Aging Cyborg, III, IV, V, VI, and VII

I CONTINUE my autobiographical-postphenomenological narrative about the experience of an aging cyborg. I left this narrative in the last chapter with a section on open-heart surgery in 2008. At this time I was still a full-time faculty member at Stony Brook. By 2010, my knees begin to pain me when walking or cross-country skiing, a favorite “focal activity” I shared with Albert Borgmann, another philosopher of technology. X-rays showed the signs of aging knees. Thus begins Aging Cyborg III. (Note that X-rays were discovered by Roentgen, who made the first imaging devices in 1895. See a wonderful science history by Bettyann Holitzmann Kevles, Naked to the Bone: Medical Imaging in the Twentieth Century, published 1997.) My X-rays showed that both knees had lost half their cartilage so that one half each was now bone-on-bone, thus the pain, but half of each knee retained cartilage. In response, my orthopedist recommended unicompartmental implants (i.e., half joint implants). Later I learned a bit about the economic policy regarding such implants. There had been an overproduction of the devices, which up to my time had only been recommended for younger patients. To lower the surplus, the medical community began recommending use for older patients. There are always economic politics behind protocols! I did not know this when I concurred, so at my Stony Brook University Hospital, in a single day, I underwent—again with local anesthesia—a double implant procedure. Knee implants were thought to be the second most successful surgery of the late twentieth century, with several hundred thousand performed per year in the United States. I was then seventy-six years old, and the older one is, the greater the risk from any general anesthesia. This is why in many of the incidents I cite that only local anesthesia is used. Forgive the gory description that was totally painless: I am lying on a bed, a sheet strung across my stomach to screen sight of my knees. I nevertheless hear and smell the grinding of bone but feel nothing. The operation itself is not prolonged, and I am sent to recovery with my new unicompartmental stainless steel and plastic implants. After physical therapy, although there is some residual stiffness, no pain and full walkability soon return. By wintertime, however, I note cross-country skiing is not what it once was. Most obvious is a loss of finer balance, so now trails need to be restricted to wimpy, flat terrain. All is well until the summer of 2013 when suddenly my right knee begins to pain me. My family and I are, as usual, spending our summer in our mountain retreat in Vermont. Our local clinic’s doctor diagnoses an infection three years after my first implant surgery—he and the expert orthopedists at nearby Dartmouth Clinic in New Hampshire panic. A culture is called for because if the bacterial infection is aggressive, the implant must be immediately removed. If the bacterium is active, it could spread and endanger my very life. It takes several days for an analysis to show a result and at first Linda and I think I may have to undergo surgery and end up with long recovery time—minimally five months—in Vermont. Fortunately, the diagnosis reveals that the bacterium is “indolent,” so we can delay the surgery for a return to the Hospital for Special Surgery in Manhattan, now end of summer 2013. Of course the replacement process will be slow, and all my scheduled activities for the entire fall term are cancelled. It will turn into a full fall delay before travel can resume. First there is a five-week removal and sterilization process of the unicompartmental prosthesis; once the old prosthesis is removed and my wound is certified sterile, a new full knee implant may be inserted. Rock star surgeons, however, are hard to schedule. Each process occupies a number of weeks. The temporary implant is mostly composed of a type of concrete, which, despite being excellent for physical therapy, is clumsy and lacking flexibility. The ultimate prosthesis is again stainless steel and plastic and, while it causes some residual stiffness, is painless. While this ends my many decades of cross-country skiing, it allows me to walk well if somewhat slower than prior to the implants. I, in the midst of this, also continue to philosophize, and once I am on the road again, one event is a conference in Arizona with a group of transhumanists who have a utopian-bionic view of human enhancement. As mentioned earlier, I often call this a “technofantasy,” and when it comes to any kind of internal technologies, in addition to the experimental compromises, there are also technobiological ones. In the case of knees, any time metal or plastic is placed, the body reacts with a biofilm that adheres to the flesh/implant surface. So long as such a film is “friendly” or sterile it is harmless, but it can also cause infections. These are unpredictable and thus are or can be toxic. They constitute a biotechnic ambiguity and a barrier to any bionic technofantasy. So, once again, being an aging cyborg is a positive trade-off from immobility or a clumsy electric scooter or wheelchair but not an immortal, bionic enhancement. Being a cyborg is a compromise and definitely not a bionic miracle, which is a mere technofantasy. Technologies, metaphorically “mortal,” have shelf lives.

Aging Cyborg IV

Yet aging inevitably continues, and next comes a surprise diagnosis with a medical technics process, this time in 2014. Long ago I used to be a somewhat skinny guy. By midlife I began to have a mild “potbelly” as I gained weight with age. Now five years past my heart surgery, I began to again have breathing problems and some symptoms similar to an acid reflux, so once again a series of imaging technologies were suggested: I underwent CT scans, an X-ray, a barium GI track endoscopy (using a tube device equipped with a light and scope), and another imaging of my entire esophageal tract. But here I need to insert other autobiographical elements. The reason so much of the imaging was directed at my GI tract relates to the then recent death of my younger brother, Jon. He died of esophageal cancer in fall 2014 at age seventy-seven and had, as part of that symptomatology, severe gastric acid reflux. I worried after taking several trips to see him in his last year and decided I had better check my own GI tract to make sure I didn’t have anything similar. I didn’t: all the imaging came back showing no cancer, no polyps or lesions, nor any acid reflux. However, my very sharp gastroenterologist did detect a problem: gastric volvulus or “twisted stomach.” After several consultations it turned out that after heart surgery my diaphragm had weakened, and part of my stomach had actually crept up into my chest cavity, a paraesophageal hernia. So as with my “rock star” heart surgeon, I found a similar rock star GI surgeon who used a laparoscopic process that left five “Machine Gun Kelly” scars on my stomach. He successfully moved my twisted stomach back into its proper place, and after recovery the only bad result was an even bigger and lower potbelly.

Aging Cyborg VI

Here I want to insert a variant on my autobiographical-postphenomenological narrative in the form of a noninvasive and positive result event. I call it my eighty-second year scare. I have already included the events around my younger brother’s death at seventy-seven. As it turns out, both my mother and father also died at seventy-seven. My father died of the ultimate effects of prostate cancer, that bane of males. He was a Kansas farmer, and after his prostatectomy at age sixty-three, I visited him and once went with him to consult with his urological surgeon. I was struck, as I waiting in the office, to see a room full of aging farmers—all with prostate cancer. So, when we finally entered the office for the consultation, I asked, “How many of these men with prostate cancer are farmers who use mercury gas treatments for stored wheat?” The doctor answered, “All of them.” Remembering how hot granaries become in a Kansas summer, I knew that my father never used the recommended protective masks for such grain treatment and suspected the same of the others in the waiting room. Mercury gas is a recognized carcinogen.

The result for me was to have all my urologists from middle age on worry about the genetic likelihood of prostate cancer for me. My university urologist was, in fact, so insistent upon recommended biopsies that over the years I succumbed to five of these, all involving sonograms and all of which returned negative. Later, my brother also underwent a prostatectomy, raising further my earlier urologists’ genetic concerns. Upon retirement, a new Manhattan urologist worried about my PSA levels (a notoriously problematic and often undependable blood test) recommended that I undergo a new urological MRI exam (no biopsy). After an hour inside the MRI machine—very noisy—the test came back showing a perfectly normal prostate. In this case a newer technology was liberating. My annual results remain normal.

Aging Cyborg VII

Aging continues, and I return to perceptual prostheses and very minor and common procedures. I have always had excellent vision although in my sixties I did have to resort to reading glasses—and at about the same time to hearing aids. Again, some autobiography: I begin with listening prostheses, hearing aids. It is common knowledge that both eyesight and hearing decline in aging. It is less clear when and how one becomes aware of such loss. By middle age it is common for an aging person to be aware of loud ambient noise situations in which it becomes more difficult to hear conversations. By my sixties I was aware of this loss, but as the author of two books on sound and acoustics and with considerable background knowledge of hearing capacities—for example knowing that adolescents can often hear from .20 to 20,000 hertz—I knew that as one ages there is a gradual loss of higher frequencies. Once at a conference in Boston, while in my sixties, my son, Mark, and my wife, Linda, urged me to join them in a visit to the Museum of Science, Boston. One of the exhibits had a sound device where one could put on earphones and turn a dial to test one’s hearing perception, a diagnostic technology. I did my test and discovered that my highest frequency range was a little over 11,000 approximate hertz. I panicked—could it be that bad? So as soon as I returned to Long Island, I did a search in my Macropædia only to discover that my limit was about normal for my age. After that I began to research hearing aids. Once I took an audiology exam that focuses upon language perception with the advice to begin with two, not one, aids (in order to retain the perception of direction and distance). I ended up with my first digital aids. During this process, I learned how focused upon language perception such devices are. For example, vowels are easy to amplify and need little manipulation. They have a longer sound durée than consonants, which are shorter and call for digital manipulation. It is the lack of consonant perception that leads to lessened language comprehension (combined with loss of high frequencies, which sometimes makes females harder to hear than males!). But here technological advance meets the low-grade American health-care system. Improvements in acoustic technologies outspeed the four-year limits of hearing aid insurance! Thus as I aged, and particularly after retirement, I had taken to two-year hearing aid purchases (at a cost, of course, since my insurance only allows a four-year subsidy). My latest device purchase, in a move from a German to a Danish design, was made in 2017. As it turns out, my right ear is better than my left, which has deteriorated to the point that my left aid is not actually a hearing aid but a broadcaster which takes all sounds from my left side and sends them to the complex digital hearing aid on my right side. This, in my estimation, is better than a cochlear implant and retains a natural sound. It is a significant improvement upon the previous devices.

Visual technologies, always simpler and more attended to than acoustic technologies, rely upon optics and optical theory, older and simpler than sonic technics. These also entail the experiences of aging. As noted, I had always had excellent vision—interrupted for a short time by two accidental corneal scratches, both occurring during a Vermont summer. My middle daughter accidentally scratched one cornea with her finger. Later that same summer, a pestiferous porcupine began to chew on the foundation log of our then three-room log cabin. I chased it off after dark but ended up scratching my second cornea by running into a tree branch. Those who have suffered corneal scratches know that these are painful and badly distort vision. So, for a time I had to wear prescription glasses. Fortunately, my vision returned and the only leftover was another period of needing reading glasses.

Upon retirement, the move to Manhattan called for a new ophthalmologist, who discovered very small cataracts in each eye. Even so, I could still pass unaided reading tests so as not to need glasses for driving. But as is normal, the cataracts increased in size until by 2017 a cataract lens procedure was recommended. I opted for a multifocal lens and a new procedure, femtophotography, and scheduled the femtosecond laser process with two weeks between the two eyes. Femtophotograpy is one trillion times faster than stroboscopic photography and can image a single photon in motion. A similar leap in precision goes with this new cataract process. Each procedure lasted about fifteen minutes. As I have noted elsewhere, nanoscale technics are the mark of twenty-first-century technologies. The leap in precision is startling.

While two weeks lapsed between eye processes, in the interim I could blink eyes and see the difference between the cataract and non-cataract eyes: the cataract eye was considerable darker and differently colored than the new lensed eye. Once both were completed, my vision was so spectacular that I could read the very smallest print lines on eye charts, and the hardest adjustment was to no longer need reading glasses. But the acid test is yet to come. Sandra Harding, feminist philosopher of science, claims in Is Science Multicultural? (1998) that Dogon people in Africa can, with the naked eye, see the larger satellites of Jupiter as protuberances. I discovered some years ago that I, too, could do this and after sighting this phenomenon on the way home from a concert in Vermont, checked with my telescope to confirm my angles were correct—they were. But so far all our trips to retry this have had cloudy skies. I intend to try again this summer. In short, this is the medical technics that actually comes close to human-enhanced vision. But as a prosthesis, it is obviously a permanently installed mediating technology.

This now brings a decade of my life, age seventy-four to eighty-four, to an end. I have recited seven aging cyborg events, but one was simply a diagnosis that turned out negative. These events translate into every other year occasions between which I, although slowed down from preretirement, remain quite active. If anything, retiring to Manhattan means at the least that the city is full of excellent medical facilities, doctors, and hospitals. Everything is nearby and encourages us never to delay seeking advice and diagnosis. In my case, skipping ahead to the last chapter, my aim is to keep going, hoping to equal the longevity of my older peers.

Cyborgian Postscript

I don’t want to allow a foreshortened impression that of the seven medical events I describe over these ten years, all are indicative of a deteriorating aging process. If one takes a composite of these events, they are very uneven. Open-heart surgery is obviously a traumatic event—although recovery time in my case was very fast. Here the social phenomenon of what I am calling the rock star surgeon is important. Manhattan is concentrated with many of the world’s best hospitals that in turn accumulate rock star surgeons—specialized doctors who do only, or nearly only, one thing hundreds or approaching thousands of times per year. This was the case with my heart, gastroenterologist, cataract, and knee replacement surgeons. But whereas heart surgery is traumatic, cataract surgery is not. Some 3.6 million per year are performed in the United States alone. Cataract surgery, now a laser procedure, takes fifteen minutes per eye, and this implanted visual prosthesis results in improved vision by day three. Knee implant surgery is followed by weeks of physical therapy, but within months motility can be cane free; this, too, is an implanted prosthesis. Hearing aids are removable and are familiarly embodied within a few days. Thus, while seven events in ten years may seem like a lot, recovery and embodiment learning time has been relatively fast in each case.