Chap­ter 1 of the book, titled “The Long Game: From Fast Death to Slow Death,” intro­duces read­ers to the con­cept of longevi­ty through the eyes of a physi­cian deeply impact­ed by the deaths of his patients. The author recounts the pow­er­ful expe­ri­ence of his first direct encounter with patient death dur­ing med­ical school, which left a last­ing impres­sion on him. This event, along with his expo­sure to both acute and chron­ic forms of death dur­ing his res­i­den­cy at Johns Hop­kins, shapes his per­spec­tive on med­i­cine and its lim­i­ta­tions.

The chap­ter con­trasts the imme­di­ate, often vio­lent, caus­es of death (“fast death”) encoun­tered in the ER, such as trau­ma from guns, knives, and acci­dents, with the pro­longed degen­er­a­tion caused by dis­eases (“slow death”) like can­cer, car­dio­vas­cu­lar dis­eases, and dia­betes. Despite the high stakes and the inten­sive med­ical inter­ven­tions in emer­gen­cies, the author finds him­self more trou­bled by slow deaths, which seemed more pre­ventable yet ulti­mate­ly inevitable.

Tran­si­tion­ing from active surgery to focus­ing on longevi­ty, the author crit­i­cizes con­ven­tion­al approach­es to aging and dis­ease. He is skep­ti­cal of the promis­es made by longevi­ty enthu­si­asts and the over­sim­pli­fied solu­tions ped­dled by both tra­di­tion­al and mod­ern med­i­cine. Instead, he pro­pos­es a more nuanced under­stand­ing of longevi­ty, empha­siz­ing not just lifes­pan but healthspan—the qual­i­ty and func­tion­al years of life. He shares a per­son­al turn­ing point, spurred by a com­ment from his wife, that led him to reeval­u­ate his own health and lifestyle choic­es, under­scor­ing the impor­tance of ear­ly inter­ven­tion and pre­ven­tion in com­bat­ing meta­bol­ic dis­eases and their pre­cur­sors.

The author cri­tiques the med­ical com­mu­ni­ty’s reac­tive stance towards chron­ic dis­eases, advo­cat­ing for ear­ly detec­tion and pre­ven­tive mea­sures to com­bat the under­ly­ing caus­es of slow death. He high­lights the inef­fi­ca­cies in cur­rent diag­nos­tic cri­te­ria and treat­ment pro­to­cols that wait until dis­eases become overt and ful­ly devel­oped before inter­ven­ing. Con­clud­ing the chap­ter, the author posits that under­stand­ing and mod­i­fy­ing risk fac­tors ear­ly on can sig­nif­i­cant­ly impact one’s healthspan and lifes­pan. He promis­es to explore these themes more deeply through­out the book, offer­ing insights into how indi­vid­u­als can prac­ti­cal­ly and proac­tive­ly extend their health­i­est years.