OLD AND ORNERY

This is written in the spirit of reflection rather than accusation, though it may not come across that way.  After my mother’s death while I waited for her estate to be settled, I asked for a copy of my medical files.  I was working for the City of Portland which had “the best insurance deal in town” according to my doc at the time.  He felt this justified elaborate and expensive testing, but he did not feel any obligation to tell me what was going on -- what results showed.  I had chosen this doc in part because he had experience in his church with a clergy-advising committee.  People who are chosen for this role are considered by others to have a certain amount of wisdom and sophistication. 

In those years (‘92-’99) I was struggling with my knees and beginning to age, plus having a lot of trouble with my stomach hurting.  I attended the many little doc-talks around Portland, where they explained what they did and whether it would be a good idea to schedule time with them.  (Of course, it always was.)  I’d had fiberoptic observation of my whole GI tract from both ends, several tests for diabetes that didn't detect diabetes, meds for high blood pressure that made me cough so much that co-workers complained I might be contagious.  And so on.  NO ONE confronted me with the obvious: depression.  Dying mother, deranged brother, worry about retirement, worry about former husband who was also dying.  Deadend job, at first with a bully for a boss.  Depression was not unjustified.  But I had a strong taboo on “woe is me”.  I just went numb.  

The doc was slow sending my file, I think because he was carefully redacting it in case I were planning a lawsuit.  He had been an outstanding heart surgeon, whose practice shrank to nothing when fiberoptic and stent technology arrived.  Now he was coasting until retirement.  I’d tell him my symptoms, he’d suddenly stand up and leave for ten minutes without explanation, then come back to tell me the diagnosis and write a prescription.  

I gradually realized he was either calling a colleague for advice or checking his textbooks.  I doubt that they had been bought recently.  A new boss at work figured out both my planar fascitis and my bum knee, and advised me what to do.  The doc didn’t know -- he just thought I should get a lot more exercise.  In euphemistic terms, he let it be known that overweight old women are just lazy and eat too much.  Finally, he leapt up and left once too often and for too long, so -- without signing out -- I just went home.

His nurse called to see if I were all right.  She didn’t ask why I left.  He himself never called.  When I got my file, I read it quickly and put it aside.  Later I looked more closely and saw that he had diagnosed “early CHF.”  By this time I was using Google and looked it up.  CHF is Congestive Heart Failure.  He never discussed it with me, except to insist on a treadmill stress test that just about destroyed me, not that he noticed.  I sat in the lobby for an hour until I felt like I could drive home.  This didn’t impress him.

Part of the reason for the leap to Valier, when I really ought to have stayed in Portland another five years until retiring at 65, was thinking about “early CHF.”  Portland was a city in disorder.  At least two cocaine dealers lived in my apartment building, armed hispanic gangs ran through downtown shooting randomly (killed at least one person innocently waiting for the bus), the TV station upstairs from my fav coffee shop was invaded by a shooter, the buses in my part of town were being robbed at gunpoint, and we clericals were all being instructed about what to do when the big earthquake hit and the bridges collapsed. The union was thinking of suing because the air conditioning system was infested with black mold, but no one was doing anything.  My mother’s house was in a neighborhood that had shifted to being ghetto.  Shooting every night.  One of my co-workers had repeated concussions from bike wrecks on the way to work in traffic.  He became convinced that I was accusing him of being a pedophile.  Years earlier I had helped him adopt a little girl.  He brought her panties to work and planted them around the office as a joke.  Maybe he WAS a pedophile, but more likely he just had weird brain damage.

Stress, do you think?  

Lucky for me, when I got to my ramshackle house, my new Valier neighbor Dale and his buddy helped unload my U-Haul.  Things have pretty much stayed where we put them until recently I had to move my 4-drawer file cabinets to the garage because they were making the floor sink.  I did some painting -- the bathroom was gruesome until I just painted everything white, including the spiders -- and replaced only some of the appliances that immediately began to fail.  In the middle of it all, I sat down and wrote.

Fifteen years passed faster than a speeding bullet.  A few years ago an eye doc saw damage from diabetes (now stopped, due to metformin and diet protocols)  The tests had improved enough to detect and monitor it.  No one in Montana has said anything about CHF.  When they use the stethoscope on my chest, I ask and they say,  “Oh, it’s fine.”  No one suggests stress tests.  (Suits me!)  Stomach rarely hurts.  I’ve lost fifty pounds since I came and can now put my socks on while standing up.  

This guy can't stand up to put on ANYTHING.

But recently the docs and techs ask,  “Do you get out of breath?  Do you wheeze?”  They don’t say why they are asking.  When I say (honestly) NO, they don’t seem to believe me.  So what are they thinking?  Why is CHF treated like it’s -- I dunno -- an STD?  Or cancer?  I’m divided between pushing them, which might mean they become a lot more invasive, or just continuing to take care of myself, which might be stupid.  I've scheduled a lactic acidosis test, which is advised after taking metformin a long time.

Coming to Valier was not trying to find a safe place -- it was returning to a known place, even though few people here remembered me.  In Browning, nearby, they DID remember me.  In Heart Butte they remember me, but even 2001 was a long time ago.  In Cut Bank there are people who have torn strips off of me during the past half-century and probably still have them in a desk drawer somewhere.  This house is the kind of house widows used to own so the rent (usually from single school teachers) would supplement their retirement.  I rented those old houses and loved them.  In Valier the school is obliged to build houses because today’s teachers will not live in ramshackle little old houses.  The school teacher next door just moved out of the twin to this house. 

Time’s stream moves quickly.  Things catch up.  The years I spent sleeping out in an F150 cargo van while circuit-riding have had a curious after effect: snoring.  The kind that comes from obstruction like an accumulation of phlegm or misalignment of thingybobbits in the throat.  I only realized this lately.  No one will tell you that you snore (it’s considered like having bad breath -- shameful) and I don’t sleep with anyone anyway.  Once at UU General Assembly I slept in a dorm “pod” of bunkbeds, and all the other occupants disappeared the second day.  I didn’t know them and didn’t know why they left.  Now I get it.

Only once did I sleep in a retreat center where I was loud enough that one of the ministers had a talk with me.  He was on a CPAP at night for his snoring.  They had just been invented.  One cannot plug in a CPAP in a barebones cargo van.  I waved it aside.  The necessary testing is expensive and so is the breathing machine -- IF you can tolerate something strapped to your face while you sleep. (Too much like being inseminated by Alien!)

Now when I proof writing, I find strange typos and malapropisms -- not a lot.  I can’t remember names, but I never was good at that.  I take short naps.  I have little protocols, regimes, and sticky reminders but I forget to take my lists to the store and forgot to buy coffee last time.  (Eeeks!  A bag of coffee in Valier costs $2 more than it does in Conrad.)  Little strokes?  Lack of REM sleep?  “Normal” aging?  What I know from watching so many people get old (many of my best friends have died -- men and Indians die young) is that it’s a good idea to plan ahead.  Set deadlines and triggers, research to discover possibilities and markers.  This may be the beginning of an on-going thread.

PUSHING UP THE PERCENTAGES

About thirty per cent of people who sign up for weight loss programs, medical or pop, will stick and succeed.  About thirty per cent of people diagnosed with diabetes will change their diet and succeed.  About ten per cent of everyone who tries something addictive (from alcohol to opiods) will be hooked to the degree that they probably never kick.  I can’t cite you the studies.  I’m just trying to break up some of the absolutes, the assumption that everyone who has a physical problem will be “fixed” by diagnosis, meds and behavior change.  We ‘get’ meds.  But even the simple habit behavior of taking them is neither automatic nor easy nor best done alone.

Thirty per cent of the people in AIDS primary care stay.  That means seventy per cent of people with a lethal disease are offered help but leave it.  Why is this?  In fact, the people who manage this primary care, the social workers, often leave the system as well.  Why is that?  The first impulse is to do something to “fix” the “broken” clients, because that’s the basic assumption of social work.  But what about “fixing” the social workers and their attitudes, their oppositional and identity-destroying tasks?  Why are they so often female and usually middle aged?  How does the Nightingale become Nurse Ratched?  

http://www.drugsandalcohol.ie/18464/

Here’s some evidence to show how the kids feel about it.  I assure you that Native American kids, Jewish kids in the Bronx, and wild-ass kids in the Carolinas all feel the same way for the same reason:  THEY ARE NOT INCLUDED.  The SW’s and nurses and people sit on panels to talk about kids the way they would talk about managing cows, as though THEY were the only ones to know how to have a calf, as though THEY were the cows.  They are mostly doing that because men will not.  Men are doctors, principals, coaches, politicians.  They are important and make a lot of money.  Women are care-takers, which is not considered a profession.  They are the ones who put in the catheters, grade the papers, prevent the low scorers from playing in the football game (unless overruled by the administration), and go to the customer counter to tell the citizens why they can’t build where and how they want to.  They do the dirty work.  They are untouchables.  

The only people who are lower are the clients, esp. the ones who have fucked up, the poor, the diseased, the unwanted children.  LOWER people have no say.  They are lower because they don’t know how to do anything, they have no resources, and so on.  Stigma.

All this is a very screwed up understanding of the way society works when it succeeds.  It works when it is a collaboration, when the clients are empowered, when they get to work for their own salvation and improvement on their own terms by their own definition.  If only 30% of a shop’s customers ever returned, then the shop owner would do some very serious rethinking.

We are accustomed to thinking of medicine as a “bug” addressed by a “pill.”  No longer can we think that way.  Only a small percentage of the “cure” or control is molecular meds -- though it IS addressing a bug (virus, bacteria, malfunctioning body) and though it is a medicine that might be administered in a pill, a liquid, an IV line, an implant, a nasal vapor, and so on.  To work, these very powerful but subtle molecules must be exactly quantified, administered on schedule, never skipped.  They have nasty side-effects (worse than going to the dentist), cost way too much, can only be acquired with effort and begging, and even then are sometimes simply not available because they weren’t manufactured and shipped in a timely manner.  I’m not talking about exotic AIDS drugs -- I mean my own ordinary metformin prescription for diabetes II.

To achieve all these things requires a support system:  someone to check the computer at the pharmacy, someone to run interference, someone to remind you, someone to nurse you when the symptoms are overwhelming, someone to get help in an emergency, someone to see what you need when you can’t see it yourself.  There’s no reason why every one of these persons must be adults, medically trained, or official in any sense.  A lot of it is ordinary parent stuff: temps, bp, oxygen levels, nausea mitigation and hydration, cleaning.  Kids can do it for kids, if they have access to the information and maybe some skill training.  Adults who make a living as social workers, nurses, home visit helpers, are not motivated to admit this is possible.

Simply knowing about dire consequences will not be enough to change the behavior of people.  Mostly I’ve been thinking about two populations:  kids with HIV-AIDS and small town folks (esp. women) who have diabetes -- that’s me.  Doctors who have threatened me with going blind and having my feet sawed off only paralyzed me.  Even the many slick magazines with their hints and tips and “possible cures,” the endless recipes with sugar replacements and so on, just interfered with me trying to get clarity about what was factual and what the parameters were.  What did I HAVE to do to prevent eye damage?  What diet standards did I have to obey?  What was the solid evidence?  And so on.  Specifically.  

The finger sticks for glucose monitoring are wicked -- not because of pain but because no one will really tell you want they mean.  Those little tags to stick in the gizmo cost a dollar each.  You take the numbers and keep the charts and eventually you just get tired of it, esp. if the readings stay normal.  And the companies that make the readers are careful to make them go obsolete in a few years, if only by not making available any more of the right little tags.

Beyond that, diabetes is like feminism in that suddenly a raised consciousness reveals how much sugar controls relationships in our society.  Every clerk has a little dish of candy, every bank cashier has suckers to give kids, every church service is followed by “coffee” which is really treats.  Substituting carrot sticks for cupcakes won’t do it.  I don’t know what specifics affects kids with HIV-AIDS in this way, so I reckon a person will have to ask them.  But I expect they know what is sweeter than sugar:  sex.

What I’m saying is that popping pills or should be only a small part of a modern life.  What we need to recover is the old-fashioned stuff where people kept track of each other and lived “regular” lives guided by habit patterns and predictability.  A little Victorianism is a good thing.  Ask Dr. Bramwell, eh?  Streaming on Netflix.  I don’t suppose many street boys sit around watching old PBS/BBC shows, but some of the rest of us do.  Each episode illustrates vividly than pills are not enough when poverty is the affliction.