Wednesday, May 15, 2013

As I grow older, I have to resist falling into medicine's " Pandora's Box (Don't go to the doctor!)


I wanted to make a note about my own medical strategy, as I near 70. 
  
I depend mainly on momentum.  I’ve gotten through my adult life with rather minimal use of health care services, after been a “sickly” child.  The one big exception occurred in January 1998, when I fell in a convenience store in Minneapolis and sustained an acetabular hip fracture. But I was back to work in three weeks, on crutches, healed fully, and never looked back.

At some point in the relatively near future, I’ll do the “Clear Choice” thing, but with two private dental surgeons, who charge a little less for a little more value (more implants).  It means a full day under sedation.  The time consuming part is obviously the remaining extractions.  A good part of this had to be prepaid with checks. 

It’s possible to fall into a trap, I suppose.  If there were to be some kind of serious problem during the day, I could be without teeth until other things were done.  It’s a bit risky.

I haven’t done a lot of the things people recommend – like the colonoscopy.  I grew up in an era when “you got what you got”, and when the end came, it was usually sudden and quick, but often after a more of less normal life span. (For men, reaching 70 was OK, and 80 was good – and this usually happened without much intervention.

I think once you go down the road of multiple tests, it’s very hard to resist the pressure for invasive treatments.  You’ve opened a Pandora’s box and can fall into the abyss.  Once you start spending time in the hospital, it’s hard to stop it.  It’s a downward spiral.  We all know the risks of infection, and that doctors won’t stop trying to do more treatments.  In the cardiac area, the possibilities seem endless:  bypass surgery, valve replacement, pacemakers.  Some of these can be done less invasively than in the past. 

Also, as it stands now, you can’t have Internet access in the hospital – they don’t allow even cell phones.  It sounds like they could allow it if you paid for it.  Medicare wouldn’t have to cover it. (It's pretty easy to see how the urge to treat everything affects Medicare sustainability.) 
  
My mother had coronary bypass surgery at age 85 in 1999 – a possibility that I didn’t see coming and didn’t know was possible at that age.  She got eight good years, and started deteriorating in 2007, to pass at the end of 2010 after an agonizing decline. During that time, a surgeon did a lumpectomy and wanted to do further one.  I had to “just say no”.

My father had an aortic aneurysm at age 74, in 1977, underwent an open resection, and lived eight years afterward.  They were all good. He was ill only four weeks at the end of 1985.  He died of metastasized prostate cancer on New Years Day, 1986.  He could not have tolerated the idea of long illness or invalidism. 
  
There is a lot more pressure now on elders to accept the idea that they could live a long time dependent on others, and there is more pressure, as a result, for filial responsibility, an ironic observation.  Even though I grew up in more conservative times, there was not an expectation that life could or should be prolonged a long time at the end.  There wasn’t the ability to do it.  Now there is, but only for people with strong social supports, who love others who love them back.  The trends in medicine definitely run counter to the hype-individualism and weaker social capital of modern society.  I am certainly not someone who needs a social life set up for me; I could never tolerate it.  

Oh, never go to the doctor.  You might not come home. Remember Dave Letterman and how he joined the zipper club.  

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