I had an annual physical last Friday, well more than a year since my prior physical. My primary care physician, whom I'll call "Dr. A", left the practice, and I've been waiting around for his replacement to appear. Note 1
The first depressing event occurred before the physical even started, when a nurse recorded my height and weight. In particular, the height measurement revealed that I've lost nearly 4 cm in height (1.5 inches), compared to my height when I was younger. I presume this is due to shrinkage in the discs between my spinal vertebrae, which is certainly not particularly encouraging.
I have a folder of medical records which must be nearly 10 cm thick, but a transition is now being made to records which are entirely computerized. My new primary care physician, whom I'll call "Dr. S", spent much of the visit filling out numerous computer screens which will become my ongoing health record in the future. It turns out that this is called an "LMR", for "Longitudinal Medical Record".
The questionnaire started out innocently enough, with entries listing all my medications, and the essentials of my medical history. What was depressing, though, was when I started being asked questions that seemed more appropriate for someone in his 80s or 90s. These were questions like, "Have you fallen lately", and "Do you have problems with any Activities of Daily Living".
I've heard the latter phrase before, often abbreviated "ADL". I heard it in the context of long-term care insurance. Some policies only begin to pay when the insured becomes incapable of carrying out some number of Activities of Daily Living, perhaps two or three of them. These are things like getting out of bed unassisted, walking, or feeding yourself, I believe. At 70, I'm evidently old enough that these questions have to be asked. Dr. S even observed me as I walked across the room, I guess to see if I have any problems with my gait.
One question dealt with my hearing, which I will shortly need to have tested, I think. It's clearly weaker than it was before, although it's not as bad as Margie's. She already wears hearing aids. The volume setting on our television set provides an informal measurement, because it shows a bar across the bottom of the screen that grows to the right as the volume is increased. To the right of the bar, the actual numerical value of the volume setting is displayed.
When Margie has set the volume on the television while wearing her hearing aids, the volume seems too low to me. That is, I don't hear as well as Margie hears with her hearing aids working. But then in the evening, when she removes the hearing aids for comfort, she has to crank the volume way up to hear the television set properly. It's then much too loud for me. So I evidently hear much better than she does without hearing aids, but worse than she does with them. Just one more bodily function going south.
Dr. S ordered a whole bunch of blood work, much of which was overdue. A test of my thyroid function was included, maybe because I reported that I often feel cold (I don't know if a thyroid function test is routine in an annual physical at my age). Bringing up that subject was another thing that made me feel old (in this case, cold and old, I guess). I recall my grandmother's apartment as she was approaching her 90s. She kept it at around 25 degrees Celsius (77 degrees Fahrenheit), and it felt like a steam bath. I didn't particularly understand it at the time, but now I guess I'm getting there myself, although I'm not quite at that level.
Of course, Dr. S is a good deal younger than I am. It would be surprising for my doctor to be older than I am, because a doctor older than I am really ought to be retired. Doctors these days seem different than the doctors of my youth. For one thing, standing at the computer, Dr. S was touch typing. The doctors of my youth seldom knew how to type, because they considered such an activity to be beneath them. They had secretaries for that. Their time was too valuable for "clerical work".
Another difference: when asked a question about the supplement CoQ10, Dr. S admitted to having no knowledge of the subject. In my youth, most doctors would never admit to being ignorant of anything medical. They often seemed to feel that their positions required them to put forward an image of being total experts on anything that in any way touched on the field of medicine. Actually, my former doctor, Dr. A, was also willing to state when he didn't know something. That's one of the things I liked about him.
A couple of the questions I was asked by Dr. S dealt with depression. Am I often depressed? The answer was no. Perhaps that's a benefit of getting old. Small problems seem unimportant to me, and I don't get upset over them. I'm much more attentive to, and appreciative of, the pleasures of life. In many ways, I'm happier than I've ever been. I just wish my body weren't so evidently sliding downhill.
There is another way in which Dr. S differs from the vast majority of the doctors of my youth: Dr. S is a woman. When I was a child, pretty much every doctor I met was male. I've long since gotten to the point where this makes no difference to me, but I'm not sure all men react the same way. The wonderful humor writer Dave Barry once wrote about having a colonoscopy performed, it turned out, by a doctor belonging to what he described as "the extreme opposite sex".
He was so embarrassed by this that after the procedure, he thought that his only alternative was to leave the city and enter a witness protection program. Of course, Barry has made a comic career partly out of being an arrested adolescent. One of his books is called Dave Barry's Complete Guide to Guys. I'd tell him he needs to grow up, but if he took my advice it would cost him a lot of book sales. Note 2
It's not Dr. S's fault that, having passed seventy, I need to be asked such questions for my medical record. And of course, it's better to be asked than not. There can be important questions that don't get answered unless they're asked. Once, during Margie's social work training, she was finishing up her second and final interview with a married couple. Although she thought she had obtained all the relevant information she would need, she finished with a routine question: "Is there anything else you'd like to tell me about?" The husband replied, "You must be referring to my drinking problem." Margie, having previously heard nothing about any such thing, said, "Uh, I think we may need to have another meeting." Note 3
I spent yesterday evening at the fourth session of the town of Wayland's annual Town Meeting. Wayland has what's called an "Open Town Meeting", where any registered voter who shows up is a member of the legislature. Friday was to be the fourth and final session this year. Although the meeting generally terminates at the conclusion of the warrant article which is being discussed at 10:30 PM, a motion had been made to stay in session until all the warrant articles had been completed, since there were only four more articles to be done.
At that point, a man sitting in the front row collapsed. The meeting went into recess as various first responders in the hall rushed to his aid, and a truck from the emergency medical service arrived within five minutes or so. I was way in the back of the room, where I was manning the Help Desk of the ELVIS committee ("ELectronic Voting Implementation Subcommittee). Nevertheless, I could see that someone was doing chest compressions on the victim as he was rolled out on a stretcher, not a particularly good sign. A motion was made and passed to adjourn the meeting.
The next day, we found out that the man, sadly, did not survive. He was 84 years old, and had been a fixture at Wayland’s Open Town Meeting for 50 years. Apparently, he had been taking a nap when he died abruptly. His was actually the second death on the Town Meeting floor in nine years. In the previous event, a man had died while starting to speak at the podium. I was once told, by my friend Steve Perlman, that if I speak a few more times at Town Meeting, I'll pass into the category of "Town Nut". But I don't expect to die at the microphone.
I talked about mortality in my very first blog entry, entitled, Introduction: what are these pages? This blog is sort of my immortality, as I plan to leave it to my family. It's also an interesting activity for my retirement. I recently added to the top of my blog home page the motto, "Blogito, ergo sum" - "I blog, therefore I am", a humorous motto that's been thought of by many others - a Google search on the phrase gives almost 38,000 hits.
You never know how much time you have - make the most of it.
Note 1: Apparently, the long delay in replacing Dr. A was getting his replacement listed on the "Insurance Boards", allowing the acceptance of third-party payments. This took months. I don't know why anyone thinks it's good for our health care system to be basically run by insurance companies. [return to text]
Note 2: Some women patients also prefer a doctor of the same gender, particularly in specialties like obstetrics (but Margie sees a male gynecologist).
I recall once hearing about a young girl whose mother was a doctor. The girl also knew several other female doctors in the same family, and saw a female pediatrician herself. One day, the girl was introduced to a male doctor. She thought this was very funny, as she had apparently concluded, without being told, of course, that all doctors are women. She went around telling people that so-and-so was a doctor! Even though he was a man! [return to text]