The Easy Way Out

I ran into Ruth the other day — not literally, thank God because she’s a parking control officer, and that would be awkward. I’ve known her since I moved here 30 years ago; she was the only teller at the Bank of America who knew the answer to anything. When they fired all the full-time tellers and replaced them with college students, Ruth joined the meter maids and I got another bank.

I see her every six months or so, cruising the streets in her Interceptor III ticket bomber. She always pulls over when I wave. But it seemed, the other day, that more time had passed than usual.

“How ya been?”

“Oh fine,” she said. “I dropped dead last year.”

And not at home in front of the computer or at the dinner table, either. No, Ruth dropped dead at the 12K mark of the Bay to Breakers, the San Francisco clothing-optional fun run for 50,000. One of her coronary arteries called a strike, and Ruth hit the ground like a stone.

But if you’ve got to have a coronary, Bay to Breakers is a great place to have one. Few of the runners are professional, much less in good shape or sober, and so paramedics lay in wait on every corner. They had Ruth in hand before she even bounced. Which was good, because seven full minutes passed before they could jump-start her heart She remembers watching the ambulance and its motorcycle escort drive away with her body in it. It was one of those memories that you’re not supposed to have.

Anyway, she looks really good for a former corpse, and she’s running again. She’ll retire one of these days. One of these days. Yep. One of these days.

The thing is, that a lot of people hope to die like Ruth. They just want to go till they stop: one minute, all systems go: then, shutdown; lights out; oblivion. The darkness. No muss, no fuss, no bother. Even more so if they’re broke. I’ll work till I die, they say. I’ve got no choice, so that’s what I’ll do. They want to die like Ruth.

Only, Ruth didn’t stay dead. Remember? The medics pulled her back in time. And she’s alive and well.

But what if she was alive but not well? Mobility impaired, perhaps even brain damaged. Maybe a stroke? Laid up for life? Who’d have taken care of her?

That is, by the way, an awfully popular question these days.

Everywhere I look, people of my age group, in their 50s and 60s, struggle to take care of elderly parents. The competent adults who raised them are now weak, unable to take care of themselves or manage their own affairs alone. Their aging children must see them through the hellmaze of modern medicine and make the decisions that their parents can no longer make or understand. As medicine keeps them alive, but not well.

Many of these struggling children, the ones that I know, have no children of their own. And to a man, and a woman, they see what their parents are going through, and have become, and wonder, who’s going to take care of ME? Who’s going to do this for ME? Because there is no one, no relative, whose duty that it will be. And their own years of decline loom in the middle distance.

My office mate has dealt with this for over a year now. I’ve heard her end of many calls. Endless arrangements for treatment. Loss of a father to Alzheimers. Endless, fruitless discussions on the phone with an angry distressed, 88-year-old mother who wants out, out, OUT of rehab and back to assisted living, even though she’s just had a stroke and is nowhere near ready. She’s be fine on her own, she’s sure. Meanwhile, all her complaints about life in rehab are completely true. Even when rehab’s not evil — usually, they try — it sucks.

And her daughter, my office mate, calms her down, for the nth time and all is well. Until tonight or tomorrow when she calls again and wants out, out OUT, right now! Come and get me! And my co-workers is in her 50s with little money and lives alone in a mobile home; and when her body and mind start to fail her, her only support will be a younger brother who can’t stand the sight of illness. And she asks herself, “Who’s going to take care of ME?”

Rhumba and I ask ourselves the same question. She’s just out of hospital and rehab, where we both had our hands full watching out for her. We made sense of the bureaucratic tangles. We turned back the nurses who kept bringing drugs she was allergic to, even after the orders had been changed. I put on gloves and helped the nurses treat her. I roamed the halls at night hunting down the staff who’d promised to change her dressings but were nowhere to be found. And, sometimes, roamed them with a box of fresh-baked cookies from the bakery down the road, just for the good PR: “Look, nurses, COOKIES. Courtesy of that kindly woman in Room 35, Bed B who so appreciates your attention.” I’ve got no shame at all.

And there was that horrible day when the rehab staff dispatched us by handi-cab to a long-awaited specialist appointment, and gave Rhumba a malfunctioning wheelchair to ride in. They fiddled with it a bit, gave up, and took us to the front door. And once we were outside the nurses turned back. We were on our own. Apparently, by policy and law.

One of Rhumba’s legs burned like fire; had been doing so for days thanks to an allergic reaction to blood thinners. I tried to roll her chair out to the street where the cab waited, but she wailed in pain every time that her foot slipped from the wobbly footrests and hit the ground. I dropped to my knees in front of the chair, bear-hugged the damned thing’s loose parts back into position and literally knee-walked it, and Rhumba, all the way to the cab. We had to get to that appointment. The specialist might be able to stop Rhumba’s pain. I would have done anything.

And yes, the specialist did treat her wounds, and her pain. Though when we got to his facility, we had to get Rhumba’s bad chair another 100 yards from the cab, through a hospital, to his office. Again, with no one authorized to help us. I’ll spare you that part of the ordeal. It was absurd and awful. It was modern medical bureaucracy at its worst.

So tell me; fifteen years from now, when we’re both a lot older and creakier, can we do all that again? Can we defend ourselves again? And if not — as I suspect — who’s going to take care of US?

“Maybe we should band together,” Rhumba’s boss said to me. She’s our age. She’s just seen her husband through a bad patch in a bad hospital; and if not for her intervention he might be dead now. “If there’s no one else to look after us, maybe we can look after one another.

“It’s an attractive thought, and I’ve heard it from others. There are volunteers who look after foster kids and make sure that they don’t get eaten by the welfare system. This would be the same. Is it workable? I have no idea. Is there an alternative besides, “trust the system?” I haven’t seen one, outside of never getting sick and then dying quickly.

God. Old age is supposed to be the time to ramp down, not ramp up. But the times are different now. More will be asked of us. Of that, I’m sure. Maybe we’ll be better for it. Or broken by it. I don’t know.

What I do know is that, hoping to die like Ruth, quickly and simply, isn’t enough. Old age and death is a process, a long one. Modern medicine makes it even longer, and also more difficult. It might be simpler to die quickly, but most of us will fade gradually. And we will need help along the way. It is past time to start thinking about that help, and how to get it to everyone.

Somebody’s got to take care of all of us. Even if that someone is us.

3 thoughts on “The Easy Way Out

  1. lk

    Welcome back, Jim. Just to add to the topic (and our discussion by phone), I do believe the emphasis of modern medicine has shifted and will continue to shift to gerontology. When a significant and growing portion of the population is having health problems, I expect the medical industry (backed by our government) will turn its efforts to dealing with those problems. Not because so many people are suffering, as nice and altruistic as that would be, but because even the wealthy and powerful get old and suffer. Whether that filters down to us, the not-wealthy, well… I expect a certain amount of it to do so. Will it come in time for us? We’ll see…

    1. admin Post author

      LK, right now the system is set up to not deliver specialists in aging. It’d definitely an MD specialty, but they don’t make a lot of money, so if you’re looking at paying off that massive loan debt quickly, you the MD choose a more lucrative speciality. As is often the case, there’s no policyy except everyone for themselves and no incentive to serve the greater good. Which, in the end, is all that saves us.

      We met a lot of great people in medicine. But when the system’s bad, there’s only so much they can do. There’s never enough of anything — not enough time, not enough people. “Enough” costs more money, and the insurance companies, and their stockholders, don’t allow that. And the insurance companies aren’t the only villains.

  2. Kevin

    I am sorry that you and Rhumba had such an ordeal. Thank you for writing about this, though. It’s good to see we are not the only ones without children who worry about interacting with the medical system when we are older. For older men in particular, leaving the workplace due to age or health also tends to remove (or, at a minimum, to greatly increase the distance from) the majority of their social network. Banding together in some way is vital though, because there are going to be times when we need someone besides us to look out for us.

    Our medical system needs more patient advocates and fewer profit-driven executives. I like to think universal single-payer would help immensely in that respect, but I don’t know if we as a country will ever have the courage to try.


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