Do What You Can, While You Can

There is a familiar question: do you eat your favorite food first, or save it for last? As a child, I was the sort of person who ate what I disliked first and saved the best for the end. But at some point, I realized that there is no guarantee we will always be able to enjoy the foods we love.

I came to understand this at the first hospital where I worked, a hospital specializing in geriatric care. Former university professors, cabinet ministers, and company presidents came to us as outpatients or were admitted to the hospital, but by then many were bedridden or living with advanced dementia. Whenever I saw them, I was struck by the realization that none of us can remain in our present position forever. Nor can we assume that we will always be able to enjoy good food, or remain healthy enough to travel.

Wine is one of my great pleasures. This year, I bought two hard-to-find bottles of 1985 Henri Jayer. Buying them was one thing; the question was when to drink them, and with whom. So I set myself a goal: “I want to remain healthy enough to enjoy wine until I am 75.” I will turn 75 in 2035. By then, these wines will be fifty years old and should be magnificent. And I think my body may still be up to enjoying them.
Seventy-five is one benchmark for me.
Growing older means realizing that pleasure may not wait for us.
That is also why I do not think very much in terms of setting money aside simply as “retirement savings.” I currently have diabetes, heart failure, and high blood pressure, but even if someone told me to give up wine now, I would have no intention of doing so.

Travel is the same. By our mid-eighties, even the most luxurious journey imaginable—flying first class, with a chauffeur waiting at the airport—can be exhausting. A trip involving economy-class connections and bus travel is harder still. When I travel abroad, I rent a car and drive myself. Each time, I wonder how much longer I will be able to travel this way. That is precisely why we have to go while we are still healthy enough to go.

There is another philosophy that is the other side of the same coin.
None of us knows when we will die.
Precisely because we do not know, we should enjoy the present.

There Is No Guaranteed Formula for a Longer Life

One thing I have learned very clearly as a doctor is that people can take meticulous care of themselves and still become ill, while others can live carelessly and reach a great age.

Medicine may lower the risk of disease or improve our chances of living longer. But it cannot guarantee the course of a person’s life or lifespan. There is no such thing as a method that will ensure longevity. Yet people struggle desperately because they believe there must be one.

Perhaps people are afraid of death, but I think much of that fear is based on a vague image of what dying will be like.
Having watched many older people die, it often seems simply that they go to sleep and do not wake up.

My mother died recently. She had gradually stopped eating, and one day the hospital called to say that her pulse had become difficult to detect. When I arrived, she could still nod, so I thought she might have a few more days. But that evening, the hospital called again to say that she had stopped breathing, and she died. Perhaps that is simply what dying can be like.

After 85, Cancer and Dementia Are Commonplace

An experience at the geriatric hospital where I worked changed my view of life.
We performed many autopsies there. What I saw was that small cancers unknown to the patient, the family, or even the physicians, as well as changes in the brain associated with Alzheimer’s dementia, were present in virtually every older patient—particularly those over 85.

Yet even among those found to have cancer, cancer had been identified as the cause of death in only about one-third of cases. In the remaining two-thirds, another disease had been the immediate cause of death. In other words, a lesion may exist in the body without ever causing symptoms or determining a person’s lifespan.

Many people assume that cancer is a painful disease from which one dies in great suffering. But as these cases—and the fact that many cancers go unnoticed until they are advanced—show, cancer is often asymptomatic. Cancer itself can, of course, cause pain. But I also believe that one reason cancer becomes such a painful ordeal is the treatment, which can impose a considerable burden on the body.

Bird, Rabbit, and Turtle Cancers

There is one way of thinking about cancer that I find particularly persuasive. Professor Welch at Dartmouth describes three types: “bird cancers,” “rabbit cancers,” and “turtle cancers.”
Bird cancers progress extremely rapidly. Even when they appear to have been detected early, microscopic metastases may already be present. Many pancreatic cancers fall into this category. In such cases, treatment often does little beyond extending life for a short time.
Turtle cancers progress slowly. Even if left alone, they grow only little by little and do not metastasize. Because they do not threaten life, there is little point in detecting and treating them early in the first place. Some thyroid cancers and many prostate cancers fall into this category.

Rabbit cancers are the only ones for which early detection can be lifesaving. Yet current medicine cannot reliably determine whether a small cancer that has been found is a “rabbit cancer” that will take a life, a “turtle cancer” that can safely be left alone, or a “bird cancer” for which it is already too late.
That is why, when screening identifies an abnormality, I see little value in becoming excessively fixated on the numbers or rushing into treatment that places a heavy burden on the body.

Make Peace with What You Cannot Control

As we move through our fifties, sixties, and seventies, health checkups inevitably come with warnings: “If you leave your blood pressure like this, you will have a stroke,” or “If your blood sugar stays this high, you will end up on dialysis.”
But no matter how faithfully you follow treatment, sometimes illness strikes and sometimes it does not.

There is a well-known large-scale study conducted in the United States. Older adults with an average systolic blood pressure of 170 were divided into one group that took antihypertensive medication and another that did not, and were followed for more than five years.
About 5 percent of those whose blood pressure was lowered with medication had a stroke, compared with about 8 percent of those who did not take the medication. To be sure, antihypertensive medication reduced the risk of stroke from 8 percent to 5 percent. But viewed another way, 92 percent of those who did not take the medication did not have a stroke.

Lowering blood pressure also tends to involve more than simply taking medication. People are expected to reduce salt, eat lightly seasoned food, change their daily habits, and accept all kinds of restrictions. Even if you spend the rest of your life that way, the risk of stroke falls only from 8 percent to 5 percent; it does not become zero. And medicine cannot predict whether you will endure the restrictions, take the medication, and still fall within that 5 percent, or take no medication, make no such sacrifices, and remain among the 92 percent who do not have a stroke.

I believe it is better to recognize that some things lie beyond human control. Around the age of 50, I decided to stop struggling against what could not be changed. I was later diagnosed with diabetes and high blood pressure, but I do not pursue excessive treatment merely to lower numbers, nor do I live by denying myself what I enjoy.

Do Not Be an Uninformed Patient

That said, we should still acquire information in advance, on the assumption that bad things can happen. For example, everyone in Japan over the age of 40 pays long-term care insurance premiums, yet very few people learn in advance how to use the system if they develop dementia. In that sense, many people are what Japanese slang calls jōjaku—at a disadvantage because they lack essential information.

Choosing a hospital is another example. In medicine, the clearest example of an uninformed patient is someone who chooses a university hospital solely on the strength of its name.
In 2014, it came to light that eight patients had died following laparoscopic liver procedures performed by the same surgeon at Gunma University Hospital. Later investigations found that as many as thirty patients had died in total, including those who had undergone open surgery. The surgeon’s technical competence was clearly an issue, but the university’s systems were also at fault—not least the lack of proper supervision.
This is probably only the tip of the iceberg.
Gunma University Hospital had long been said to prioritize research over clinical practice. It was not necessarily strong in hands-on patient care. Yet people choose it simply because it is a university hospital. Tokyo is only about an hour from Gunma by bullet train. There are any number of hospitals in Tokyo with highly skilled doctors, yet people still choose the nearby university hospital. Patients need to be better informed. We must not be dazzled by titles and allow ourselves to be carried passively along a medical conveyor belt.

The Hospital I Envision

We are moving from an era in which living longer was considered enough to one in which the real question is: how long can we remain healthy?

For more than ten years, I have carried an idea: to build a hospital that brings the very best physicians together under one roof.
Japan has a universal health insurance system, so rich and poor alike receive care through the same insurance-based hospital system. In a capitalist country like the United States, by contrast, there is a system in which those able to pay more can gain access to better doctors.

Given how economically stratified Japan has become, I believe there should also be room for a membership-based “hospital of exceptional physicians.” We would bring together the most highly skilled doctors from across the country and create a hospital supported by membership fees.
The hospital would also have an affiliated medical school. It would attract residents who want to learn from these exceptional physicians. The clinic where they treat patients would provide care free of charge. You would feel safer with a “protégé of a great physician,” trained directly by the best, would you not? It is like sushi prepared by a chef who trained at a first-rate restaurant.

One system would give those able to pay access to medical care at the highest level; the other would ensure that the skills of exceptional physicians are passed to the next generation. One day, I would truly like to build a hospital that brings those two things together. That is another dream I continue to carry.

This article presents the personal experiences and views of Dr.Hideki Wada. It is not intended to recommend stopping or changing any particular treatment or medication. Please consult your treating physician or another qualified healthcare professional regarding decisions about your care.

July 2026
Interview conducted at the Hideki Wada Mind and Body Clinic
Interviewed and edited by DK Sugiyama
Project Manager: Chiho Ando
Written by Eri Shibata, Deputy Editor-in-Chief of My Philosophy
Photography by Hirona Goto
Produced by the My Philosophy^® Editorial Team