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The aggressive and unsuccessful surgery was a hard lesson in questioning my mind-set. It now seems self-evident, but mistakes are often necessary to bring insights. I learned to pay more attention to risk, to take time to consider side effects. Loss aversion can be a steadying force in making clinical choices. Pam took this cautious approach to medicine from the outset, and I moved closer to her thinking.

So when I reached my forties and found that my cholesterol level was 242, I had to decide whether to take a statin medication or forgo it. My father’s tragic death impelled me to confront the reality that elevated lipids plagued our family; our genetics were inescapable. Not only had he died from a heart attack at an early age, but his two brothers, my uncles, also had coronary artery disease.

But the failed spinal surgery had made me risk-averse, particularly to anything that might affect my muscles, after years of suffering back pain. And as it happened, like Susan Powell, I had an acquaintance who had taken a statin medication and developed severe muscle inflammation. He was a doctor at our hospital, and one day in the parking lot, I saw him hobble away from his car. I thought he might have developed a degenerative neurological disorder, but he told me that he had taken a statin medication for an elevated cholesterol. Although many months had passed since he had stopped the drug, his muscle pain still had not subsided. I knew this was an anecdote, an “n of 1,” but it made a deep impression on me. Availability, dramatic stories of benefit and of harm, affect us all, patient and physician alike.

So when my internist wanted to prescribe a statin, I declined at first. I had pivoted 180 degrees from my prior orientation. I would take a natural approach. Of course, you don’t recalibrate your mind-set completely. I was still a maximalist—I zealously adhered to a very strict diet, lost twelve pounds, exercised even more intensively. Six months later, my cholesterol had fallen four points to 238.

Although I was about a decade younger than my father was when he died, I felt that I had entered the phase of life where, like all the men in my family, I was marked for heart disease. I had to do something more.

My primary care physician suggested I begin on a standard dose of a statin, but I negotiated with him. “Let’s begin at half dose,” I said. I was aware that side effects were often dependent on dose. Although still committed to a natural approach, still strict about diet and exercise, I was forced to compromise. You can always increase the dose, I told myself. I would begin with a half step.

In six weeks, my total cholesterol was 160, and my “good” cholesterol, or HDL, was above 60. My muscles were not affected, then or in the ensuing years.

I was gratified, and not only because of the better numbers; I had understood my preferences and followed a deliberative process, reflecting on my thinking and acting in a way that makes sense to me.

[Pam’s Narrative]

My father, an engineer, enthusiastically applied scientific principles to child rearing. When I, the first child, was born, he studied Dr. Truby King’s method and decided that I would be fed on schedule, every four hours. He gave my mother a chart, carefully reviewing the plan before he left for work. After I screamed nonstop for two days, my mother, an artist and freethinker, took matters into her own hands: She fed me whenever she thought I was hungry. When my father asked how she could deviate from expert advice, my mother had a ready answer: “Doctors don’t know everything.”

My mother was ahead of her time with regard to a healthy diet. My friends had marshmallow cereal, Wonder bread sandwiches, and Twinkies. Not in our house. We had peanut butter and honey on whole-wheat bread with carrot sticks. In the 1950s, whole-wheat bread had not reached its current culinary heights; ours tasted like a mix of cardboard and sawdust. Fruit for dessert, no cookies. Milk with meals, no soda.

My father was an early riser and an