Wednesday, May 25, 2011

On Aging Parents

Mother and Child
Artist Unknown

As some of my readers know, I'm an only child. While I can honestly say that up until now, it's been a picnic being an only, the new realities of being an only child whose aging parents have health concerns have been something of a challenge. Last week I was worried about my dad's health (he's in Seattle most of the time) yet I was forced to choose between visiting him in early June and being here in Miami to keep an eye on my mom, who's having hand surgery, and whose current doctor I feel I have to stay well on top of, because of his prevailing attitude that if you're 72 and still alive at all, clearly you're fine! (Translation: get out of my office! Next patient!) The reality, sadly, is that she really isn't so fine right now. She has lost more than 20 pounds in the past 8 months and let me tell you it was 20 pounds she definitely could not afford to lose. I felt just great having to choose between staying to take care of my mom and going to visit my dad, who's had some serious stuff going on in the past year. I'm so fortunate that my wonderful stepmother is healthy herself, and willing to deal with a sometimes rather obstinate husband and his resistance to the whole healthcare scene, since my father's health has been dicey. I'm equally fortunate that, like me, my stepmother is clearly not going to take the attitude that if you're breathing, you're doing just fine. Because these days, if you're old, let's just say in my experience you have to be ready to fight the good fight.

I still remember that moment, about 7 years ago when I realized my mother had really lost height. She's Irish and from a family rife with autoimmune and osteoporosis issues. But it's a shock when you have that moment of realizing that this person who used to be your height, or going way further back in your mind, who was so big, comforting and warm, is now smaller and frailer than you ever thought possible. And it's even more of a shock when you're trying to get that person decent healthcare, even when you're fortunate enough to be able to do private pay, to find that most general practitioners do not want to take geriatric patients.

After shifting to Medicare, at age 70 my mom was dropped by her GP, who told her to go elsewhere. Given the retirement haven that Florida has typically been, you'd think that there would be a lot of geriatricians down here. I guess there are. But I've called quite a few and they aren't taking new patients. Mom called 13 physicians before finding one who was taking on new patients. I currently find only 78 listed in the the Miami (pop. 2.5M) geographic area HealthGrades listing. That includes her present doctor, who was quite content to have her just "put up with" this painful synovial cyst on the middle finger of her left (writing) hand, which keeps getting larger (the joint keeps trying to stay lubricated!) and more traumatized by her  every day activities from gardening to writing checks to dressing to cooking. 

In frustration, my mother recently admitted she had tried to drain it herself with a sterilized sewing needle and pressure. She was unsuccessful, and lucky it didn't get infected. When I took her to a hand surgeon about two weeks ago, he was scandalized both that it was so large and that she'd tried to drain it herself in frustration because her doctor hadn't referred her timely. He said she was lucky not to have infected the joint with her improvised drainage attempt, because she could have potentially lost the finger. We had cold-called the hand surgeon, without a referral, by the way. Unfortunately, the joint is totally shot, no cartilage left, and rubbing bone on bone. Because of the extent of the damage, the whole joint will have to be resurfaced and the finger will be splinted for at least 3-4 weeks and then she may have to have some physical therapy. Mind you, my mother used to play a concert grand piano that still sits, growing dusty, in her living room. Chopin, Scriabin, Brahms. She played well but has had so much pain in her hands in recent years due to some of her autoimmune issues that she gave up playing. One of my mother's few pleasures in life at this point is her garden, some photos of which have been shown on this same blog. She is, as I said, left handed and so she's really had a lot of pain when she works in the garden. But it's one of the only things that makes her happy so she wouldn't give it up even though it hurts. You can see a little laceration on that cyst/tumor. That was a gardening injury. The hand surgeon told her to cut out the garden stuff until she had it off. So that's only two months in the hottest part of the year when she shouldn't tend her garden. Yeah, I'm sure that's not going to happen. Maybe when it's splinted she won't garden. I hope.

Because they will have to sedate her for the surgery, she had to go for preoperative testing, which was, of course, to be ordered by her regular physician. This appalling doctor, who was steadfastly refusing to even listen to my concerns that she had lost 23 pounds since August and now weighed only 113 lbs at a height of 5' 3", said doing surgery on her finger was a waste and that he could just stick a needle in it and drain it. When I clarified that it was not a regular fluid filled cyst and that it was synovial fluid, which is extremely viscous, and that the joint would have to be resurfaced to help prevent recurrence, he looked at me vacantly (you know, the who the fuck are you look?), obviously surprised I even knew what synovial fluid was. He still ordered the tests since we already had a date for the surgery and hey, it's money in his pocket, right? They can bill Medicare for drawing the blood right in his office. Woohoo, more $$$! Well, I didn't even like how they drew the blood there. Gentle, these people are not. I'm left with this feeling that is oddly like what I feel when I see that I don't like how someone acts with one of my kids when they're sick. Whether it's my youngest child getting sutured, or the oldest being treated too roughly in an ER, it's just that instantaneous "Don't you dare treat them/touch them/ignore them like that!" feeling. That's now the feeling that I have when I see medical people dealing with my mom. It was another one of those moments you remember... the moment when you realize that they really can't do this stuff alone anymore, because it's akin to leaving a baby with wolves.

Now I'm trying to locate a new geriatric physician that she can see asap after her hand surgery. I'm trying different channels to locate someone else on that list of 78 who is competent, has experience with autoimmune disease and who will take her as a new patient. It's kind of pressing because her pre-operative tests elaborated on my concerns about her weight loss. Her blood results are all wonky and even her chest x-ray is a bit of a concern. Does she have pernicious anemia? Some other blood or bone marrow disorder? Why are her RBCs too large and is her hemoglobin in her RBCs too low? And what is up with those kidney values? Is she, ironically since she didn't smoke, still developing emphysema after all the years of secondhand smoke exposure from her parents or is it chronic obstructive pulmonary disorder (COPD) from years of unprotected respiratory exposure to vermiculite and perlite and mulches in the garden? After having no interest in the emphysematous bullae in both her lungs, (hey, she isn't blue, right?) the practice partner of her present doctor at least was willing to agree that her weight loss was a concern and that the fact that 8 of 24 values on her CBC/SMAC 14 were abnormal is um, yeah, a little worrisome. But hey! She looks good, he said. How old was she, again? he asked. Only 72, I said. Oh, she's fine. She just has to eat more! As the Cynical Nymph would say in emoticons, that earned him the e_e look, and then I got him to take things a little more seriously after reminding him, in my charmingly vociferous fashion, that she was not just some old biddy sitting in his waiting room, with no one to notice if he let her incipient health issues worsen, including the nice cyst on her finger that was now making it difficult for her to do many, many everyday things with her left hand including writing checks to pay people like him. He evidently didn't realize she was left handed. Like pain in either hand is something you, you know, just put up with, because you don't really need your hands or anything when you're old.

We hold that life in the womb is so sacred. Children once here, not so much (especially if you consider what we're willing to spend on them to keep them safe and healthy and all the ways in which we fail at that). And the elderly? After all the Republican talk of death panels under Obamacare, what I can tell you is this- in my conservative state, going to these doctors with my conservative mother, I have been left with the distinct impression that my mother, and elderly people in general, are in everybody's way and that the quicker we get these damn old people gone, the better. After all, they are just weighing down our country, what with all the issues of Medicare and Social Security. They are the unwanted burden. They're getting all these discounts and aren't really paying much in the way of taxes. What good are they? Let's get some new young tax-payers, I mean fetuses, I mean young people. Let's protect them until they're here and then cut 'em loose and hope they grow up to be docile little capitalists.

Well, I may not always get along with my mom. She may listen to Glenn Beck and Brit Hume and Bill O'Reilly and think I'm 'left of Lenin' and at various times have driven me practically insane. But she still deserves to bend her fingers without pain and know why she's losing weight and what's up with her CBC results and her kidneys and her lungs, ya know? They may think she's the unwanted burden but they will be very wrong in trying to treat her that way. She's my mom and I know she deserves better. She going to be getting it, too.

Next Up:

After the long delay due to the above and many, many other things, we will finally have TL's GMO posts up shortly. I'll also be looking at the issue from several angles- hunger, drought, global warming. GMOs seem scary from the angle of monopolies, but if we remove the business angle, we can assure you that GMOs are here to stay. In fact, they may be your best hope for the future. There's the science of GMOs and then the rhetoric and the financial monopoly aspect of GMOs. Thelma-Lee's post will set you straight on the basic science. You'll be better informed by far for having read them...

Corn image by Achim Raschka.

© Bright Nepenthe, 2011

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