Tuesday, June 8, 2010

Day 199 - The Only Good Thing about Doctoring

           Nelson is alternately afraid of, happy with, or mad as hell at the people who provide his care on a daily basis. He seems consistently pleased only with Anne, even though she most consistently gets him involved in stuff he doesn’t want to do. Anne likes to arrange outings and adventures to keep Nelson engaged. She wants to keep him active and interested in the world around him. He hates these outings—or pretends to. Sometimes it’s hard to tell.
There is almost always an argument about whether or not he will go on one of these jaunts. Nelson protests that he doesn’t feel well, and the rest of us should just go without him. Anne tells him that we are not leaving him home alone. Then he gets mad about that. I think his real frustration is that the rest of us can’t have a good time without having to drag him along. There is some nobility, I think, in his feeling that way, but it still means we have to play out this big scene before we go anywhere, even if it’s just out to lunch. The curious thing is that as soon as we actually get him into the car and committed to the outing, he starts enjoying himself. For all the grief he gives her, Nelson loves Anne with all the capacity he can muster. He should.
The rest of his care team is a different matter. He thinks the daily caregiver is stealing from him—well not so much that she is, but that she would if we don’t make a concerted effort to nail everything down and lock everything up. He can’t stand the physical therapist, Ben, who comes twice a week to make him walk up and down the street.
Nelson thinks that Ben works him too hard, and yet he seems actually to be getting stronger and more sure-footed as a result of the work. Nelson hasn’t noticed this part however, or if he has, he has attributed it to a natural return to his former vigorous self rather than the result of a slow and laborious rehabilitation.
There is also an occupational therapist that comes once a week. Nelson likes her because she is cute and vivacious and they seem to have a lot of fun together. That is Nelson tells her stories of growing up in rural Kentucky and building radar and communications installations in the South Pacific during World War II, and she listens and asks questions. Then they play ball. She bounces a soft rubber ball at him and he catches it. The purpose of this exercise is to improve his eye-hand coordination and his balance. Apparently this is a lot more fun than walking with Bill.
In spite of Nelson’s obvious preference for the occupational therapist, however, he spends the two days before her arrival worrying about the visit, hoping that she will cancel, trying to get Anne or my wife to call and change the appointment, and generally telling anyone who will listen that he just isn’t up to any more of this therapy nonsense and why won’t we just let him sit in his chair and watch TV in peace.
          In addition to the two therapists, Nelson gets a weekly visit from at least one nurse. The one who usually comes functions as a kind of case manager, and her job is to monitor all the aspects of his care and his health and report back to the doctors anything that seems to require attention. She also draws blood once a week, which is sent off to the lab to determine whether they need to adjust his medications, especially his Coumadin. Nelson likes the nurse because she is attractive and friendly and spends a lot of time with him listening to his complaints as well as his stories. But, like with the occupational therapist, he spends an inordinate amount of time dreading the nurse’s visit even though he seems to enjoy it quite a lot when she is here. He told me that she reminds him of one of his daughters. He means by this not that she is particularly like one of the four girls he raised, but that she could easily be a fifth. She fits into his world that well. He just can’t stand the thought of her coming over until she gets here.
          I get Nelson. I empathize. He may be a pain in the ass to deal with, but from Nelson’s perspective so are we. I see myself in mirrored in his attitude. I feel Nelson’s flinty disposition crystallizing in my soul. I’m 61. Nelson is 89. Any way you cut it my life is more than half over. You can argue half-full/half-empty if you want. It won’t make any difference to me. Once you get beyond the halfway point, both ways of stating the case are equally unattractive. My life is either way over half finished, or way less than half of it is left. And I’m not ambling into old age amiably either. I’m in freefall, and picking up speed. My cup of infirmities is filling up. It seems over half full already, and I don’t have enough cup left to be comfortable with the pace.
          I’m already unhappy about the things I have to do that I just plain don’t want to do because I don’t feel like it. My feet hurt. My knees hurt. My hips hurt. My back hurts. I know I’m not going to feel better about being dragged out and forced to maintain a semblance of sociability. I may feel better about myself. I may even have fun, but when I get back I’m going to feel worse than I did before I left.
This is where Nelson is. He would be happy to sit in a chair until we get back from our little adventures, and then to continue to sit in his chair while we tell him all about it. That way he’d get all the social interaction without any of the physical discomfort. He’s already got enough memories. He doesn’t need to exert himself to make any more. It would be pointless. His memory is fading. Why tax it with new stuff…especially since it’s the old stuff that makes him feel good. It’s pretty much only the old memories that interest him.
          One of my favorite things to tell people is that, as we age, memory is the first thing to go. After they digest this, I tell them that actually it’s not, but it is the first thing that we can talk about. This always gets a knowing look. I think it’s very funny, but it is only funny because it is alarming. No one wants to know that the first thing to go is the thing you can’t talk about. But no one wants to talk about that either. I did manage to have a conversation about it with Nelson though. I guess he’d already complained about so much other stuff he didn’t think much about crossing the line to the stuff I’d rather not have been talking about.
          At the time Nelson’s list of maladies had not started to expand exponentially. He was not then troubled with Parkinson’s or heart trouble. He was taking Flomax for an enlarged prostate, and he had just had a lens replacement for cataracts. He was already fairly peevish about his treatment at the hands of his doctors though.
He was convinced that the ophthalmologist was bent on punishing him for some slight—this because Nelson had complained about the time and trouble the cataract surgery had involved. The time and trouble as it turned out was because of the Flomax, which for some reason increases the difficulty and potential for complications in eye surgery. Nelson hadn’t known this. How could he? Because he didn’t know, he didn’t tell the ophthalmologist he was taking the drug. The doctor may not have known to ask at the time. The risk was a new thing then. Now it is well known, and my own ophthalmologist asked me right away if I was taking Flomax when we scheduled my cataract surgery.
I was riding somewhere with Nelson one day. I don’t remember where, and to be honest I’m not sure that I was riding and not driving either. Nelson was busy grousing about the eye doctor. When he had exhausted that topic he started in on the Urologist who had prescribed the Flomax. He didn’t like that doctor either, and not because of the trouble the Flomax had caused during the eye surgery. No, Nelson was upset that one of the possible side effects of some other medicine the Urologist wanted to put him on was that he might develop breasts.
“What the hell do I need with breasts at my age?” he asked me.
“Not much, I expect.” I was trying to be agreeable. I wondered what he might need with breasts at any age, but I didn't say anything. It occurred to me later that Nelson may have been making a joke, but if that was the case he promptly forgot what was funny about it.
“Exactly,” Nelson said. “So I'm not taking it. If I did, next thing they’d have to give me would be another pill for that for the breast thing. I’ll be all day taking pills to fix stuff that other pills caused. There won’t be any time left over for anything else. You all might just as well put me in the ground then.”
“Nobody wants that,” I said.
Nelson looked over at me like he wanted to be sure I meant that. “Better do it anyway,” he said. “Otherwise the doctors are going to wind up with everything. I’ve had it up to here with all this damn doctorin’.”
“I can see how you might feel that way.”
“Those doctors got a pill for everything,” he said, “and everything they give me makes something else go wrong, and then they want to give me another damn pill for that. I think they’re all getting kick-backs from the drug companies.”
“Could be,” I said, “but what makes you think that?”
“Cause they’ve always got free samples to give away to get you started.”
He gave me another one of those looks. I couldn’t imagine where he was going with this.
“You remember when all my daughters and all you sons-in-law threw that wonderful dinner for our 50th anniversary?” he asked.
“I do remember that, and you’re right, it was wonderful.”
“Well I was talking to my doctor just before that, the one who stitched up my thumb when I almost cut it off on the table saw.”
“Uh huh?”
“He asked me if I wanted to try some of that Viagra.”
Nelson paused here, I guess to let the impact of that set in. He would have been 78 or 79 at the time he was talking about. I wasn’t about to say anything at this point to break the flow of his story.
“I asked him didn’t he think I was too old for that kind of thing. He said he wouldn’t know about that, but if I was interested he had some free samples he could give me.”
“So you got some?” I asked.
“I did. I never got any more, but I have to tell you, it’s the only time I ever got medicine from a doctor that worked like it was supposed to without screwing up something else.”
“I’ll be damned,” was about all I could think of to say.
He gave me one more look. “Don’t you tell a soul I told you that,” he said.

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