Tag Archives: Age

by

The Primrose Path

Age is sometimes mysterious, isn’t it? Despite the experience and occasional brush with wisdom I have encountered, I am still a child in many ways. Naïve -not so much about things I have encountered in my drive through life, but more about those on streets I have not visited. Addresses in the shadows.

I suppose there will always be issues that will never spring to mind in our normal passage through the years and yet, in retrospect, one wonders how they were missed. Or why. What, for example, happens to different populations as they age? And who do we get to care for those who have chosen -or been forced- to walk the darker paths, then fallen neglected and forgotten by the wayside, too old to re-offend? Should we care for those who flout our laws and reject the duty to conform? Are we a family, or just a collection of intolerant strangers easily offended and quick to turn away?

Imponderables, to be sure, and yet, like it or not, there are needs that must be met… by someone anyway. I was intrigued by an article in the BBC News about aging prostitutes in Mexico City: http://www.bbc.com/news/magazine-38677679  One of their members opened a retirement facility for them.

I must admit, that the plight of aging sex workers had never really occurred to me. I’m not sure what I thought would happen as they got old, although, as a gynaecologist, I was certainly aware of their life style risks; their need for consultation in the Emergency Department was a regular and frequent occurrence whenever I was on call. For some reason, I’m reminded of that quote of Queen Katharine buried deep in Shakespeare’s Henry VIII: ‘Like the lily, that once was mistress of the field and flourish’d, I’ll hang my head and perish.’ Is that how they end their days…? I hope not.

But a retirement home –how perfect! The social safety net in Mexico is likely not as comprehensive as that in Canada, and yet even here, I’m not aware of any such facility. Indeed, the oldest profession has undergone other, more callous impediments as I noted in a 2014 blog on prostitution laws: https://musingsonwomenshealth.com/2014/06/12/prostitution-laws/  So perhaps it might be asking too much to wonder if such a facility might be in the offing -if not governmentally sponsored, then perhaps privately funded. Or better still, a legal adoption of  something like the New Zealand model might discourage exploitation and even offer salaries and, who knows, pensions…? Comfort for their end of days?

*

I do not ordinarily sit in malls; I do not ordinarily go to malls, for that matter, but sometimes circumstances foster unexpected opportunities. I was tired that day –tired of fighting through Friday crowds in search of things I probably didn’t need, or at least could likely find with a little effort somewhere else. I had just decided to look for a place to rest and collect my thoughts, when I saw a woman check her watch and stand to leave an uncomfortable-looking wooden seat near where the tide of people was sweeping me. I immediately swam over and moored before the woman right behind me could claim it for herself.

The seat was one of four that served as a kind of breakwater for the waves of people flowing down the shop-lined banks in confused eddies. Bolted to the floor, they were arranged in a little circle, presumably to facilitate conversation, but only two of the occupants seemed to know each other. They were deep in conversation so even an exchange of pleasantries seemed inappropriate, but just before I closed my eyes, I managed to catch their attention and smile at them. In the seat beside me was an old man who also smiled, but seemed more preoccupied with his watch than anything else.

The women were quite old and both looked as if they’d seen better days. Although their clothes were clean and obviously worn with an attempt at style, I could see fraying at the hems, and areas where the patterns were disrupted by attempts at repair. Both their faces were wrinkled, as much by life as age, I suspected, and the one directly across from where I sat, seemed hollow around her cheeks and gummed her words through sparsely distributed teeth. Short and gaunt, she sat proud and straight in her chair, however, her long, greying hair swept back in an elegant ponytail that danced each time she talked. She had dressed that day in a green, fading sweater and black jeans that seemed a bit too large, so the cuffs were carefully rolled to matching folds.

The other was a larger woman with short, ash-white hair that she had scrunched under a blue baseball cap that had some sort of a truck logo on its front. She was dressed in a red and white flower print dress which seemed to hang shapelessly below a tattered and faded nylon jacket that had probably once been totally black. At her feet was a big, stained cloth shopping bag that bulged oddly in places with items too irregular to be just clothes.

Friendly strangers, they both smiled back at me before resuming their conversation.

I closed my eyes and tried to relax into the wooden slats, but their words kept floating over to me during lulls in the storm of voices and accidental elbows hurrying past me. I could tell it was an unsafe anchorage at best.

“Haven’t seen you for a while. You still working, Ethel?” It must have been the pony-tailed woman, because her words seemed strangely distorted and her lips smacked together a little as she spoke.

A gaggle of children passed nearby so I missed some of the response. “… men anymore, Rita…”

“Yeah, I guess, eh?” But I didn’t think Rita sounded very sure. “You still on the…” A demonic laugh surfaced in the crowd for a moment then faded along with Rita’s words.

“Yeah,” Ethel replied. “Hard to get off though, eh?”

I opened my eyes to get a little more comfortable on my seat, and saw Rita nodding in agreement. “Hang out in the same place?”

Ethel shrugged as I closed my eyes again. “They know me there,” she answered.

I imagined Rita nodding in agreement. “Mmmh,” I heard.

School must have ended for lunch, because a group of noisy teenagers rambled past, joking and poking each other. “What shelter you going to nowadays?” Ethel’s words caught my attention, even amidst the confusion of teenage jests and I opened my eyes, pretending to adjust my position again.

I could see the indecision on Rita’s face, and her lips moved as she considered her answer. “Used to go to the one on Main…”

“Yeah, me too,” Ethel agreed, glancing at her. “Got assaulted there, though, so I sometimes try the Sally Ann…”

“Mmmh.”

“What about now, Rita?” She adjusted her baseball cap as she spoke. “Where you headed tonight…?” She sounded suspicious. They were clearly not good friends –just acquaintances, perhaps, who’d found themselves in adjoining seats to shelter from the weather for a while.

Rita stared at Ethel for a moment, obviously uncertain how to answer. Then she ordered her eyes to scan the passing crowd. “Found a new place. Some of the girls got together…” But it wasn’t the noise of passing voices that ended her words.

Ethel tried to find out more, but Rita suddenly stood and waved, as if she recognized someone in the crowd, and dived into a particularly noisy wave and disappeared.

Ethel sighed and then gathered up her things and melted into a similar eddy going another direction. Despite her weight, she seemed frail and aged. Her movements were no longer fluid, her gait was unbalanced and she hobbled with a decided limp. But as she disappeared, her eyes brushed mine -by mistake, I thought at first, but when I remembered it later, I wondered if it had just been habit. A desperate plea for another friend –however temporary.

 

 

 

 

by

A Flicker of Hope

It’s interesting what catches our attention when we surf the apps on our smartphones nowadays. Some of the more provocative articles have dubious sources, of course, but with a little digging the original study can often be found and the claims checked. The problem, however, is that even these results need to be reproducible in case either the methodology or the results were unreliable –and also the conclusions drawn from them. That’s why it’s often unwise to believe everything you see reported –or, on the other side, to report everything you want to believe… Fear and Hope are wonderful incentives, and so the issues in the study need to be thoroughly researched and vetted for bias and innuendo and references to the original study need to be included.

Perhaps because I am now retired, any article about time-related changes catches my eye more easily. So I find myself particularly interested in studies that suggest progress is being made -not with respect to age itself, but more the evolving process of aging: the gerund. It was with considerable interest that I read the BBC news on the use of flashing light therapy for Alzheimer’s http://www.bbc.com/news/health-38220670

I also attempted to read the original paper from MIT (entitled Gamma frequency entrainment attenuates amyloid load and modifies microglia) published in the December 2016  issue, of the journal Nature should you wish to struggle though it, but I have to confess that for me, even the title was difficult…

At any rate, the article suggested that flashing light in the eyes of mice that were genetically engineered to have Alzheimer’s-type damage in their brain, ‘encouraged protective cells to gobble up the harmful proteins that accumulate in the brain in this type of dementia. The perfect rate of flashes was 40 per second – a barely perceptible flicker, four times as fast as a disco strobe.’ And ‘Build-up of beta amyloid protein is one of the earliest changes seen in the brain in Alzheimer’s disease. It clumps together to form sticky plaques and is thought to cause nerve cell death and memory loss.’ Research has focused on ways to prevent this plaque formation using drugs, but with limited success so far. If a non-invasive method like a flickering light can activate the immune system to do it by itself, so much the better. ‘The researchers say the light works by recruiting the help of resident immune cells called microglia. Microglia are scavengers. They eat and clear harmful or threatening pathogens -in this instance, beta amyloid. It is hoped that clearing beta amyloid and stopping more plaques from forming could halt Alzheimer’s and its symptoms.’ Fine with me.

I did, however, initially wonder about how bothersome the flickering would be –news reports on television usually caution their audience whenever even flash photography is found in the report, presumably because of the risk of triggering epileptic seizures. But, as the article discussed: ‘For the patient, it should be entirely painless and non-invasive “We can use a very low intensity, very ambient soft light. You can hardly see the flicker itself. The set-up is not offensive at all,” they said, stressing it should be safe and would not trigger epilepsy in people who were susceptible.’ Better and better! It’s just preliminary stuff, of course, but at least it opens up new pathways and ideas for further research.

As if even reading about the concept was in itself therapeutic, the article immediately triggered what, at first blush, would seem to be a non-sequitur memory of a patient I saw many years ago. The issue as I recall was not so much about mental aberration -although the patient herself was apparently suffering from paranoid schizophrenia- but more about her speculation on the possible effects of flickering light on mental function.

I was, I think, in my first year of residency training in the gynaecology program and was doing a rotation in one of the older teaching hospitals in the city. In those days, things were very busy on the wards and so our tasks were apportioned according to our seniority, the senior residents doing the lion’s share of new consultations, while we juniors were given those jobs that, while important, required less experience -pap smears, usually.

My senior’s name was Sara, I remember, and she decided I should be the one to go to the psychiatric ward to do a pap smear on one of their more ‘unusual patients’ as she said to tease me.

“What do you mean ‘unusual’?” I asked. Sara didn’t like to go onto that ward, for some reason, so she usually made some excuse.

She stared at me for a moment before answering, I remember. “Oh, you know, she has paranoid delusions and hallucinates, or something…” But it was clear that Sara really had no idea why our department had been asked to do the pap, nor had she any intention of doing it herself.

I was beginning to suspect this was merely another sluff. Sara fancied herself a consultant now and able to delegate things she didn’t want to do. “But if she’s paranoid and hallucinates, wouldn’t it be better if the doctor doing the pap smear was female?”

Her expression turned angry at that point, and I recall her almost attacking me with her eyes. “Oh for god’s sake, there’ll be a nurse there with you the whole time… Or maybe they said two…” she added, uncertainty softening her glare, but not her resolve to send me to that ward.

I showed up at the psychiatric area and was allowed in only after identifying myself via the phone just outside the door. Then I was led to the brightly lit nursing station, and a rather large matronly nurse handed me the chart of the woman needing the pap.

“She hasn’t had a pap smear in years,” the nurse said in a soft voice, so it couldn’t be heard in the corridor outside of the station. “And her voices told her she has cervix cancer…”

“Her voices?” I should have been more professional, but I was already feeling a bit apprehensive about being inside a locked ward. “I mean, shouldn’t we wait until she’s feeling a bit better before we…”

“We can’t seem to find any good medication for her yet,” the nurse interrupted. “The doctor thought that we could at least calm her by checking her cervix.”

Greta –I still remember her name- was already in the examination room, sitting in her gown on a little table that had a set of rickety old metal stirrups at one end. They’d apparently had to borrow everything from another ward for the job. As soon as I entered with the nurse, Greta examined me from top to bottom with suspicious eyes.

“You’re a man,” she said before we were even introduced.

The nurse, whose name I forget, walked over to Greta and held her hand. “You remember we talked about this, Greta,” she said in the same soft voice she’d used before. “And you said it was okay…”

Greta nodded, smiled and lay back to put her feet in the stirrups. “They said I should show you my cervix,” she said, the italics staring at me between her knees. “Not the one with cancer, though…  I’m supposed to keep that one hidden.”

“Her voices,” the nurse quickly whispered in my ear as I sat on a little stool they’d also borrowed for the occasion along with a light on a long, flexible metal pole. It looked as old as the stirrups.

I got the speculum and the pap smear paraphernalia ready as the nurse readied the light. The bulb kept flickering, though. I fiddled with the bulb to see if it was loose, but it seemed tight enough. And it was obviously plugged into the wall. On, off, on, off… the light was beginning to annoy me. I snapped the switch a few times, but still, it insisted on flickering. On, off, on, off…

“I’ve got a flashlight,” the nurse said, but when she turned it on, it was so weak, I knew I wouldn’t be able to see cervix high up in the vagina with it.

“Well, maybe I can do the pap smear with the flickering light,” I said and shrugged.

Suddenly Greta raised her head and stared at me again. “Sometimes the prongs don’t make good contact in the wall. Everything’s so old in this place,” she added, shaking her head. “Take the plug out and squeeze the prongs.”

By this time I had the speculum in my hand, so I nodded to the nurse to try Greta’s suggestion. Sure enough, squeezing the prongs stopped the flickering.

Greta was still staring at me through her legs. “I may be crazy, doctor, but I’m not stupid…”

I put the speculum down on the medical tray I had on my lap. I sensed Greta wanted to explain something. “It’s a signal, you know.” I didn’t think I should reply. “The light’s always trying to tell you something –sometimes it’s angry, but more often it’s just trying to help…” Her feet still in the stirrups, she raised herself onto one elbow and continued. “It gets right into the brain to help, you know. It doesn’t stay there long enough, though, and that’s why it has to keep going in and out, in and out… And each time it tries, it flickers…” Then she stopped talking for a moment and stared at the nurse with an amazed expression on her face. “That’s what the doctors should be trying –not all those horrible pills…”

Maybe that incident stands out because it was the first pap smear I’d ever done. I don’t remember the result in Greta’s case –I was near the end of my rotation in that hospital- but I do remember Sara asking me what I’d done with that patient.

“Why?” I asked, afraid Greta had accused me of doing something improper.

“The ward told me that your patient seemed much calmer after you left and she apparently kept telling everybody you’d come up with a new treatment, or something…” And then I remember Sara smiling condescendingly at me, as if to say that junior residents could never do anything of the sort.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

by

Unquiet Meals

I suppose Age has blunted me –or at least made me suspicious of fads, curious about recent phenomena that wear the clothes of certainty, vogues that hitchhike on the backs of something else never meant to carry the weight… But one must not be caught rubbing the poor itch of one’s opinion, to paraphrase Shakespeare. One must seek either corroboration or refutation in equal measure; one must make the time and effort to critically analyze what one would fain discard. So it was with no little frisson of excitement that I read just such an attempt in the BBC News. Gluten allergy, and its social and physiological disguises, was the subject: http://www.bbc.com/news/magazine-37292174

I have never denied the existence of true gluten allergy, Celiac Disease. Its prevalence obviously varies with the group being measured, but it averages to around 1% of the population and is a true auto immune phenomenon where the body detects the presence of –in this case, gluten- and views it as hostile. It then produces some countermeasures –autoantibodies- which, in turn, can have effects on various organs, the small bowel often being the one that results in the diagnosis.

The existence of a non-celiac gluten sensitivity, however, is more controversial. Studies –including the one the BBC reported- seem to vacillate wildly, so I suppose it is merely another example of confirmation bias as to which one you choose to believe. Me? I remain skeptical, firmly encamped in the valley floor between the two hostile mountains that glare and threaten each other from a safe distance. And if some of my patients choose to avoid gluten in their diets, so be it -I’m an obstetrician/gynaecologist, not a dietary immunologist. But sometimes my concerns peek above the mischievous gluten dust.

You know, you can’t tell the gluten-free apostles from the gluten abusers in the average waiting room. I can’t, anyway. Geraldine looked, well, normal as she sat slouched in her chair in the corner. Although my day sheet said she was in her thirties, my eyes said forties. Her blond hair was streaked with silver –although nowadays that may just be a whim- but her face was folded into little wrinkles like previously crumpled paper that had been hurriedly smoothed. She was dressed in black jeans that belied any definite attempt at ironing for the appointment, and her oversized grey sweatshirt matched her face for creases. The very idea of needing to avoid gluten apostasy did not spring unbidden to mind, I have to admit.

And yet the sullen face that watched me as I extended my hand in greeting did suggest that Geraldine was unhappy with her referral. In my practice, this is usually an indication that the patient was hoping that, contrary to what they Googled, I would still turn out to be a female. Although I am quick to disavow them of this, I find it still takes a few minutes more to gain their trust.

Once she had reslouched herself in a decidedly less comfortable seat in my office, I brought up the note from her doctor on my computer screen. It was a one word note –not terribly unusual from this particular GP, but not terribly helpful, either: ‘IMPOSSIBLE’ it said in bolded and underlined capital letters –rather striking, really.

“So, Geraldine,” I said, feeling my way along my words, “how can I help you?”

She glared at me for a moment, and then withdrew her eyes to the safety of her lap. “Didn’t my GP tell you?” It was at once hostile yet tinged with resignation –as if the GP was simply passing a rather complicated buck onwards. As if I were only one more stop on the journey.

Her answer was so uncomfortable it caught me unprepared. “Well…”

“He just wanted to get rid of me…” she said, venom dripping from the corners of her mouth at first. But she thought about it for a moment and neutralized her face. “He never listens, anyway.”

I tried to smile –sometimes it works. “Listen to what, Geraldine?”

Her eyes rose quickly from her jeans, like two birds flushed from a bush. “He doesn’t believe in gluten,” she said, a little too quietly for me to judge the temperature of the insinuation.

“How do you mean?” I walked right into it.

The cage door of her eyes flew open, and her mouth unlocked like Pandora’s box. “He refuses to believe that gluten is alive and flourishing in the world…” I’d heard similar words from religious acolytes proselytizing on street corners; maybe gluten was now another proxy for the devil.

“So…” I said, but before I could finish my thought –well, actually before I could even develop one, she interrupted.

“He doesn’t believe me. For years I was plagued with diarrhea and bloating so he sent me to a GI doctor who tested me but couldn’t find anything. All she could say was that it wasn’t Celiac Disease.” She stopped for air. “And now, whatever I tell my GP he just shrugs and says, it’s not the gluten.”

I pretended to type something on my computer screen, but I was just doodling.

“Anyway, I decided to cut out gluten in my diet, and the bloating stopped. The diarrhea stopped… But, then I started…” she added cryptically.

“Started what?” It wasn’t the most gynaecologically phrased question of which I am capable, I admit, but it was all I could think of in the moment.

Once again her face contracted like an animal about to spring. Or flee… “Started having sex!” she said, italicizing the last word. And then, mercifully, before I could gather my thoughts about why anything she’d had to say had anything to do with sex, she explained. “You can’t have sex when you’re bloated all the time, doctor! You can’t have sex when at any moment you might have to get up to go to the toilet!”

Okay, call me naïve, but I hadn’t thought of it quite like that before. It was a different world out there. “But eliminating the gluten in your diet helped, you said.”

She nodded her head vigorously. “I was a new woman.” She stared disconsolately out the window behind me for a second or two. “So I decided I’d better up my birth control method. I hate condoms and diaphragms… and I refuse to wear an IDU…”

“An IUD, you mean?” I said, attempting a gentle correction, but her eyes tried to ravage my face immediately.

“Whatever! So my GP put me on the pill!” she said, italics and contempt now mixing freely with the original venom on her lips.

“And…?”

“And I got bloating again, doctor!” Her eyes executed a predator roll somewhere near the ceiling before heading for me again. “So I did some computer research and discovered that the pills contained lactose and cellulose as fillers…” She folded her arms across her chest and waited to see what I thought of that.

“You’re wondering if they are code words for gluten, Geraldine?”

“Wondering?” she said between clenched teeth, the word only barely able to squeak through at the last moment. “Wondering?” she repeated more loudly and forcefully, articulating each syllable as if maybe I hadn’t heard her correctly the first time. “Are you another gluten atheist, doctor?” she asked scornfully.

“No, gluten exists, Geraldine,” I said, conscious of falling into her religious idiom. “But so do common side effects of the birth control pill.”

She tilted her head like a cat figuring out the best way to attack the mouse. “Nope, I know this was the same kind of bloating I got with the gluten.” Her fists clenched, daring me to contradict that.

But there was something about her face… “How long did you take the pill?”

She shrugged and then played around with her eyes, uncertain where to roost them. “A month maybe… And then I took them on and off for a while to see if they made a difference.”

“And…?”

Another shrug. “And yes, stopping them got rid of the bloating for a while.” She stopped and decided to stare at me. “And then it came back, even though I wasn’t taking them.” She took a deep breath and then sat up straighter on her chair. “I asked my GP if it could be some residual effects of the gluten and he decided to send me to you.”

“When was your last period, Geraldine?” Common things are commonest, eh?

A smile managed to crinkle its way onto her lips, and her eyes softened like sponges in water. Her expression turned almost mischievous. “I thought you’d never ask, doctor.” Even her voice, now, was pleasant.

“You’re pregnant?”

She nodded happily. “And it’s going to be a gluten-free pregnancy…” And then as a concession, “Is that all right with you?”

I smiled and nodded. No matter what I said, she’d do it anyway, so I thought it’d be safer to do it under supervision. “I’ll send you to a dietician to help you choose the proper foods for the pregnancy.”

She rolled her eyes again –but this time it looked more like a victory role. “Sorry about the theatrics, doctor –I just had to be sure where you stood on all this.” And then her face fell, if only just for a second. “Funny,” she added, “I thought you’d be more of a challenge…”

 

 

 

 

 

 

by

The Unfallen Yellow Leaf

‘Age, with his stealing steps, hath clawed me in his clutch,’ as the gravedigger in Hamlet says. I’m not so sure I agree –he was speaking about a skull, after all- but I have to admit there are times when I do feel old, and shipped ‘into the land as if I had never been such’; when I do wonder if whatever I have done has gone as unappreciated as a shadow from the moon, as unnoticed as an owl in the night.

I used to think that ‘Aged’ was just a word –but an adjective, not a noun; a descriptor rather than a described -somebody else, in other words… And that makes a difference, even when it is not mentioned in your CV but, rather, implied in the later stages of your career. I prefer to see the years as a kind of parliament where habits, and opinions and experience, all cohabit equitably, calmly debating the memories they were each elected to serve, sifting through them, perhaps, to decide if any merit publication.

And I’m sure there are some memories out there where my face is almost discernible in the background; where at least my voice was recognizable at the time. ‘What you lose as you age is witnesses, the ones that watched from early on and cared, like your own little grandstand’, John Updike wrote in one of his ‘Rabbit’ novels. He’s right, of course –and yet… Sometimes it can happen that you forget the very ones that watched from early on; you forget they cared.

Janice sat giggling in the corner of the waiting room, watching a little child toddle across the room towards her, his legs bowed around bulging diapers, his progress uncertain but determined. I could see her eyes from the reception desk; they glowed with excitement and her head seemed to bob in time to every tottering step. Her entire face became a smile, an expectation living vicariously as the little boy approached, followed closely by his beaming mother.

The consultation request from her GP said she had been referred for antenatal care -as if the rapture in her eyes, and the glow on her cheeks could be mistaken for anything else. Some people wear their pregnancies like jewels. It’s why I love obstetrics.

As I walked across the floor to greet her, she suddenly jumped up and extended her hand. For some reason I had the impression that she wanted to hug me, and would have under different circumstances. Not that I don’t enjoy being hugged, but it did seem unusual from someone I’d never met before. Pregnancy can be an unpredictable gem, though, and I have learned to appreciate its various rewards over the years.

“I’m so happy to finally meet you, doctor!” she bubbled as we headed down the little corridor to my office. “Pregnancy opens so many doors,” she added, smiling at nothing in particular with her eyes.

Indeed, she spoke as much with her eyes as with her mouth as she glanced around the room like a tourist in Paris. They pointed like children in front of each picture hanging on the walls, flitting from pictures to plants and back to pictures again -excited hummingbirds. They finally came to rest on a little terracotta begging lady I’d placed on an oak table in the corner. Pennies dripped from her little bowl, mute testaments to her longevity in the office.

“Where on earth did you get the pennies?” Janice whispered, this time rolling her eyes.

I had to shrug; it was a long story.

“I Googled you before I came, of course, and all your patients seem to mention the begging bowl… Now I see why,” she added shaking her head with what I took to be admiring disbelief.

“And there’s the carving of the woman holding the child and hiding behind the leaves!” she said, excitedly pointing to the little, pot-bound Areca plant on my desk. I was beginning to feel a bit like an employee at a Disney resort.

But then she calmed a little and instructed her eyes to leave the office thermals they soared and perch on my face. I could actually feel them, heavy on my skin, their prey firmly captured. It was almost as if I should understand that they had come back to roost; that mine was the aerie they had once called home. And throughout that first visit, I thought I felt her disappointment –a father finally seen after many years away, that no longer recognizes his child. I could sense a hope for reminiscence, a need for demonstrating familiarity, sharing secrets I couldn’t possibly possess.

Indeed, I got to know her quite well in that pregnancy, and the initial expectation of acknowledgment she had worn, soon blended imperceptibly into an easy friendship. Who once were strangers, now were allies in the weeks, then days, before delivery. But there was always something in the background that I sensed she was disappointed I hadn’t recognized. Something she was now holding as a surprise; something I should have known from the start.

And then, a week before her dates predicted she should deliver, I saw her sitting in the waiting room with an older woman. She’d told me her mother was flying in for the delivery and seemed excited that I was finally going to meet her. I could even feel the italics in the word.

I saw the two of them whispering excitedly in the corner seats Janice always chose, glancing secretly at me as I greeted other patients with earlier appointments. I thought I heard them snickering once or twice, but sometimes people do that when they’re nervous.

They both stood up and glanced mischievously at each other when I approached them. Her mother was a short matronly woman with greying hair that was precariously balanced on top of her head like a silver hay-stack. Her face, though wrinkled, held a pair of familiar eyes that strained at their cage doors just waiting for liberation.

It’s an interesting thing about faces: no matter how much they change, they stay the same… Or is it just the eyes –roses by any other name…?

The waiting room by then was empty, and there was nothing to stop Denise from hugging me, followed, as if on cue, by her daughter.

“So now do you recognize my daughter?” she said, her face an imp, her eyes laughing silently as they flew towards me.

“She’s changed a bit…” I stammered, still flustered by the secret, and admittedly a little embarrassed at being old enough to deliver a patient I had already delivered so many years before…

 

 

 

by

As I Age

As I age, it becomes increasingly clear to me that Life is far more complicated than I could ever have suspected. It is like a stew where I keep finding new ingredients –some to my liking, and some… Well, let’s just characterize them as unexpected -mysterious strangers that surface from time to time, wreak havoc, then disappear again like shadows on a moonless night.

Social movements are often like that –or, rather, social solutions. Society changes over time and it has been the fashion of late, to see this as an evolutionary adaptation to underlying conditions –the slow but steady metamorphosis of caterpillar into butterfly. And yet, sometimes the change is more abrupt -a mutation- and we are forced to deal with the consequences. When things around us change, we attempt to keep up –or at least, like the Red Queen in Carroll’s Through the Looking-Glass, find ourselves running faster and faster to stay in the same place.

And one manifestation of this is the need to preserve a thin weft of values as a template during the inchoate and often thread-bare interregnum. I’m thinking, of course, about the age-old philosophical conundrum of whether we should tolerate the intolerant –and if so, then how? And at what price the compromise? One example from many: the need to establish special female-only transportation in the city of Zhengzhou in eastern China to help women feel safe from sexual harassment. To guard them. http://www.bbc.com/news/blogs-news-from-elsewhere-36169029  Of course, the problem is by no means unique to China -other countries have discovered the same need and arrived at similar solutions.

But it seems to me that the issue is far more complex than these solutions might suggest. This gender issue, in some ways is not dissimilar to the racial problems that surfaced so violently in the last century in America. To think that having different buses for people of colour would salve the problem was proven to be naïve, and in itself discriminatory.

It comes down to the difference between toleration and acceptance: putting up with something that might not actually be approved of –enduring it: ‘toleration is directed by an agent toward something perceived as negative. It would be odd to say, for example, that someone has a high tolerance for pleasure’; versus  Acceptance: acknowledging and welcoming something as itself; permission versus approval. A power struggle either deferred, or shared.

To equivocate for a moment, should we tolerate mere tolerance, or accept it…? As an interim solution, of course. In other words, is it better to have the segregated buses for women, say, than groping and intimidation on more inclusive public transit? To say that there should not be sexual harassment is all well and good, but it ignores the present reality –there is, and to ignore it would therefore be akin to tolerating it. So are we  trapped in a never-ending game of chase-your-tail, forever condemned to wander the Mobius strip looking for an exit?

Perhaps it might be helpful to distinguish the component parts of the issue (I have adapted some principles from the peer-reviewed Internet Encyclopedia of Philosophy: http://www.iep.utm.edu/tolerati/#SH4a).  It seems to me that there is a difference between the more superficial and emotional response to whatever is being tolerated (Let’s call this the Reactive Stage) –the need to separate the aggrieved from the aggressor, for example- and the Rational Stage: the more dispassionate and reasoned analysis of the problem –if indeed such an analysis is feasible, or could even be rationally justified. In other words, on what grounds does the prejudice in question continue to exist? Is it remediable, or inevitable? Should we be forced to retreat behind our own societal boundaries and accept the relativistic excuses proffered that we simply can’t superimpose our own values on those who are not like us? That we, in fact, do not understand –nor likely ever will, since we are other?

Or, closer to home, can we ever hope to change attitudes such as disrespect and insensitivity to aspects of personal autonomy that have been entrenched –and indeed accepted- for countless unquestioning generations -that, until recently, were not even considered problems requiring solutions?

Well, societies do alter as time and members change; I’m not sure we could characterize the alterations as necessarily evolutionary, or teleologically driven, but certainly the initial reactive and then the more rational stages can often be discerned. The societal attitudes towards Gay rights, for example, have undergone major shifts within the past few years –even the initial toleration, which was rare in past decades, is now remodelling itself as acceptance.

So what -if anything- has Age taught me? What has the passage of years and the successive unfolding of events disclosed? Well, it has become clear that in the long run, our enemies become our friends; that we seek and find compromises satisfactory to each –bargains that in due course cease to be seen as concessions by either party, but rather as amicable balance; that Force only suppresses while it is being applied; and that discussion is inevitable and infinitely preferable to confrontation. We may not be able to evince our much-touted rationality in all things, but we are all eventually susceptible –amenable even- to accommodation.

Omnia vincit amor, I suppose.

 

 

by

Unregarded Age in Corners Thrown

I worry too much; I didn’t used to, but it kind of crept up on me along with my aches and pains over the years. Age is something that has always been fraught with tensions as we stumble through the calendar first wanting more, then less and then, I suppose, trying to forget about it altogether -ignore it when it clearly needs to be addressed. Demands recognition.

Age –especially old age- is one of those concepts that is very much contextually driven. Age-driven, in fact: where one sits on the spectrum very much influences age perception. An elder would live many fewer years if it is a teenager, rather than a senior who is canvassed.

But a good case can be made that age is not a mono-dimensional concept. Chronology does not come in one flavour; not all eighty year olds, say, are tied to the same constraints. Age might better be considered as a quartet with the other members consisting of Biological –we all age differently, Psychological –some aged people retain their faculties better than others, and Social –some elderly people, whether by fiat, or necessity, no longer work outside their homes and are no longer as connected to social networks. Indeed, in times past, ‘old’ might well have been related to usefulness rather than chronology.

http://www.bbc.com/news/magazine-34465190

So there we have it: usefulness. Purpose! Self-worth. All contingent concepts to be sure. And retirement, despite the positive connotations that Society has tried to foist upon it, is still a denouement –however it is rationalized. However many cosmetics are applied. Wallpaper may fool strangers, but it is still wallpaper…

So, you see why I worry. It is not that there might not be new opportunities available in retirement -new venues- but simply the realization that it is a final chapter of a thoroughly read book. An epilogue.

But I digress. It is something of a fool’s errand to attempt to encapsulate Retirement under one banner. It is a chapter as yet unprinted, and at best only sketchily conceived. There are also portions of it written, even if unwittingly, by someone else.

There is a store I visit every so often to buy dog food. It is a large and perhaps corporately criticized chain, but my dog is fussy and became addicted when she was only a puppy to a brand only they seem to offer. To tell the truth, I enjoy the store; I enjoy wandering the aisles and feeling -what? – pride at resisting things I do not need and casting a cold eye on those I do not want. It is a juvenile thing, I suppose, but maybe that’s the point: a recapitulation of past temptations seen through different eyes. Different years…

But on my way in, I saw a face that seemed familiar. It wore the uniform of the store and yet it seemed out of place somehow. A bush growing in a patch of vegetables –or more aptly, perhaps, a tree standing all alone in the middle of a field of wheat. Staid and stolid, watching, bemused, the tender stalks waving frenetically around her feet.

It was not so much her age that separated her from those around her as her composure, her calmness in the Storm of Store. In the eye of the hurricane of shoppers intent on their own missions, her smile was like a shrine erected at the doorway, a refuge offered, but seldom taken. Seldom noticed: the store was not a temple –just another place to visit when the need arose, a series of shelves to inspect. There were no sacred places here, no altars, no need to reflect on the meaning of it all. The store fulfilled a function, not a curb-side meditation.

I have to admit, the face was so unexpected, so completely out of context that I passed it by with barely a thought, although I did stop halfway down a nameless aisle and wonder why. And it was there that it –she– caught up with me.

“Doctor?” she asked tentatively, clearly uncertain from behind at least, that it was me. And when I turned to face the voice I remembered somewhat shakily from the past, she smiled broadly. I could see it was all she could do to refrain from hugging me; instead, she proffered a bony hand, its skin replete with veins and the brown patches of age.

“Doris!” I somehow managed to retrieve the name from a long closed memory drawer -although not without an awkward pause because it was not the Doris I remembered, but an older, frailer model. Doris had been well into her seventies when I had last seen her in consultation but this face, this figure, was a worn and crumpled copy of that older woman I had once filed away.

Her smile looked painful it was so wide and welcoming, but it was her eyes that immediately captivated me. Like delicate pale blue figurines trapped behind the glass of an old cabinet, they begged for release, and when she opened their cages they flew to my face and rested there. “It’s so nice to see you again, doctor,” she said with her joy so evident I was almost taken aback.

Her frailty dissolved as I watched, and the younger Doris emerged as if it had been hiding all the while. I remembered her now as the vibrant woman who had quoted poetry to me when I was trying to take her history. Who had dismissed the referral from her GP as ‘misguided over-concern’ from a young doctor uncomfortable in dealing with a patient older than his grandmother. And as a result she had brokered the compromise of seeing an older specialist. When I also agreed that she really had no cause for concern, she’d bonded with me and even showed up at the office the next week with flowers. I suppose we all like our judgements to be validated.

But on that occasion it had led to a discussion of age, and whether or not to succumb. Whether, as Dylan Thomas had written, to go gentle into that good night. Or to… Rage against the dying of the light. She most emphatically was with Thomas, whereas I, in an uncharacteristic disclosure, had expressed uncertainty as to whether with identity obscured and purpose thwarted, I would be forced to go gentle into whatever the good night hid in retirement.

“Nonsense!” I still remembered her saying that, her face fierce, her eyes locked on mine. “Is ‘Doctor’ your last name? Age and function do not change who you are –just what you do…” Then her expression softened and her eyes unlocked from me and twinkled when they had returned to her face. She got up from her chair with an enigmatic smile and turned to me as she was walking out of the room. “Do not become what Shakespeare called Unregarded age in corners thrown. I would be very disappointed.”

I took a long hard look at her, standing in the aisle with her uniform proudly displayed and I smiled. “You’ve certainly taken your own advice, Doris. Not too many people your age would have chosen your path. You look happy.”

“Have you ever read any Robert Frost?” she asked after observing me quietly for a moment.

I nodded, suspecting what was to come.

She closed her eyes and a beatific expression emerged as if she were about to pray.

“Two roads diverged in a wood, and I— I took the one less traveled by, And that has made all the difference.”

There are forks in every road. Maybe she was praying -praying for me…

by

A Gift of Age

Is philosophy a reward of age, or is age itself a gift that metaphysics merely opens: Weltanschauung? Is it just that there is a time when thoughts flow along different and unaccustomed neurons? Or are they maybe shunted to the diminishing residua of nerve cells that are still firing? I ask myself these questions sometimes when night closes in and stimuli flee. At times like this, I wonder if the weight of years are more hindrance than benefit. Less a present, more a penalty.

When viewed from outside the prevailing ethos, age –especially its accumulation- is a gift. A bonus on the journey from which only the very young think they are exempt. And despite the mounting detritus of discarded cells and greying hair, it is a book whose pages, although well-thumbed and sometimes soiled with regret and torn by mistakes, are nevertheless extant, and readable. They are stories told without a plot and written, often, for the author with little hope or even desire for publication.

And yet, congratulations are sometimes lip-serviced  -the words mere decoys to disguise a different meaning: better you than me. In underestimating the years attained, the truth is seldom spoken except casually, as a joke –retractable, and yet echoing uneasily in the room long after it is uttered. Age is a gift, and yet shoddily packaged, the ribbon askew and poorly tied, the paper faded and rumpled with constant handling. Still, it is something at least… A recognition if nothing else.

But I’m making aging sound like night thoughts: a punishment rather than the achievement that it is.

We were talking about this, a patient and I, when she came in for a renewal of a hormonal therapy that helped her cope with one of the gendered ravages of her wealth of years.

“The young just don’t seem very thankful for what we’ve done for them, do they?” she said with a maudlin sigh when the subject came up.

I sat back as well as I could in my creaking chair, and smiled that gently exasperated smile that old folks are allowed. “But we look back; they look forward, don’t you think? Retrospective analysis is the domain of the experienced. Why do you think we have memories?”

“I suppose,” she said shrugging her shoulders in polite acknowledgement of a point with which she was evidently not in complete agreement. “We always seem to criticize generations other than our own when they do things differently, don’t we?”

I nodded. “But if each generation didn’t change a little, we’d probably still be chipping away with stone axes…”

A tiny smile crept onto her lips in spite of her attempt to remain pessimistic. “Speaking of the youth looking forward, I remember thinking of that when I had my first child. You probably don’t remember, but I had a rough pregnancy –high blood pressure, gestational diabetes, and then Melissa not growing as fast as she should in the womb…”

I actually did remember. “She was born prematurely – I induced labour about 34 weeks gestation or so, didn’t I? I recall being rather worried…”

Her face lit up with the shared experience, but her eyes stared far off into the past. “I remember thinking that she should be so thankful she was born. So thankful she was healthy.” I nodded again. “Anyway, a friend who came to see me while I was still in the hospital said that as well as getting presents on her own birthday, Melissa should give me a gift each time. A celebration of how lucky she was.”

I sat up straighter on my chair. “What a great idea, Melanie. And..?”

Her eyes twinkled at me. “Yup –all three of my kids. It’s a sort of family tradition now. Some of their friends are trying it as well, they tell me.”

The idea struck me as terribly innovative. Maybe others had done it, but I hadn’t heard about it. “Think it’ll catch on?”

She shrugged. “It’d be sort of like an accessory nipple in a way don’t you think?  I mean, I suppose that’s what Mother’s Day is for…”

I thought about it for a minute. “Mother’s Day is a bit generic, though. A child’s birthday is unique -an acknowledgement of its own presence in the world… and all because of its mother. It’s not a national day, it’s a personal day. And that’s what makes it so special.”

She stared at her hands she’d folded in her lap and was silent for a moment. We were both quiet. “Why do we think about these things more as we get older?” she said finally, breaking the silence almost reluctantly. “Or is it just me?”

I shook my head slowly. Absently. I was also lost in my own questions. She was right; it did seem to matter more nowadays that we poked around in the past, stirring the embers. But why? Did we really need the fire? The heat? The light? Were we awakening memories, or searching for something else? Looking, perhaps, for ourselves..? As if in the ashes of the dying fire there were patterns. Clues which, if properly mixed, could tell us where we, the lighters of the fire, had gone.

I could feel Melanie staring at me. “I can see you rummaging around in there, doctor,” her voice said, rustling through the room and bursting past the opaque curtain my eyes had drawn across it. “Come out again. I still need you…”

I had forgotten to write her the prescription for more hormones, yet somehow I only heard the words ‘I still need you’. But they were enough. I suddenly realized that the most satisfying gift of all, the most welcome treasure of age, was presence, not presents. And despite anything else that might go amiss, I was needed. Isn’t this what we all work for? When all is said and done, does anything else really matter?