5/28/23

 Sunday, May 28, 2023

In bed at an unnoted time after falling asleep on the recliner during a strange Olivia Coleman movie set in Ireland, au at 6:07 with nasty back pain, emerging from a misty dream set in Washington with a group associated with Rastafarian music.  49℉, high of 67℉, wind N at 4 mph, 1 to 7 mph and gusts up to 12 mph.  The sun rose at 5:16 and will set at 8:21, 15+4.

Double Dip at my age?  I started my day thinking of the upcoming 'double dip' colonoscopy & upper GI endoscopy on 6/1, wondering if this is a good idea for a guy in his 80s.  The internet tells me 85 is the widely-accepted cutoff age. with those 75 to 85 in a gray zone depending on health, history of colon cancer in the family, and history of polyps in past exams.  With my Dad's colon cancer and my history of polyps, I'm a fit candidate.  Do I feel good or bad about this?  

I am reminded of Dr. Ezekiel Emanuel's article in The Atlantic (October 2014) "Why I Hope to Die at 75."  For some reason (why???) I printed a hard copy of the article and saved it in a file folder. 

"Here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic."

 He was 57 and in excellent health when he wrote the article.  

The picture he paints of life for someone my age isn't pretty. 

"Half of people 80 and older [live] with functional limitations. A third of people 85 and older with Alzheimer’s. . .  The good news is that we have made major strides in reducing mortality from strokes. Between 2000 and 2010, the number of deaths from stroke declined by more than 20 percent. The bad news is that many of the roughly 6.8 million Americans who have survived a stroke suffer from paralysis or an inability to speak. And many of the estimated 13 million more Americans who have survived a “silent” stroke suffer from more-subtle brain dysfunction such as aberrations in thought processes, mood regulation, and cognitive functioning. Worse, it is projected that over the next 15 years there will be a 50 percent increase in the number of Americans suffering from stroke-induced disabilities. Unfortunately, the same phenomenon is repeated with many other diseases. . . Aware of our diminishing capacities, we choose ever more restricted activities and projects, to ensure we can fulfill them. Indeed, this constriction happens almost imperceptibly. Over time, and without our conscious choice, we transform our lives. We don’t notice that we are aspiring to and doing less and less. And so we remain content, but the canvas is now tiny. The American immortal, once a vital figure in his or her profession and community, is happy to cultivate avocational interests, to take up bird watching, bicycle riding, pottery, and the like. And then, as walking becomes harder and the pain of arthritis limits the fingers’ mobility, life comes to center around sitting in the den reading or listening to books on tape and doing crossword puzzles. And then …"

Emanuel's personal policy, he says at age 57, is

"At 75 and beyond, I will need a good reason to even visit the doctor and take any medical test or treatment, no matter how routine and painless. And that good reason is not “It will prolong your life.” I will stop getting any regular preventive tests, screenings, or interventions. I will accept only palliative—not curative—treatments if I am suffering pain or other disability.  This means colonoscopies and other cancer-screening tests are out—and before 75. If I were diagnosed with cancer now, at 57, I would probably be treated, unless the prognosis was very poor. But 65 will be my last colonoscopy. . . What about simple stuff? Flu shots are out. . ."

So here am I with my chronic pain in the ass looking forward to the acute pain in the ass that comes with a colonoscopy, or at least the preparatory cleansing it requires.  And an upper GI endoscopy prompted by my GERD and Barrett's Esophagus.  And having recently sought out and obtained my SIXTH covid-19 vaccination.  What am I, nuts???  I'm like the Pushmi-Pullyu in Doctor Doolittle, not wanting to live as I do but medically pushing off death.  Which is it? Wihat's the status of my Living Will and my HCPOA?  I need to get some focus but I'm not prepared to grapple with all this before breakfast and before reading the papers on a sunny Sunday morning of a holiday weekend.  Maybe not ever.

Dinneer With Caela and Saul, B'Thumped.  Lovely.