society, should think about how much additional years of our lives are worth.

If you were 75 years old, and had been diagnosed with a terminal illness, and there were a drug available which might extend (might being one of the operative words) your life by 12 – 24 months, would you take that drug if it cost nothing?  Yes, almost certainly.  How about if it cost $100 per year?  $100 per month?  $100 per day?  $100 per hour?  There are drugs that cost more even than that.  How much is it rational to spend to prolong life?

In general, I think it’s overly optimistic to expect people to be rational about death; nevertheless, these are questions which we should be able to at least entertain, if not answer.  I’d like to think I’d be able to have a discussion about my own end of life care, what I’d be willing to spend and endure, and what I would be willing to ask my family to spend and endure.  I am comfortable, at least intellectually, with the idea that my life is of finite and measurable worth.

But I know that I will never, ever be to think rationally about what my father’s life is worth.  I can accept that the value of my life is not unlimited, but the simple, emotional truth is that, to me, his life is priceless.

It is not that I love my father, in any meaningful way, more than I love my mother, or my brothers, or my spouse.  But my father’s death has been the great terror of my life since I was a young child, and I would do anything to postpone it.

I once told him, when I was very little, that I hoped I would die before he did.  He told me with great emphasis that that was the unkindest thing I could ever wish for him, that no parent should ever outlive their child.

I didn’t want to upset him, so I negotiated: I told him that, in that case, I hoped that we died at that exact same instant.  He failed to appreciate the compromise I was offering him, and told me that he hoped that he would die many, many years before I did, that I would have a long and happy life even after he was dead.

I didn’t tell him, but I didn’t think that was possible.  I still don’t.  The idea of living a happy life in a fatherless world is incoherent – it does not compute.  It’s like telling me you wish me a long and happy life after the sun goes dark for good.

When I was young and the black dog of my father’s death would appear at the edges of vision, my mother told me that that fear would diminish as I got older, as I started my own family and had my own children.  She told me that, when my own offspring were in the world, the death of my parents wouldn’t obliterate it.

I don’t have children.  Maybe I will one day, and maybe she will be proved right – she usually is.  But perhaps all she is really describing is the replacement of one apocalypse for another.  I cannot bear the thought of my father’s death – will I be able to bear the thought of my child’s any better?

I think what I’m trying to say is this: ‘worth’ is a concept with meaning only when there are choices.  “What’s it worth to you” suggests two options: the thing you want and the price you might pay, both with value you can understand and which you can compare.  Death of the most loved ones, this does not have value against which something else can be measured.  This is the scaffolding upon which the world has been built, and without it, nothing has value.

And the point is moot.

Death and the ICD-10

     I was perusing the 2010 National Vital Statistics Report this weekend when I started to wonder about the letters and numbers that are listed after each cause of death: for example, syphilis (A50 – A53), or accidental drowning and submersion (W65 – W74).

     These numbers turn out to reference the ICD-10-CM, which is the United States Clinically Modified version of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision.  Published by the World Health Organization and begun in 1983 to replace the ICD-9, the ICD-10 is a classification system designed to track mortality and health statistics in a way that creates statistical comparability between countries.

     What this means, essentially, is that the WHO has published a list of all the ways that it can think of to die.  A very cursory read-through of the ICD-10-CM opened this particular neurotic’s eyes to new and various ways to die that I, frankly, had never really considered.

     For example, there are different codes for morbidity as a result of contact with hot drinks (X10.0) versus contact with hot food (X10.1) versus contact with fats and cooking oils (X10.2).  Note: morbidity as a result of contact with hot drinks is not the same as morbidity as a result of contact with hot tap water (X11) even if, like me, you drink tap water.

     You can die from falling out of a grocery cart (W17.82).

     Apparently, you can be bitten to death by squirrels (W53.21).

     There is a code for morbidity as a result of contact with non-venomous plant thorns and spines and sharp leaves (sharp leaves!) (W60), which sounds like a slow and excruciating, if perhaps effortful, death.

     Crocodiles and alligators can kill you by biting you (W58.01), striking you (W58.02), crushing you (W58.03), or via “other contact” (W58.09).

     Somehow, you can die from contact with a non-venomous frog (W62.0) – maybe from choking on it?

     You can burn to death from a fire while on water skis (V91.07).

     Horrifyingly, you can die from the effects (unspecified and therefore more frightening) of a foreign body in the auditory canal (T16).

     There are more, many more; Wikipedia informs me that the ICD-10-CM enumerates some 68,000 morbidity codes, and once I start clicking through, I find myself nearly unable to stop.  I’m going to pull myself away now, and wander back out into the world, avoiding for as long as possible any of 68,000 ways to die.