“Feed Me” and the Medical System

Remember Audrey II from “Little Shop of Horrors” whose appetite was voracious?  As we age, entering a hospital can feel a lot like dining with Audrey II.  The medical system, like Audrey II, may devour us in its self-perpetuating system, encouraging increasingly complex tests, and ultimately leave us broke, exhausted and with little relief from the original malady. No wonder so many of us are hesitant to open the door to medical testing.

My “breathless” story is an example of that. I run out of breath too quickly. Our 8th grade gym teacher chased us around the track with a paddle. Despite that very real motivation, I was always the last of the runners, hampered by breathlessness.  In graduate school, I gave myself a pulmonary function test, and my FEV (Forced Expiratory Volume) was less than normal for my age.  Later, I asked a pulmonologist acquaintance whether I should re-do the test, or investigate possible causes, explaining that I had grown up with heavy smokers and had lived for a while in military housing where insecticides were regularly dropped from the sky.  My friend recommended that I simply let nature take its course, arguing that a baseline wasn’t useful.

Now in my 70s, the breathlessness is more severe, so at my request my primary care doctor sent me for a chest CT scan (June, 2019, $2300). A few days later, she called to say “Don’t move, don’t stress, but we think a heart attack is imminent, and it could be fatal.” I didn’t move for the 10 days it took to find a cardiologist (June, 2019, $500), who promptly scheduled an echocardiogram (June 2019, $2000) and a Nuclear Stress Test (July, 2019, $5800). “Never mind” he said in our follow-up appointment (July 2019, $250), “you are normal for your age. It was all a misreading of the CT scan.”  The CT scan had also found a pulmonary lesion, but a second follow-up CT scan (September, 2019, $3500) revealed that it too was of no concern.

Skip forward past a broken leg and the start of a pandemic, during which the breathlessness did not abate. The next stop was a pulmonologist (May, 2021, $600) who performed a pulmonary function test (May, 2021, $400) and requested another CT scan (April, 2021 $2400). And then, suspecting small pulmonary emboli, he requested a perfusion test (June, 2021, $2700) and a CTA test (August, 2021 $4000), ending with a sleep study (October 2021, $6000).  Today (May, 2022) the pulmonologist defined the results as “good news; there are many serious problems we know you don’t have” and recommended that I adapt to the breathlessness by taking breaks as needed. He and the cardiologist both noted that breathlessness could be impacted by arthritis, weight, conditioning, hiatal hernia, and  age.

These medical bills would bankrupt many Americans.  For me, with Medicare, I paid less than $1000 of the $30,000 in bills (note: these numbers are neither exact nor inclusive of all expenses; I left out a bunch).  Some lessons:

  • We in our insatiable curiosity have created a medical system which can give us many details about our bodies and make many diagnoses, but we still don’t understand how our organs function and dysfunction.
  • The cost of our medical care is unfairly distributed.  Those with the least amount of insurance are billed the highest rates in order to offset the negotiated prices paid by Medicare and insurance companies.
  • Medicare is perhaps the best financial benefit of being over 65 years old.

Uncharted Waters

Uncharted waters,

Living life while letting go,

Now is all there is.

There’s always been a do-list on my desk, carefully dated and delineated in a spiral notebook. Some days, there have been 20 or more new entries. Periodically, I joyously strike a line through each accomplished task.

These days, there are fewer items on the do-list: backup the computer, make a physician appointment. Currently, a new spiral notebook is filling with phrases to ponder and meditations to remember… a new list for my future quiet moments.

Searching for the written ideas of others about aging, I find numerous books with eat-this, do-that advice, such as Rebellious Aging. These seem directed to the 50-year olds and 60-year olds struggling against aging. Of more interest to me are the more metaphysical, psychoanalytic writings of Kathleen Singh Downing and Helen Lukes. My current favorite is Wise Aging: Living with Joy, Resilience, and Spirit by Rabbi Rachel Cowan and Dr. Linda Thal. These authors see aging as a life cycle, a time of reflection, a transformation from do-lists to reflections, which is where I seem to be, while living life with joy.

These posts will thus be a mixture of life as I am living it and reflections on aging. I suspect that the ratio of “activities” to “reflections will change over time. Let’s see.

Invisible Woman, Part I

We celebrated the spring holidays with family, Sitting together in the sunshine after a joyous celebratory brunch, the family’s young adults chatted about the young adult/scifi books they had recently read and enjoyed.  I contributed the name of a young adult/scifi  author I had recently read. My beloved young family members looked at me, then without comment, returned to their conversation.   I felt invisible. As Emily Dickinson said in one of my favorite poems “I am a nobody; are you a nobody, too?” 

My friends tell me this happens to them.  One couple I know were guests of their children and grandchildren for a week, celebrating the 50th anniversary of the couple.  “It was nice to see the children and grandchildren getting along, but we realized that there no place for us.  We came home several days early” said my friend when I asked about the family time.

Social isolation of the elderly is a national problem.  From the CDC: A report from the National Academies of Sciences, Engineering, and Medicine (NASEM) points out that more than one-third of adults aged 45 and older feel lonely, and nearly one-fourth of adults aged 65 and older are considered to be socially isolated.  I am lucky to live in a senior community, where we strive to communicate and listen to one another with patience.  We elders contribute to our social isolation with our hearing and vision issues, slowed information processing, a preference for what has been, and deficiencies in  technical expertise.  And maybe we, too, suffer from ageism and don’t expect to be welcomed in the discussions of the younger folk. 

I can’t help wondering if this is a reason that poor Joe Biden just can’t earn the approval of millennials?

Life in a LifePlan Community (CCRC)

Spring nightfall view from my cottage patio in my CCRC

My husband and I are very lucky to live in a senior community where long-term health care is promised as a part of our rent and entry fee. (Such communities are called “Life Plan Communities” or “Continuing Care Retirement Communities.”)  Our monthly cottage rent includes our apartment, a meal a day, fitness programs and the shared cost of our personal and skilled care health center, which adds a hefty $1500/month/person.   The payoff comes when we need the support of the fulltime care available in the health center; we have priority access to our 5-star facility at no increase in rent. 

The boundary between “independent” living and life in the health center is not clear, except that government regulations require more stringent inspections, staffing and regulations than for those of us living “outside” the health center.  Movement from independent living to the health center is essentially voluntary.  Thus, independent living includes residents over 100 years old who are cognitively capable of independence, as well as a few 75 year olds who can barely find their way home after dinner.  Life with the cognitively challenged health center residents is funny and, frustrating.  For example, how do you explain the need to wear masks to those who can’t remember their name?  Or how about the story of a resident who kept the proceeds from a craft sale under his mattress, while $4000 worth of checks became worthless with the passage of time. 

Our Community is well described, and well promoted in its short videos of residents and resident life. If you’re interested, check out the KCC Videos found here.

We ARE lucky. Life in a senior community is also a constant reminder of the fragility of the aged, the impermanence of us all, and the positive impact upon our vitality of our continued engagement with the world and one another.