Wednesday, February 27, 2013

A Talk With My Doctor

-- by Tom Phillips

My doctor was mad at me, I could tell, when I called him last summer.  He could hardly remember who I was, because I hadn’t been in to see him in two and a half years.  What have you been doing, seeing some other doctor?   No, I said, I just haven’t been sick.   That was no excuse.  You’re over seventy years old now, he said, calculating from my chart.  You should be practicing preventive medicine!    

In my opinion, I was practicing preventive medicine.   I exercise daily, eat healthy foods, don’t smoke and drink only in moderation.  Every morning I take a low-dose aspirin to guard against heart attacks.  And I stay informed about medical issues.   The more I read, the more wary I was about his version of “preventive medicine’:  that is, vaccinations against commonplace diseases like flu and shingles, and periodic tests looking for early signs of cancer.   The worst shocker was the news that the PSA test for prostate cancer, which he had administered without asking me if I wanted it, was far more likely to lead to unnecessary, harmful treatment than to save me from death by prostate cancer. 

Still, this was “my” doctor, and as far as I could tell he was competent and professional.  I didn’t want to break ties with him, because some day I will need a doctor, and I didn’t want to go through the trouble and uncertainty of searching for another.   So I decided to follow the advice of countless counselors, and “talk to my doctor.”  I worried a lot about it, fearful that he would refuse to listen to a layman’s opinion on medical issues, and dismiss me as a patient for putting my wisdom above his. I made an appointment, without citing any specific reason.   Just in case, I brought along an article by a professor of medicine, one of a number of doctors who are now warning against excessive testing and screening. 

As soon as my doctor entered the examining room, he started checking my body and its vital signs, until I interrupted and asked, “Can we talk?”  To my surprise, he seemed amenable.  He put down his stethoscope and listened to my spiel, the burden of which was that I was more worried about the risks of “preventive medicine” than I was attracted to its benefits.  He made no objection to any of my arguments, saying he could only suggest courses of action, and it was up to me to decide.  He did say he’d like to see me more than once every few years, to keep a record of my bodily functions as a baseline.   

He agreed to drop the PSA test, but recommended a colonoscopy, as I hadn’t had one for several years.   I said I was agonizing over it, after reading about studies that cast doubt on the effectiveness of this nasty, risky procedure, especially among the elderly.  He didn’t press it.  He offered shots for flu and shingles, which I declined.  No argument.  He then proceeded to take my blood pressure, perform an EKG and take blood to be tested for cholesterol, etc.  After this he shook my hand, and for the first time ever, called me by my first name.   

When I called a week later, he said I was in excellent health, and I should just “keep doing what I was doing.”  I made a mental note to see him every January, to keep in touch.   

I don’t know about your doctor, but mine turns out to be OK, just a little harried and hurried most of the time.   He worries about his mostly elderly patients, afraid they’ll hang back and avoid treatment until it’s too late.  I told him not to worry, if I think something’s really wrong, I won’t be shy about coming in.   

So we have a deal, mutual respect.  All I had to do was demand it.  Doctors can suggest, but it’s up to the patient to decide.   I’ll keep that in mind when it comes down to the end game. 

Copyright 2013 by Tom Phillips








Monday, February 18, 2013

A New Way to Walk

-- by Tom Phillips

I got a new way to walk!   I made it up myself, incorporating tips from Pilates and various types of dance.  It’s fast, efficient, and easy on the joints.  Of course, the online world is already well stocked with tips on how best to carry on this simplest of human exercises, so much of what I suggest may be familiar.  But I checked, and nobody else puts it together quite this way.  So here it is, my new way to walk:  

Lift your gut, drop the tailbone, and soften your knees.  Tilt slightly forward, and glide.   

To expand: 
Lifting the gut doesn’t have to be strenuous, just enough to get some weight off the hips.  The more weight you can carry upstairs, the less pressure on the lower joints. 

Dropping the tailbone means bringing the upper body into a vertical line, in preparation for moving.   Softening the knees is not really bending them, just not locking them.   A locked joint is a poor shock absorber.  

How to start moving?  Rather than use muscle, just tip the whole body slightly forward, leading with the sternum, and one foot will glide out to prevent a fall.  Want to go faster?  Pull the gut up higher and lean more forward. Don’t lengthen your stride in front, just push a little harder off the back foot.  Swing your arms gently in opposition.   When you really get going you can speed up by extending your arms in front, with a soft punching motion, out and in. 

Don’t walk with both hands in your pockets!  I did this last year, tripped over something and landed on my chin.  Eight stitches.  Try my new line of walking gloves, keep hands warm while swinging them in opposition!   Just kidding, this is not a commercial scheme, just an old man hoping to share his latest self-discovery.   

I always disliked walking as an exercise until I discovered this technique.  Now it’s a pleasure.  Walking briskly like this gets the heart rate up and keeps it there for as long as you want, but doesn’t make you pant or sweat.   

Try it, you might like it.  Lift the gut, drop the tailbone, soften the knees.  Tilt slightly forward, and glide.  As Miss Piggy sang, I got a new way to walk, and my new walk suits me fine! 

-- Copyright 2013 by Tom Phillips






The Road to Dotage: Mile #2

Down the Shore
By Tom Phillips

The road to dotage turns out to be strewn with rocks and boulders. Why should it be different from any other phase of life? Last June, I was in a “continuum of wonder, free from anxiety or regret” to quote my last blog. But after a month of summer vacation, I returned to find my house infested with a widely dreaded type of bug, and my mind infected with anxiety, regret, anger, bitterness and despair. After weeks of nearly constant interaction with children, grandchildren, friends and strangers, almost all of them younger, I perceived myself as decrepit, discounted, rejected, ignored, used, used up, useless. Don’t get me wrong. I had fun, I relaxed (see photo) it was good to see everyone. Still, I couldn’t help but feel the erosion of my place in the world.

The Road to Dotage: Mile #1

"Paca" with Grandson Reed
What a pleasure it is to run into one’s self in an unlikely place.  Not long ago I was browsing in the Northshire bookstore in Manchester, Vermont, filling time while my wife looked for a gift.   In the psychology section of the second-hand book nook, a title jumped out at me: “The Delights of Growing Old,”[1] with a cover drawing of a rakish Parisian gentleman, nattily attired and puffing a cigarette.   His name was Maurice Goudeket;  I’d never heard of him, but within a day he became something like an alter ego.    

Like Goudeket, I am in my early 70s, a writer and journalist, finally released from the need to seek gainful employment; comfortably retired, healthy, and happily married.   He was a Parisian and I’m a New Yorker, but we live the same way:     

“ ‘I have nothing to do today.’  This is a remark that no longer has any sort of meaning for me.  For if it should so chance that I am freed for a while from those everyday duties that by their very monotony give a feeling of emptiness, then so many activities open before me that my only difficulty is in choosing between them.   With these few free hours of mine in view, thousands of writers have written thousands of books on every conceivable subject, and hosts of artists in every age and country have brought into being a great body of work that museums have gathered together for my personal benefit..   

I get up before anyone else in my household, not because sleep has deserted me in my advancing years, but because an intense eagerness to live draws me from my bed…

Every morning my coffee has a fresh taste, and this comes as much from me as it does from the pot.  There is the paper too, which will put me in touch with the entire world; and any paper, properly read, has an almost incredible amount of astonishing, moving, ludicrous items in it…  

Eventually I emerge into the street, and of all wonders, the street is the most wonderful…  Always there are faces, a sea of faces, with everything they conceal and everything they give away …  

This indeed is what they call growing old, also known as a person’s dotage.  But as an Irish landlady once confessed to me, “I like my dotage.”   On a really good morning, it is a continuum of wonder, free from anxiety or regret.     

Getting there is not guaranteed, and many people never make it.   Some die too soon, and many are broken by ill health, poverty or a lifetime of conflict.   And for those who do get there, it is not a painless process:  to gain this new life, you have to lose the old. 

For Goudeket, the delights of growing old arrived only after years of depression and struggle.  He was 65 when he lost his first wife, the novelist Colette, and he thought his life was over.   Colette was 16 years older than Goudeket and much more famous, but as he tells it, they worked and lived together for 30 years in a state of mutual adoration.    

After a period of numbness in deep mourning, he set out to make the rest of his life a memorial to their partnership – editing her posthumous publications, and dwelling in a landscape of memorabilia. 
He stayed on in their Paris apartment, looked after by the same servant, with not a stick of furniture moved.  Mentally, he tried to preserve the thoughts and feelings of his 30 years with Colette -- envisioning the rest of his life as “a long and soothing meditation on the past.”   But somehow the past began to fade.  A crack appeared in the wallpaper.  Even the fixed memories began to appear in different lights.  Re-reading Colette’s work, he found himself looking at different aspects – noticing the style more than the contents.  His feelings also did not go according to plan.  Instead of soothing nostalgia, he found his memories brought him joy and excitement.   Meanwhile his body began to rebel:   

I was seized with ungovernable fits of impatience, a kind of muscular revolt, which obliged me to stay out until dawn:  I thought all this was caused by my unhappiness, but in fact it was nothing of the kind.  Night after night I came home at four in the morning and got up again at eight, as fresh and lively as though I had not committed any excesses at all.  I tried to damp down the blaze that was filling me to the gentle glow that my chosen life required, but I tried in vain.  I was having an attack of energy, as some people have an attack of listlessness.  

Long story short:  he married again, to the young widow of a friend, and in his 70s was father to his first-ever child, a boy.  

My own road to dotage was not as glamorous, but also begins with a loss, followed by dashed expectations, and attacks of energy.   

Twenty years ago, reading the business section of the paper every day, I noticed an ominous trend.  Somehow at or around the age of 58, great movers and shakers were being brusquely removed from their prominent posts in the world.  They always vowed to “pursue other opportunities.”   None was ever heard from again.  Sure enough, when I arrived at 58 (also the age at which my own father had died) I was dismissed from my long-time post as a writer of the CBS Evening News, and sent off to pursue those elusive opportunities.   

Determined to be the exception, I scrambled to put together a second act.  I hauled out my skills as a free-lance writer, a teacher, a musician, even an actor, dreaming of re-inventing myself and confounding those who had devalued me, not that they would notice or care.  The results were piddling.  In my best year, I replaced about one-fifth of the income from my former job, and less than that of my self-esteem.   I had no idea how much my perception of myself had depended on my career, but there it was.    

My wife went to work full-time.  I stayed home to cook and clean, and confront my own inadequacies as a father.  The flip detachment I had cultivated as a prosperous head of the household didn’t work at all when I became the stay-at-home dad to three teenage daughters.  I learned a long-overdue lesson – to help someone through their trials, you have to be willing to do more than observe and kibitz.  You need to participate, and feel some pain yourself.   It took years.   

My prevailing mood was depression, complicated by unruly bursts of energy that kept me awake half the night, jumping out of my skin.    Like Goudeket, I took this as a sign of my unhappiness, but in fact it was nothing of the kind.  I was having an attack of energy, but I didn’t know what to do with it.   I poured my energy into my various comeback schemes, all of which ended in disappointment and renewed depression.   

Still, I made a promise to myself:  that at 70 it would be over.  For various socially conditioned reasons I felt it necessary to spend my allotment of threescore years and ten  in striving after worldly glory.  But after that, no one including myself would criticize me for giving it up.    

So sometime around my 70th birthday, I released myself from ambition and the need to compete.   I had no idea what the results would be.   I spent the first few weeks in reflections on my own decrepitude, the ghastly realization that with every passing week, the possibility of turning back became more unlikely, more ridiculous.   

And thus I allowed my dotage to begin.  Amidst what I had come to think of as the wreckage of my life, I began to experience what Maurice Goudeket called “la douceur de vieillir”..   this continual surge of memories that comes breaking in on my inner silence, this contained and sober joy, this lighthearted music that bears me up, this wider window on the world, this spreading kindly feeling and this gentleness….”   

M. Goudeket’s account of his dotage, like the account of his marriage, is obviously idealized.   He and I have our bad days along with our good, like everyone else.  And I’m still a beginner at this, barely six months into my seventies.  But the state he describes is real, and it is happening.   

For me the delights of old age flow directly from the renunciation of everything we sought before.   Having exhausted our (and the world’s) attempts to define, discover, invent or re-invent ourselves, we at last have the freedom to let life show us who we are and where we’re going.  

Dotage is a time of radical discovery – but not because we have become so wise that we can “know” ourselves.  Such knowledge is impossible!  We are too deep, complex and contradictory, too subject to accidents and chance.   What will happen to us tomorrow is as unknown and unknowable as what will happen after we die.  But in this flux of incertitude we are free to discover whatever we want, about ourselves and the world -- pleasant and unpleasant, shocking and soothing.    

It’s not that we have nothing to do.   Dotage comes with duties:  to love, to forgive, to wonder, and prepare for our death.   We like to think of old age as a settled time of reflection, but in fact our lives are more fragile and volatile than ever, more subject to sudden change or sudden end.   Even now I feel things happening to me this week that I don’t understand, new patterns of sleeplessness and agitation.  Is this male menopause?  A fatal disease?   Or just another divine inspiration, a fit of madness that will push me to go places and do things I never imagined?   Only if it’s the last of these will I blog about it.  

Copyright 2012 by Tom Phillips  

1.  The Delights of Growing Old  (La Douceur de Vieillir)
Maurice Goudeket  (translated by Patrick O’Brian)
Flammarion, 1965