Tuesday, October 30, 2012

If you don't want to join the Letterman Zipper Club, never to go the doctor: active seniors may like things the way in the 50s, when we didn't try to live forever


I will have my annual Medicare physical Nov. 1 (it was postponed from today because of Sandy), and will follow up with a visit to an orthopedic surgeon about pain in my left hip, left over from an acetabular fracture from a convenience store accident in Minneapolis in 1998.

That could mean surgery, which could be simple (one morning, outpatient) or more complicated, meaning hospitalization and a period of no access to Internet (as I discussed on my main blog Oct. 27).  Or it could mean only medication and no interruption.

There’s always the possibility that any physical will turn something up.  In the generation in which I grew up (50s and 60s) people usually lived out their lives, productively in their own way, until something potentially fatal happened.  Usually, little could be done, and people died rather quickly after being active almost all of their lives.  That was “normal” and generally led to life spans of 65-85 years. 

Medicine can now prolong lives much longer, but this requires a change in heart of values from the patient, and it also demands social cohesion from family or others around him or her.  As Dr. Oz says, most radical treatment doesn’t work unless “you love somebody who loves you back.” Or as Jonathan Rauch, advocate of gay marriage, writes, a single person is an “accident waiting to happen.” Social isolation can preclude the possibility of life extension.

Yet, for me, the best result is to be 100% active as long as possible, and that may mean doing as little as possible.  As we know from prostate cancer, which often remains indolent for years, many men are better off for many years or decades if they do nothing.  (That doesn’t seem to be true of breast cancer for women.)  But prostate cancer can suddenly explode, as it did with my own father, who died after only four weeks of illness on New Year’s morning in 1986, just before his 83rd birthday.  But that was the way he wanted it.  He could not stand the idea of dependency or helplessness or shame, despite my mother’s devoted attention.  With less “pride” he probably could have lived much longer, but he didn’t want that.  He wanted to keep everything until the end.  Then he let go.

My mother broke her hip in 1996 at age 83, and during ensuing hospitalization the first sign of heart problems ensued.  Interns were surprised I didn’t “know” much more about her health, and there was a concern that the fracture had resulted from old breast cancer metastasis .  It had not. That blew over. In 1997, she had a hip replacement, which led to a more complicated hospitalization than had been expected. I arranged brief home health care.  Because of circumstances regarding my book publication and to avoid “conflict of interest”, I took a job transfer to Minneapolis in September of 1997.  In 1999, she had a heart attack (which had probably been detectable earlier, but it was easier for me that it was not), and that resulted in coronary bypass surgery in May 1999 at age 85 (after deciding that angioplasty was itself too risky).  I had never heard of bypass surgery, which in her case was very invasive, done at such a late age.  I had a concern that this could not be done unless I gave up the job and came back, but that did not happen. Nevertheless, this was a scary time for me, given filial responsibility.  It could have been fatal for my own intentions for my own life.  It could have meant sacrifice.

I could say, on an intellectual level, that we should have a real discussion about how far we should go with extending life.  In mother’s case, the surgery worked and she got at least eight good years out of the surgery despite the advanced age, before starting to decline at around age 94 (and passing away right after her 97th birthday).  So the surgery seems justified by the result.  But it’s clear that today, in comparison to times past, radical treatment at advanced age cannot be justified except for people who have strong social support systems, including other family members (not just spouses) who can deal with the personal sacrifice.  I can say that we should have a public policy discussion about his question, in light of all the concerns about the sustainability of our health care and Medicare systems.  People take offense when I say this, like how can I look at something in such an detached, “impartial” way when “she’s my mother”?  If I had children, I couldn’t afford to be objective.  But I think there is a point where we must become objective.  There are times when some people would let go.  I can be one of them some day.  Everyone of us will die of something (except those of us who get to become angels, as in my novel and screenplay).

Remember what happened to David Letterman in 2000, albeit it at age 50 or so?  He went to the doctor, and didn’t come home again until he was a member of the zipper club, his destroyed chest a subject for cartoonish, even clownish satire in Esquire.  That is not for me.  I must keep on trucking.  

Wikiepdia attribution link for picture of Asheville, NC (Oct. 1991 visit). 

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