Friday, December 5, 2025
63 BC Roman consul Cicero delivers the last of his famous Catiline Orations before the Senate on the fate of the Cataline conspirators
1955 Historic bus boycott begins in Montgomery, Alabama by Rosa Parks and other civil rights activists
1967 Pediatrician Benjamin Spock and poet Allen Ginsberg were arrested in New York while protesting against the Vietnam War
In bed at 9:35, up at 5:30. 14°, wind chill -2°, high 27°, windy morning, cloudy day.
Meds, etc. Morning meds at 9:30 a.m. I applied the 20% urea exfoliant/moisturizer to my left leg last night. This morning, it's very bumpy, which I assume is from dead or dying skin cells exfoliating. Dr. Khalid made quite a point of using the 20% urea cream, but I'm sill a bit confused about it, specifically about how to deal with the exfoliated skin cells without opening up new vectors for bacterial infection. I'm semi-paranoid about re-infection, redevelopment of cellulitis, and re-admission to the hospital.
I'm also wondering this morning about my irregular, slow heart rate, and whether that is what accounts for my chronic fatigue and dizziness/balance problems. The nurses at the VA have been picking up the low rates on the last few visits, rates of 31, 32, or 33, compared to the normal average of 67 to 74, or so. My home readings last week:
11/25 13:00 150/63/31
11/27 11:19 172/85/31
11:21 171/65/63
11:32 168/68/32
11/28. 14:38. 144/68/63
14:47. 143/70/33
14:54. 144/60/33
11/29. 12:27. 148/75/70
1::34. 151/63/69
2:44. 161/73/:67
12:53. 156/69/64
11/30. 11:45. 152/76/63
11:52. 158/75/62
12:00. 169/81/63
12/1. 11:42. 202/82/62
11:50. 200/84/62
12:00. 184/92/61
12:10. 192/94/62
Kali Kisro declined to change my blood pressure meds because of concerns about potential cardiac side effects. She has referred me to the Cardiac Clinic, but I haven't heard from them yet. Congestive heart failure? Premature ventricular contractions? Other stuff? I won't be surprised.
In my Harold and Maude/Thanatos current life, I was kind of glad to learn that I have some heart problems, since my primary concern has become living long into total decrepitude, debilitation, and dependency, coupled with chronic pain. A heart attack, cardiac arrest, or cardiac failure all seem preferable to a painful terminal cancer or one of many dementias, or life in a nursing home wearing a diaper and being bathed by someone who, perhaps, loathes me. I would never say this to Micaela or to any of his children, but I've often thought how lucky Tom St.John was to die when, and where, and how he did: snorkeling with his wife and son in the Caribbean at age 79 of cardiac arrest. There are so many worse ways to go. Of course, I know that the only sure way to avoid a terrible death is to take charge of your own death. That is an option that seems easy enough for a person who would leave no loved survivors, but not so easy for one who would hurt innocent others by his suicide. I think of how Earnest Hemingway did himself in with his wife Mary upstairs. I often think of Zeke Emanuel's article in the October 2014 issue of The Atlantic, "Why I Hope to Die at 75." It's an arrogant, presumptuous essay, but not dishonest. He gives almost no value to life after 75, even though many people find their life after 75 to be great and very much worth living. But Zeke is a physician and he knows more than most of us about the ravages of old age. Excerpts:
[H]ere 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.
I am talking about how long I want to live and the kind and amount of health care I will consent to after 75. Americans seem to be obsessed with exercising, doing mental puzzles, consuming various juice and protein concoctions, sticking to strict diets, and popping vitamins and supplements, all in a valiant effort to cheat death and prolong life as long as possible. This has become so pervasive that it now defines a cultural type: what I call the American immortal.
But as life has gotten longer, has it gotten healthier? Is 70 the new 50? Not quite. It is true that compared with their counterparts 50 years ago, seniors today are less disabled and more mobile. But over recent decades, increases in longevity seem to have been accompanied by increases in disability—not decreases. . . [A]s people age, there is a progressive erosion of physical functioning. . . . . [O]ver the past 50 years, health care hasn’t slowed the aging process so much as it has slowed the dying process.
[T]he contemporary dying process has been elongated. Death usually results from the complications of chronic illness—heart disease, cancer, emphysema, stroke, Alzheimer’s, diabetes. . .
So American immortals may live longer than their parents, but they are likely to be more incapacitated. Does that sound very desirable? Not to me.
[O]ne in three Americans 85 and older has Alzheimer’s. And the prospect of that changing in the next few decades is not good.
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 …
Once I have lived to 75, my approach to my health care will completely change. I won’t actively end my life. But I won’t try to prolong it, either. Today, when the doctor recommends a test or treatment, especially one that will extend our lives, it becomes incumbent upon us to give a good reason why we don’t want it. The momentum of medicine and family means we will almost invariably get it.
My attitude flips this default on its head. I take guidance from what Sir William Osler wrote in his classic turn-of-the-century medical textbook, The Principles and Practice of Medicine: “Pneumonia may well be called the friend of the aged. Taken off by it in an acute, short, not often painful illness, the old man escapes those ‘cold gradations of decay’ so distressing to himself and to his friends.”
My Osler-inspired philosophy is this: 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.
Ay, there's the rub.
To die, to sleep— No more; and by a sleep to say we end
The heart-ache and the thousand natural shocks
That flesh is heir to: ’tis a consummation
Devoutly to be wished.
To sleep, perchance to dream: ay, there’s the rub!
Hamlet, Act III, scene 1.
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. No screening for prostate cancer at any age. (When a urologist gave me a PSA test even after I said I wasn’t interested and called me with the results, I hung up before he could tell me. He ordered the test for himself, I told him, not for me.) After 75, if I develop cancer, I will refuse treatment. Similarly, no cardiac stress test. No pacemaker and certainly no implantable defibrillator. No heart-valve replacement or bypass surgery. If I develop emphysema or some similar disease that involves frequent exacerbations that would, normally, land me in the hospital, I will accept treatment to ameliorate the discomfort caused by the feeling of suffocation, but will refuse to be hauled off.
What about simple stuff? Flu shots are out. Certainly if there were to be a flu pandemic, a younger person who has yet to live a complete life ought to get the vaccine or any antiviral drugs. A big challenge is antibiotics for pneumonia or skin and urinary infections. Antibiotics are cheap and largely effective in curing infections. It is really hard for us to say no. Indeed, even people who are sure they don’t want life-extending treatments find it hard to refuse antibiotics. But, as Osler reminds us, unlike the decays associated with chronic conditions, death from these infections is quick and relatively painless. So, no to antibiotics.
Obviously, a do-not-resuscitate order and a complete advance directive indicating no ventilators, dialysis, surgery, antibiotics, or any other medication—nothing except palliative care even if I am conscious but not mentally competent—have been written and recorded. In short, no life-sustaining interventions. I will die when whatever comes first takes me.
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I have lived almost 10 years past age 75. I live with daily fear of falling. I have a hard time getting up from a chair. My eyesight, hearing, and perhaps my sense of taste are failing. This afternoon, I made a loaf of banana bread from scratch, i.e., with mashed ripe bananas, flour, brown sugar, eggs, sour cream, melted butter, baking soda, vanilla, and cinnamon. The recipe doesn't take long, but I had to pause midway through the preparation of the batter to bring my rollator into the kitchen so I could sit on it while mixing the ingredients. I can't stand for 10 or15 minutes ; severe arthritis L4-L5, L5-S1. Getting dressed in the morning is a project. If I don't shower, first I gently rub my lower left leg to remove exfoliated skin cells caused by my lymphedema, then I apply the 20% urea to cause more exfoliation, then Eurcerin moisturizer, then Vaseline to protect against bacterial invasion of tiny skin openings, then I wrap gauze bandaging around the Vaselined lower leg, then I don a knee length compression sock, then a compression foot device, and finally a velcro leg wrap. I have 'trigger fingers' on both hands, and have taken to wearing 'arthritis gloves' when I sleep. I inject myself with a very expensive immunosuppressant drug every two weeks to control my polymyalgia rheumatica and another expensive injection every Friday for my diabetes.
My medical history reflected on my VA record includes Cervical radiculopathy , Trigger finger, Polymyalgia rheumatica, Chronic pain, shoulder pain, Pain ofSCT 133261000119105), Pelvic bilateral hands, Exposure to potentially hazardous substance (and perineal pain, Low back pain, Grief, Diabetic macular edema of left eye, Mild nonproliferative retinopathy of left eye due to diabetes mellitus type 2, Tinea corporis, Benign paroxysmal positional vertigo, Psoriasis, Neurocognitive Disorder (SCT 709073001), Mild cognitive impairment, Chest pain, Lipoma, Cellulitis of forearm, Memory impairment, Depression, Chronic post-traumatic stress disorder, Osteoarthritis of hip, Unsteady gait (SNOMED CT 22631008), Diabetes mellitus, Benign hypertension, Hyperlipidemia, Gout, Gastroesophageal reflux disease, Barrett's esophagus, Diabetic retinopathy, Age related macular degeneration, Arthritis, Benign localized hyperplasia of prostate, Chronic primary bladder pain syndrome (SNOMED CT 38731000087104), Interstitial lung disease, and Genitocrural intertrigo. I don't know where some of these listings come from, including the PTSD, but most of them I recognize readily. They are the reason that every morning I take 16 pills and capsules. I am a walking exemplar of Emanuel's "American Immortal." Shame on me????
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