Monday, February 2, 2015

* Dr. Spock for the Aged


I was born in what is now called Yale-New Haven Hospital in 1944.  Ten blocks away Dr. Benjamin Spock was busy writing his famous 1946 baby book in his own childhood home on  New Haven’s Cold Spring Street.  The hospital threw me into what today looks like a heated breadbox (a 1944 incubator) to try to save my life. I was two months premature and my skin was the color of Guilden’s mustard.  I lived.

Seventy years later medical techniques are far beyond heated breadboxes.  Today’s doctors don’t just save lives, they stretch out death like warm gooey toffey, longer and longer, thinner and thinner, stickier and stickier.

Since the day I turned 70 I’ve been digging out  travel tips for this gooey journey into old age, the one from which nobody sends postcards.   If you're looking for a pick-me-upper  in the next few paragraphs here, don't read on. These are let -me – downers , summaries of tidbits I’ve discovered about old age and dying, both of which I have no way of escaping, and one of which has already taken me prisoner.   They are seeds of a Dr. Spock book of tips on how not to nervously lower your coffin, not confidently raise your baby.

The first tip comes from Being Mortal a book by a gerontology specialist, Atul Gawande, M.D.  He says that even if they already have a terminal illness,  the very first thing to check in an old person is not their heart, but their feet. That sounds crazy. Feet?   Here's why. If they have bunions or in-grown nails they are more likely to stumble and fall  ---- and if they break a bone they risk  life-threatening complications a younger person might not have to fear. First things first: Make sure your old patients can be steady on their feet.

How practical. Why didn’t anybody tell me that when my parents were growing old? I guess because there’s no Dr. Spock book for winding down what baby wound up.

Here's another tip for travelers in old age which I found in a New York Times opinion piece by another gerontology doctor, Ira Byock, at Dartmouth entitled "Dying shouldn’t be so brutal. "  If your old  patient is on palliative care (pain drugs ) make sure they are given proper doses of laxatives adjusted correctly for the changing constipation which is caused by those drugs.  Otherwise you are just swapping one pain for another. How come I didn’t I know that useful information?  No Dr. Spock again.

Not one but a  whole series of old age sightseeing tips appeared in an Atlantic article recently  entitled “Why I hope to die at 75”, also by an MD, Ezekial J. Emanuel;  “But 65 will be my last colonoscopy. No screening for prostate cancer at any age . . . After 75 if I develop cancer I will refuse treatment. Similarly no cardiac stress test, no pacemaker, and certainly no implanted defibrillator. No heart valve replacement or bypass surgery.”  You can bet no  Dr. Spock is cooing this lullaby over his patient’s  living will.

 If there’s a gerontology Dr. Spock-in-waiting at my birthplace, Yale/New Haven Hospital, reading this article, maybe s/he’d like to join me in writing
A Hitchiker’s Guide for the Aged for all of us,  hitch-hikers on a one-way highway.

 Actually, I’d rather create an entire  curriculum for old age. Like college.  You pass the courses and then you, ah, you ---- graduate.


ronricho has left a new comment on your post "* Dr. Spock for the Aged":

Do not go gentle into that good night.
Old age should burn and rave at close of day. Rage, rage against the dying of the light.

Posted by ronricho to The Anti-Yale at February 3, 2015 at 8:17 PM

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