Frank was my friend
What a forty-year friendship taught me about men, health and growing older
Four years ago my best friend died. Four years ago today.
I wrote about Frank then as a friend should. It was an obituary — a collection of memories about an extraordinary man and the forty-odd years we had known each other. If you scroll to the bottom of this blog there is a link to my original obituary, which I delivered at his emotional Dublin Funeral.
I have been writing a lot about men’s health recently, and today I re-read Franks obituary. This time I noticed something else. There was a lot of men’s health hidden in Frank’s story.
My first glimpse of him was on Freshers’ Day in September 1980, in the bar at Charing Cross Hospital Medical School.
Frank wore a black Fred Perry T-shirt with yellow trim. I wore a jacket, shirt and tie. We were given paper name badges. I dutifully put mine on. Frank declined. He was smoking Marlboro Red.
God, he was cool.
He seemed older than his 19 years and was regaling a group of astonished public-school freshers with stories of south London, punk, the National Youth Theatre, the Communist Party, and a broken home. He was somewhere between Robert De Niro and Johnny Rotten. I was probably somewhere between Tim Nice-but-Dim and Billy Bunter. I knew at once that he was someone I wanted to know.
When unhealthy looked cool
Looking back at those photographs and memories more than forty years later, something strikes me.
A lot of what we now call “lifestyle risk” did not feel risky at all.
It felt like life.
Cigarettes were not a cardiovascular risk factor. They were Marlboro Reds.
Alcohol was not units per week. It was friendship, parties, pubs, gigs and staying up until ridiculous hours talking rubbish.
Sleep was not something measured by a smart tracker ring on your finger. It was what you did when everything else had finished.
Exercise was not preserving muscle mass and cardiovascular fitness for old age. It was something other people did on Wednesday afternoons while I went browsing the second-hand shops in the Kings Road.
We were medical students and later doctors. We knew perfectly well that smoking was bad for you.
Knowledge was not the problem.
At 20, your 60-year-old self is another person.
That, I think, is an important lesson in men’s health. We often give men information and assume information will change behaviour. Sometimes it does. But behaviour is wrapped up in identity, friendship, culture, habit and belonging. Telling a young man that something might increase his risk of disease several decades later has to compete with everything that behaviour gives him today.
And today usually wins.
The myth of indestructibility
Frank and I became young doctors together. We also lived what I can only describe as a mildly reckless existence around the edges of London’s music scene. We blagged our way into gigs and nightclubs. There were smoky evenings at Ronnie Scott’s, comedy clubs, East London warehouse parties and late nights that became early mornings. There was his MG with the roof down, Talking Heads’ Take Me to the River playing far too loudly, scrunched-up cigarette packets on the floor and enormous amounts of laughter.
We thought we were indestructible. Most young men do. Perhaps they need to.
Nobody wants a generation of 20-year-olds spending Saturday night worrying about their glucose level or their HbA1c.
But there is a problem. The body keeps the score even when the young man is not keeping it.
Smoking exposure accumulates. Blood pressure exposure accumulates. Excess alcohol has consequences. Visceral fat accumulates. Muscle can gradually disappear. Poor sleep matters.
Much of what eventually presents as “middle-aged disease” did not suddenly arrive in middle age.
The trajectory began years earlier.
Fortunately, men can change
There is another part of Frank’s story that I now think matters just as much. We grew up.
By the end of the Eighties, we were both ready for something different.
Margaret arrived in Frank’s life. Louise arrived in mine. There were marriages, children, careers, and responsibilities.
Life moved on. And thank God it does.
One of the mistakes we make in health is to present people’s earlier behaviour as a charge sheet.
You smoked.
You drank too much.
You were overweight.
You did not exercise.
Guilty as charged.
But what useful purpose does that serve?
The important question is not simply what did you do? It is what are you going to do next?
Men can change remarkably quickly when the reason for changing becomes meaningful to them.
Stopping smoking matters whenever you do it. Reducing alcohol matters. Losing excess weight matters. Getting your blood pressure treated matters. Starting resistance exercise at 30, 40, 50, 60 or beyond matters.
You cannot renegotiate the first bit of your life.
You can influence the future.
The question I am looking to answer is how do I get younger men to care about this?
Know your numbers before you feel ill
There is one other thing I would tell those two young medical students now.
Do not wait to become a patient.
Men are particularly good at equating absence of symptoms with absence of disease. Unfortunately, high blood pressure does not care whether you feel well. Neither does high cholesterol, insulin resistance, or visceral fat.
So, I think every man should have some idea where he stands.
Know your blood pressure.
Know your waist.
Know your cholesterol and blood glucose.
Know your family history.
Know whether you smoke too much, drink too much, sit too much and sleep too little — and be sufficiently honest with yourself not to turn “a bit” into a medical unit of measurement.
You do not need to become obsessed with health. You just need to know which direction you are travelling.
Apart from being a great dad, and my friend, Frank was an amazing doctor and hugely successful psychiatrist, I wish I could ask him how to get my message across. I feel certain he would want to help me try!
Train for the man you have not met yet
This is the biggest change in how I think about health.
At 20 we exercise for today.
Hopefully by 50 we begin to understand that we are exercising for tomorrow.
At 80 we will be grateful for any efforts our younger self made.
The strength you build and preserve now is the strength that may one day get you out of a chair, carry your shopping, climb a staircase, or allow you to remain independent. The cardiovascular fitness you keep now is part of the reserve you take into older age. The food you eat, the weight you carry, the sleep you get and the relationships you maintain are not attempts to achieve immortality. They are investments in something much more realistic.
Long good health.
Health is not the purpose of life. Life is the purpose of health.
And then there are your mates
There is one health lesson in Frank’s story that does not fit neatly onto a blood-test request form.
Friendship.
When my father died suddenly at 61, Frank was there.
When my mother died many years later, he got on a plane and came to me.
We laughed together, drank together, studied together, occasionally behaved appallingly together and, after sufficient beer, told each other that we loved each other.
Men are sometimes caricatured as being poor at emotional relationships. I do not think that is quite true. Sometimes we simply speak a different language. Friendship may be expressed through golf, football, taking the piss, a pint, a phone call, helping someone move house or sitting beside them without saying very much at all while completing the Times Crossword. But those relationships matter. Looking after your health also means looking after your mates.
Notice when somebody stops being quite as cool as he was.
Make the phone call.
Arrange the game of golf.
Have the coffee or the pint.
And occasionally risk telling them if you think they are going off course. Then, tell them how much they matter to you.
Men’s friendships can look superficial from the outside because much of the communication is hidden underneath banter and shared activity.
But the important bit is that somebody is there.
Frank was there.
If I could go back to 1980
What would I say if I could walk back into the Wolfson bar and find those two 19-year-olds?
I certainly would not give them a lecture. They wouldn’t listen. I might tell Frank that the Marlboro Red was not as cool as he thought it was.
He would undoubtedly tell me to fuck off. And then go to the bar.
But I would also tell both of us this:
Enjoy being young.
Have adventures.
Make friends.
Fall in love.
Laugh until it hurts.
But remember that somewhere ahead of you is an older version of yourself.
You do not have to live for him.
Just please don’t completely forget him.
Because, with luck, one day you’ll get to meet him.
Frank never did get to become an old man. I wish more than I can say that he had. Four years after his death, I still remember that first sight of the impossibly cool kid in the black Fred Perry, cigarette in hand, refusing to wear his name badge.
And beneath all the medical lessons, all the talk about prevention and risk and long good health, one thing remains much more important to me.
He was my friend.
Dr Frank Kelly. May he rest in peace. My love to Margaret and Milly.
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