Paul English: Why Pneumonia is Such a Common Cause of Death in Seniors

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Paul EnglishPaul English was Willie Nelson’s drummer and best friend for nearly sixty years. In 2014, English told a Rolling Stone writer that Willie Nelson had saved his life, saying, “If I hadn’t gone with Willie, I would be in the penitentiary or dead.” They met in 1955, when Nelson was an unknown country singer on a small-time radio show. English had accompanied his older brother, who was playing steel guitar on Nelson’s “Western Express” radio program. When the regular drummer didn’t show up, Paul English offered to play the drums, even though he had never done it before. He sat down and drummed on a cardboard box on live radio. Nelson liked him and asked him to play three nights a week for six weeks, at $8 per night.

Listen to one of Willie’s best-loved songs, “Me and Paul,” that tells some of the story of their long relationship and antics:
” . . . We received our education
In the cities of the nation, me and Paul
I guess Nashville was the roughest
But I know I’ve said the same about them all . . .
And at the airport in Milwaukee
They refused to let us board the plane at all
They said we looked suspicious
But I believe they like to pick on me and Paul . . . ”

I’ve copied the rest of the song below. They played together until 2010, when English suffered a stroke that ended his drumming days, but he continued to travel and work with the band right up to his death from pneumonia at age 87, on February 11, 2020.

Off to a Bad Start
English was born in 1932 in rural Vernon, Texas, into a family of non-smoking, non-drinking, devout Christians, and as a child he played the trumpet at his parents’ Assembly of God church. He went on to join gangs as a teenager and to hang out on Hell’s Half Acre, a string of bars in Fort Worth. One day, he beat up a couple guys, which got him accepted into a group of criminals called the Peroxide Gang. This gang broke into up to a dozen houses on some days, which resulted in a local newspaper naming English one of the “10 Most Unwanted” criminals in Fort Worth for five years in a row. He then bought some run-down houses and opened up a series of brothels.

In 1955, Willie Nelson was playing in night clubs located in the same area where English had his brothels, and where some people were shot for just being there. English accepted Nelson’s offer of playing the drums for $8 a night because, “I got to play in front of the girls.” The pair separated for a while but got together again in 1966 and from then on, English was Nelson’s best friend, bodyguard, accountant, road manager and collector when night club managers didn’t want to pay the band for their performances. During one of these experiences he lost an eye, and became the only member of the band with a glass eye.

A Long Life with Willie Nelson
Willie Nelson had his own story. His mother abandoned him soon after he was born and then his father did the same. Willie and his sister were brought up in rural Arkansas by his grandparents, who gave Willie a guitar when he was six. By the time he was in high school, he was writing his own songs and singing for a band called The Texans. English told one interviewer, “When I first met Willie Nelson, I thought he was an old cotton-picking, snuff-dipping, tobacco-chewing, stump-jumping, gravy-pot sopping, coffee pot dodging, dumpling-eating, frog-giggin’ hillbilly from Hill County, Texas.”

Nelson became a very popular and successful performer. He moved from Nashville to Austin and formed the Family Band, made up of his sister Bobbie on piano, English on drums, a young harmonica player named Mickey Raphael, and a long-haired hippie bass player, Bee Spears. One day, English and Nelson passed a store window that contained a huge black cape. Nelson told English that since English already looked like the devil with his black beard and his black cowboy hat, adding a black cape would make the girls love him even more. Nelson went in and bought it for English, who wore it with his black cowboy hat at every performance from then on.

The band paid a big price to become famous, touring all over the country in a station wagon with a trailer hitched to the back. On one trip they drove more than 15,000 miles in 18 days for nine gigs. When Nelson got drunk on tour, English would take him to his hotel room and sit on the end of his bed to keep him there. English said he always carried two guns, and he was known to draw them and fight with anyone who made trouble for the band. One time, he shot at Willie Nelson’s son-in-law’s car for hitting Willie’s daughter. When a night club owner did not pay the band for a gig, English drove a forklift up to the guy’s Ford Thunderbird until he paid up.  Their long relationship of friendship and support continued until English died of pneumonia at age 87, in 2020.

Why Pneumonia is So Common in Seniors
Pneumonia is the eighth leading cause of death in North America today, killing more than 60,000 people and causing more than 960,000 hospital admissions. People older than 65 and younger than two are the ones most likely to die from pneumonia. People with weakened immune systems are at increased risk (Exp Gerontol, 2011;46:953-957), as are people whose cilia have been damaged by smoking or working in polluted areas such as coal mines or with asbestos (Am J Respir Crit Care Med, 2001;163(4):983–8).  English was a heavy smoker for most of his life and worked constantly in smoke-filled environments.

Every breath you take brings in air full of germs, dirt and pollutants. Your bronchial tubes are supposed to produce mucus and the cilia, the little hair-like structures lining your bronchial tubes, are supposed to sweep in rhythm and push the pollutant-and-germ-filled mucus up to your mouth where you swallow it with your saliva. However, if your cilia are damaged, as in chronic bronchitis, or destroyed, as in emphysema, they cannot sweep up the mucus. Your bronchial tubes fill up with this filthy mucus and you become short of breath from breathing through a layer of mucus. Then if you develop an infection from a virus, bacteria, or fungus, called pneumonia, you are at increased risk for smothering to death from the accumulation of fluid.

Smoking is perhaps the most common cause of damage to the cilia, and today’s seniors grew up at a time when virtually everyone smoked. Even if a person stopped smoking many years ago, the cilia do not recover or regrow, so that person is always at greater risk for lung problems including pneumonia. Even non-smokers from that era are likely to have been affected by the heavy, universal second-hand smoke in homes and public places. As these generations who lived through the years of heaviest cigarette use pass on, it will be interesting to see if the rates of death from pneumonia go down.

Lessons from Paul English’s Story
Being with the right person or people can help you find your place in life. English credited Willie Nelson with saving his life, and being part of the band “family” brought meaning and success.  English lived a relatively long and productive life, but it was undoubtedly shortened by his own smoking and his constant exposure to second-hand smoke in the bars and music halls where they played.

Smoking damages your cilia. So does living with a smoker, and even living in a house in which smokers formerly lived. Try to avoid living or working in areas with high pollution. Try to avoid infections by washing your hands frequently, and keeping your fingers away from your eyes, nose and mouth. People over 65 should be especially alert to avoid pollutants and exposure to infected people.

Aging increases sources of inflammation (Aging Dis, 2019 Apr; 10(2): 367–382) that reduce a person’s ability to kill germs and therefore increase risk for infections (Immunity, 2006;24:491-494). People who have high blood markers of inflammation, such as CRP, are at increased risk for pneumonia and other infections (Clin Chem, Feb 2016;62(2):335–42). In particular, inflammation increases risk for serious infections in older nursing home residents (J Am Med Dir Assoc, Jun, 2009;10(5):348–53) and those who have had joint replacements (Orthop, Nov 2008;37(11):1116–20). Everyone, especially those over 65, should follow an anti-inflammatory lifestyle that includes a regular exercise program and a healthful anti-inflammatory diet as well as not smoking or being exposed to pollutants.

Paul English
November 6, 1932 – February 11, 2020

“Me and Paul” Lyrics – Willie Nelson, 1971

It’s been rough and rocky traveling
But I’m finally standing upright on the ground
After taking several readings
I’m surprised to find my mind’s still fairly sound

I guess Nashville was the roughest
But I know I’ve said the same about them all
We received our education
In the cities of the nation, me and Paul

Almost busted in Laredo
But for reasons that I’d rather not disclose
But if you’re staying in a motel there and leave
Just don’t leave nothing in your clothes

And at the airport in Milwaukee
They refused to let us board the plane at all
They said we looked suspicious
But I believe they like to pick on me and Paul

On a package show in Buffalo
With us and Kitty Wells and Charlie Pride
The show was long and we’re just sitting there
And we’d come to play and not just for the ride

Well, we drank a lot of whiskey
So I don’t know if we went on that night at all
But I don’t think they even missed us
I guess Buffalo ain’t geared for me and Paul

It’s been rough and rocky traveling
But I’m finally standing upright on the ground
After taking several readings
I’m surprised to find my mind’s still fairly sound

I guess Nashville was the roughest
But I know I’ve said the same about them all
We received our education
In the cities of the nation, me and Paul