MEDICAL TRIAGE

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Know how it feels to be very old?  

Imagine this: You’re living in Milan. You’re a fairly healthy eighty-eight year old.  Then the virus gets you. Symptoms of Covid-19 appear: Fever, extreme fatigue, difficulty breathing. In other words, difficulty staying alive on your own.

Into the hospital with you. Ordinarily, they’d intubate – stick a tube down your throat and attach it to an apparatus called a respirator that would breathe for you while doctors had a chance to work on the underlying disease and you could breathe again without help. Except now, during this tidal wave of respiratory need, the hospital doesn’t have enough respirators. Your doctors have to decide who should get a respirator and who should go without. In other words, who should live and who should die. Who would get the respirator? Grandma (meaning you)? Or the mother of four young children? Guess who they say they must choose.

According to news reports, that was the situation in Milan last week. I don’t live in Milan. I’m in Princeton, New Jersey – on the East Coast of the United States.  But the tidal wave has reached us. And I am eighty-eight years old. I have two other strikes against me, as well: underlying coronary disease (which my own doctors are managing very well, thank you), and a compromised immune system (thanks to a hospital infusion of contaminated blood in 1969). So I’m particularly susceptible to the virus. If it reaches me, I will almost certainly not be asymptomatic.

Like all my contemporaries, I recognize that the number of years left to me are limited – how limited still uncertain.  Like all my contemporaries, there are memory lapses (in my case small ones, mostly of names – and thank goodness for Google). Like all my contemporaries, the body is stiff in the morning, there are minor aches and pains that come and go, prescription meds to swallow with breakfast in the morning. But I live in a residential community where the median age is 82, in a town that skews heavily to college professors and senior executives of pharmaceutical corporations, none of them spring chickens. So on a day to day basis, I don’t really feel so old. Until now, when I read the news from Northern Italy. What being old means has finally come home to me. It means that in some previously unimaginable circumstances –to a “decider” who is someone else, not me — I’m expendable.

Expendable?  Me?

That’s what it feels like.

Well, I really don’t think it will come to that. For one thing I am very well protected physically, in a fortress of a building where the resident trustees have taken every precaution that can be taken and then some.  (More of that perhaps, in a later post.) And our state governors, if not the elected leader of our country, are aggressively preparing for the apex of the catastrophe. Many doctors have also spoken out on the nightmare scenario in Milan last week; the determining factor here would not be who’s a grandma but who’d be likely in any event to die of some other condition within the next half a year.

How do I end this gloomy post?  With determination to go on living for as long as I can.

Keep safe. Be well.  More later.

MUSICAL CHAIRS

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If you’re old enough, you may remember that game.  We used to play it at birthday parties in someone’s house when we were five and six and seven, after the candles and cake. Somebody’s mother would double as pianist. Armless chairs were set out in two rows, back to back – one fewer chair than the number of guests. Then we marched around the chairs to the music, alert for the sudden stop. Quick! Scramble for a chair! Alas – one guest was always luckless and found herself out of the game. A chair was removed, the music resumed. It was very exciting.

I never won, although I came close a couple of times – one of three pushy little girls trying to commandeer either of the two remaining chairs.  There were consolation prizes of course, as well as the real prize – all of them on the level of what could be found in a Crackerjack box and therefore not anything anyone had really wanted but nice to have won all the same. And afterwards, there were other games and maybe a few magic tricks performed by a father.

I’m reminded of this now that I’m eighty-eight and own an apartment in what is known as an “independent living community for people over fifty-five.” The truth is that very few people buy in here until they reach their mid-seventies, however energizing “over fifty-five” may sound.  Since the community is about twenty-two years old, those who initially came when they were in their seventies are twenty-two years older. Of course they may have moved on to a nursing home or the hereafter. But if not, are they still living “independently?” Well, around here “independent living” seems to have become an elastic term, meaning that you require no services from the community other than those provided to residents who can still take care of themselves. So if you’re sufficiently well fixed to afford an aide twenty-four-seven and have an extra room so she (it’s usually a she) can live with you and help you do all the things you can no longer do for yourself, you may never need to go to a nursing home.

What has this got to do with musical chairs? The disappearance factor. Not the disappearance of a chair; we’ve got plenty of chairs – in both dining rooms, in the café, the pub, the living room, the library, the large community room. It’s the people you’ve gotten to know since coming here who keep disappearing from the chairs they normally occupy. If something non-fatal happens so that they’re sent to the ER or hospital (both quite nearby), then spend several weeks to a month in a rehabilitation facility, and then come back to the community but retire into their apartment or villa with the aforesaid help of a full-time aide, arranging to have all dinners delivered – they’ve essentially dropped out of community life.  We no longer see them at activities, or outings, or movies, or meals. As in musical chairs, they’re out of the game.

That’s hard enough for the disappeared.  It’s also hard for the rest of us. Setting aside questions of developing affection or friendship, what you see happening in a place like this, even if you’re still relatively “okay,” is probably a harbinger of your future. God forbid you fall.  You realize from the experiences of those around you that even if you recover, it will take two or three times as long to regain most (although probably not all) of your prior mobility and strength as it might have done twenty years earlier.

Other residents start disappearing in another way. Put bluntly, as memory loss increases, it begins to make you a non-person to everyone else.  You completely forget to come take your place at scheduled dinners with your friends. You can’t be relied on to participate in activities, or assume responsibility for a program.  You tell the same stories again and again and again and again. Eventually you’re no longer invited to occupy a chair at anyone’s table.

In the past three months, one acquaintance – hitherto very active, although functioning (well) with one kidney — fell in her own villa and broke her shoulder.  Her right arm (the one she uses) is in a sling for a month.  Another sustained a similar fall in her apartment and hit her shoulder on the edge of a bureau, shattering it.  After two months she was back from rehab in her apartment, still recovering, when she fell again, trying to pick something up from the floor.  This time it was just bruises all over; she was lucky. A very active woman got out of her car the wrong way and put her hip out; four weeks later it’s still so painful she needs to lean on a walker to get around the building. Another friend was entering the back seat of a car when the driver, thinking she was already in, accelerated; the friend fell out and the car’s rear wheel ran over her heel. (She also broke her arm.)

My closest friend here, a year older than I am, came with me to a performance of the Messiah by the New Jersey Symphony Orchestra two years ago. This year I went with others; my friend is now in hospice. In the intervening two years, she began repeatedly to fall while walking, always because her right foot kept tripping over the left; it was a symptom of what was eventually diagnosed as Parkinson’s Plus, the “Plus” being MSA (an acronym for a hideous disease descriptively called Multiple System Atrophy). She can no longer move, and no longer makes much sense; she has a doctorate, but asks me to observe all the rabbits running up and down the corridors of the assisted living facility where she will soon die.

I may be wrong, but I believe I am now the oldest American person with a personal blog.  With astonishing regularity, Judy Kugel writes an Eighty-Something blog twice a week from Cambridge, Massachusetts; although her husband has Parkinson’s, she does try to look on the bright side of every day and has a devoted following.  She’s only in her early eighties though.  Ronni Bennett, in her mid-70’s, writes As Time Goes By from the West Coast; she has both pancreatic cancer and COPD and is an inspiration in how she’s been dealing with these appalling tribulations. I read both these blogs assiduously, considering their authors to be shining examples of how I should comport myself but don’t. As you can see, I disappear from the blogosphere for a year at a time and return with downer reports of all the not-good things that likely lie ahead.

On the other hand, so far I am still hanging in here. Which I shall have to continue to do, because I’m not one of those who can afford an aide. (Nor do I have a place to put her, or the temperament to put up with her.)  Should I be unlucky and the need arise, my offspring will have to deal with it. Also, I still have most of my memory, so can remember when not only musical chairs but a number of other things were fun. Much fun. Happy memories do brighten gloomy days. So I tend to remain an optimist. What about I couldn’t really explain to you, but there it is.  Perhaps an ostrich optimist.

And — oh boy! – do we have holiday festivities galore around here, for those not yet closeted in their apartments and villas.  Christmas Eve dinner coming up real soon, followed by Christmas Day buffet, New Year’s Eve Buffet — with music and a removable dance floor in the living room till 10 — and then New Year’s Day dinner too.  You may notice that when old people celebrate, it’s likely to be with lots of food!  Ours is excellent.  The Executive Chef recently got married; our menus glow with his happiness.

In conclusion, dear readers (if I still have any), enjoy your relative youth, your relative health and all the good things that exist in your now.  You’ll never get your now back, so revel in it while it’s here.  Believe it or not (in view of the realities I’ve just laid out in this piece), I’m looking forward to 2020 as much as you are.

A NEW YEAR’S WISH FOR EVERYONE

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One of the nicest New Year greetings I’ve received recently comes from someone in Victoria, Australia. She sent it in a comment to a holiday post of mine. But it’s so appropriate a wish for those of us who are, as the blog says, “getting old,” that I’m borrowing it to share with all of you, irrespective of your age:

MAY 2015 BRING YOU GOOD HEALTH AND THE ENERGY TO DO ALL THAT YOU WOULD LIKE TO DO!

Thank you, Barbara, for sending it.  Thank you all for reading. See you next year….

BLOGGERS, ARISE!

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GET UP, GET OUT, GET MOVING!

(Weather permitting.)

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“Above all, do not lose your desire to walk.  Every day I walk myself into a state of well-being and walk away from every illness.  I have walked myself into my best thoughts and I know of no thought so burdensome that one cannot walk away from it….

“But by sitting still, and the more one sits still, the closer one comes to feeling ill….If one just keeps on walking everything will be all right.”

— Soren Kierkegaard.