The Third Third

Who are you going to call when you start to fall apart?

I have come face-to-face with my mortality in recent days – or, at the least, with some of the vicissitudes of aging – and it is not a pretty picture. Indeed, “picture” is the right word. It is the images that I find so jarring – depressing, actually -- as if they are the evidence of my deterioration and decay. As they in fact are. I have been known to declare “Sixty is the New Forty” for all to hear; parts of my body, apparently, have not been listening. Did you know, for example, that the 20/20 that measures the acuity of your eyesight is a fairly vague range that reads differently when you are 30 than it does when you are 60? (Has this happened to you? You know you’re not reading the street signs as quickly and confidently as you once did; you know your vision’s just not as good as it used to be, even with your contacts or glasses. But the eye doctor checks your vision with one lens and then with another – is there a more tedious test? – and declares you’re seeing 20/20.) It’s enough to turn you into an aging, nostalgic curmudgeon who complains “Some things just aren’t the same anymore.” Even that 20/20 pretense fell away, though, the last time I went whining to the ophthalmologist. “We” now have cataracts, “a natural part of aging,” according to the brochure I was given. Simply over the course of time, the eye’s natural lens “stiffens and hardens,” clouding the vision. “Stiffens and hardens” – does that sound creaky, or what? I now have correctable vision of only 20/30. That’s legal for driving, I was reassured. *Legal for driving?!!! Who does this guy think he’s talking to? My dad?* I failed to absorb the rest of the conversation; I was reeling from the disconnect between my state-of-mind (about 40, maybe 45) and my state-of-being (ancient). I was plunging into an abyss that denial could no longer get me out of. Meanwhile, speaking of creaky, my back has been demanding its share of attention, including a myelogram, CT scan, and MRI to diagnose the source of some new pain and numbness that makes my foot sometimes forget to lift off the ground in preparation for the next step. I had been looking and feeling a bit clumsier than usual, and now, films in hand (actually on the computer screen), the orthopedic surgeon knew why. Try these words on for size: “Severe degenerative disc disease.” (See [][1] Not chic, not chic at all, no matter how “normal” it might be for a fair-skinned, light-eyed woman *of my age! * Actually, it was worse than that – one of the old, arthritic vertebrae has slipped even further into its age-related scoliotic arc, to impinge on a nerve and cause the pain and numbness which might not be able to be reversed, though it needed, obviously, to be repaired, most likely with bone from a cadaver (someone even older, and obviously more decrepit than I – small comfort when engaged in such an intimate exchange of body tissues). Now, I really don’t have a leg to stand on (to coin a phrase) if I were to rail against the unfairness of the gods of good health. I *have* good health, and believe me, I count that blessing every single day. And it’s not as though I have been diagnosed with any life-threatening disease. It’s just that my body is aging, inexorably, and once again, I am confronted with my unrealistic expectation (illusion? delusion?) that I, being some kind of special invincible baby-boomer case, might escape all that. All these doctors and their tests have brought out the somewhat dormant perfectionist in me; I *hate* the fact that my body is betraying me and I have so little control over making it all better, indeed, perfect again. It is clear – even with my 20/30 vision – that compromises will be made. I don’t cater to compromise well. I am not happy about these developments. I am, my husband would note, every bit as distressed as I am deteriorating. As I said in the beginning, it is not pretty. I now have in my medical file incontrovertible evidence that I am getting old, that parts of me are, in fact, very old, and irreversibly so. Damn. I look in the mirror. I’m still here. The hair is still blond. The eyes are still bright. The mouth, which gravity has pulled down at the corners, is still capable of turning itself up into a grin. I pull on the spandex. I’ll show this body; I’m going to the gym. I creak, I groan, I go. I survive. I watch Duke play basketball and remember Coach K was out for a year with back surgery, and I begin to believe I can probably be resurrected, too, even though I am at the far edge, age-wise, of the target population for successful back fusion surgery (though, perhaps, if I continue to channel this idea of 60 being the new 40, I’m not really where the statistics think I am). I’ll get there. I’ll get fixed -- repaired and reconstituted for the next 30 years. It’s true. I am, really, very lucky. It’s just age. Some parts are wearing out. It’s up to me, I guess, to make sure *I* don’t. Clearly, however, it is going to be a struggle. One challenge is **access to medical care** altogether, a challenge made all the more difficult by not knowing exactly what kind of care I really need, i.e., Do I need the orthopedic surgeon who does the simple fusion of one vertebra to another? Or do I need the neurosurgeon who corrects the whole section of the spine affected by scoliosis? How do I figure out who has the best results? How do I decide whether to cast my fate with the most highly recommended of either of these in my home town, or with someone with a higher-profile reputation in the region, or anywhere in the country? It’s not brain surgery, after all; it’s more like repair carpentry; and yet the spinal cord is involved, as is my mobility going forward. With the medical care delivery system in such disarray – it is clearly in limbo as long as Washington’s health care debate drags on – whom do I trust, and on what criteria do I base that trust? There’s the market-savvy guy who runs a veritable bone-repair factory, cherry-picking the healthiest patients for his own surgical center and operating on the Medicare and other under-insured patients in the adjacent hospital; and there’s the high-brow M.D.-Ph.D. research scientist at the local (and highly esteemed, in these parts) medical school who deigns to operate only on patients who seem to interest him, whose results he can reasonably predict because that particular surgery is all he does (when he feels like it). Then there’s a timing issue. As established above, I am at the far end of the age-range for successful outcomes with spinal surgery, *and* I have some nerve damage already. Time is not of the essence, but it is a factor, as I can only get older and – to add insult to injury – I’ve been warned not to wait until I’m 65 and qualify for Medicare (if it’s still around) because then, I’m told, none of the best doctors will even touch me! It’s enough to make you sick. Or sicker.   I have to check my impulses. I am a surgeon’s daughter, and I innately gravitate to the clear-cut option. Just do it. Fix it and be done with it. No malingering. I confess I signed up for the simple, two-vertebrae fusion before I left the first doctor’s office. I would do it two weeks hence, recover in the prescribed six weeks (with no bending, twisting or lifting) and be ready to welcome my first grandchild, with open arms and stable back, in May. Fulfilling my role as Grandma would be the motivating goal of my rehabilitation. Type A patient *par excellence.* I would perform. And it was so easy – everything right there – the imaging people, the hotel-like surgical facilities, the friendly, helpful nurse practitioner, and the confident swagger of the surgeon. But it was clear, after I talked with the second doctor, that I had not done my homework, that I had no idea, really, what the core problem was with my back, much less the best solution for it. I have spent a lifetime deferring to medical authority (that’s how my father trained me), but now I have to develop my own. I had to begin by asking myself the obvious: Why would I return to the surgeon who performed surgery on my back (a laminectomy) five years ago, *without* relieving the pain or solving the structural problem? What was I thinking? Seeking medical advice is, like seeking any advice, a question of whom you ask. Children ask Dad, for example, if they know Mom is going to say “No.” As 60-something patients, we need to be considerably more sophisticated and discerning. Asking the guy I know will tell me he can fix it just isn’t going to suffice anymore. I need more data and different perspectives. This is hard work. I am not writing this piece to complain or whine. Really. I am writing to re-enforce what I have learned we all need to do to maintain our health and sanity as we age and in the face of a complex, complicated medical system that does not necessarily have our best interests at heart. The bottom line from all advice on so-called successful aging, is that **we have to take care of ourselves. **   At a minimum, that’s eating right, exercising, staying mentally and physically active and socially engaged – and when medically and physically challenged, learning what we need to know and asking the right questions of the right professionals to get the best care. I am reminded of the neonatalogist who saved our now-25 year-old daughter’s life. We saw him a few months after she had recovered, fully, from a very traumatic birth, and he graciously accepted our thanks and gratitude. He said he loved his work. “You set an 80 year-old’s hip,” he said, “and you can derive some satisfaction from giving her a few more good years. But you save an infant, and you’ve given her at least 80 good years. That’s what really makes me feel good.” We were just lucky he was in the hospital when Della was delivered. But I’m on the hunt now for the doctor who gets his or her kicks from fixing up 60 year-olds so they can get the most out of the next 30 years, the full third third of their lives. And you should be, too. *How do you navigate the health services system? What resources – online, books, medical schools, etc. – have been most useful? How do you “negotiate” with your doctors to be certain you are getting the best care? Please share your experiences and helpful ideas in the Comments below.* [1]:
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