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The Wrong Side of 70: How I Found Myself Surrounded by Specialists

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The Wrong Side of 70: How I Found Myself Surrounded by Specialists

Ernest Hemingway famously wrote in The Sun Also Rises that one goes bankrupt gradually, then suddenly.

Hemingway wasn’t just referring to money being lost but also to the nature of many things and how people fail to see them until it is too late.

Which brings me to this burning question: How does a 74-year-old man, who just 3 short years ago was faring quite well with the modest ministrations of a primary care doctor and a dermatologist, find himself awash in ‘ologists?

I’m talking about a pulmonologist and a urologist. Add an orthopedist and a neurosurgeon to the mix. If you are choosing sides for softball, there will be two players left.

I am a healthy, active adult male who can walk 4 miles without stopping to sweat. Apart from the constant symphony and crackles, I am fine. It’s too fine for me to spend half my life trying to tie the back on a hospital gown.

The Magic Number

It happens that way, noted my former neurologist, while taking me on a guided tour of my cervical spine MRI, which looked a lot like Georgia O’Keeffe’s rendering of a cow skull and was nearly as haunting.

Thirty-nine and ten seem to be his speciality. This is when patients begin to show up in large numbers with pain radiating from sciatica and disk herniations. The result of seven decades worth of spinal wear that went unnoticed and then suddenly flares into life-threatening, soul-crushing discomfort. It was a scene I witnessed unfold in the overcrowded waiting area of the neurologist, where there were dozens upon dozens of screamers.

“I’ve also heard it called the ‘organ recital,'” says Charlie Paikert, an old friend who is about to turn 70 and has added a half-dozen medical specialists to his own active-duty roster. “Seniors can’t help themselves from launching into a laundry list of their ailments.”

Supporting such anecdotal accounts are reams of data. In 1980, about 62% of seniors saw primary care doctors vs. specialists. These numbers were reversed by 2013,. Today nearly three quarters of seniors in the United States see at least five doctors each year. One study at the beginning of the new millennium found that about one third of all non-elderly patients were referred annually to specialists. It was two referrals for each patient per year .. Still another study places the average senior in the New York area in a medical setting 25 days a year – a trip to the doctor every 2 weeks.

No Shortage of Specialists

The reasons are obvious. Seniors are more likely to experience balance problems, which can lead to increased falls, as well as new patients for neurologists, orthopedists and hand specialists. As cartilage wears away, the spinal column shrinks, and prostates grow with age. There are many specialty doctors available.

” I think that the data will point to an age where seniors suddenly require specific types of care,” said James Brandman. He is a retired oncologist and friend.

” But it becomes more complex when we get down to the finer details. Someone like you, with good health insurance and the wherewithal to [navigate] the ins and outs of the medical world, is going to be seeing far more specialists than someone with fewer financial and mental resources who lives somewhere where medical options are limited.”

That is no doubt true. Many of my doctors are housed in a building on Long Island’s North Shore. It makes the Pentagon seem like an empty schoolhouse.

There Are Notable Exceptions

All that being said, not every elderly medical patient goes through the same cycle of discovery. Some older Americans find that the cycle of discovery is not gradual, but rather abrupt.

In these instances, the oracle isn’t Hemingway but Henny (as Youngman).

“Doc it hurts when you go like that,” is one of his famous one-liners.

” “Then you shouldn’t do that,” responds the Doc.

My wife’s cousin, May, lived the first 96 years of her life in Henny’s joke. There are no major medical problems, and no doctors or medications, other than occasional aspirin.

Just 96 years of not going like that. May became bankrupt gradually, then abruptly, and was forced to move into a nursing facility.

Within 48 hours of entering the facility, May was on a dozen prescription medications: treatments for hypertension, high cholesterol, diabetes, hyperthyroidism, and osteoporosis, with a Lasix kicker. And, as expected, the nursing home doctor who prescribed May the medication cited apparently valid reasons to give her a variety of new medications.

None of this mattered much to Cousin May, as her last 15 months on earth were filled with music and the company of others. It was like she had just won the final race.

Mark Mehler is the author of He Probably Won’t Shoot You: Memoir of an Adult Protective Services Case Manager (McFarland Publishing, 2021).

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