Ageism in the health care industry

 We live in a time of medical specialization. We learn about the family doctor by watching ancient “Little House on the Prairie” re-runs. Where once one doctor oversaw all medical care and actually knew their patients, now it seems there is a specialist for each body part. Add to that the reality that as we age our body parts start malfunctioning; thus we end up seeing a lot of doctors.

Right now I’m in touch with my primary care physician (PCP), an audiologist, a neurologist who specializes in migraines, and a dermatologist. I accompany Hal on his visits to his urologist, gastrologist, an orthopedic specialist in hands and another one who focuses on backs. I may have missed one. All of these doctors are young (from my mature perspective), in their 40s or early 50s. Curiously, my doctors are all female, which I have nothing against. But Hal’s specialists are all male. We have the same PCP, a young woman in her 40s.

Another fact: more often than not these days, when we go to see one of these doctors, we’re likely to instead get the physician’s assistant (PA), usually someone in their mid-30s.

But we need their help, so we humble ourselves before the wisdom and skill of youth. And hope for the best.

I’ve been reading a fascinating book by award-winning scholar and geriatrician Louise Aronson. The book is entitled Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life (2019). Aronson, herself a woman in the prime of life, traveled a twisting path before choosing geriatrics as her specialization. She tells this story in her book.

Among other topics, Aronson gives a penetrating view of ageism (age discrimination, especially against the elderly) in the medical system, beginning with the training of physicians. She writes that

Over their four years in medical school and three to ten years of residency and fellowship training, doctors in training are taught that human beings come in two age categories that matter: children and adults. After required classes and rotations elucidating differences in physiology, social behaviors, and health needs between those two age groups, they choose whether to work in children’s hospitals or adult hospitals, and as pediatric specialists or adult specialists. If they happen to notice that older adults make up to 16 percent of the population but over 40 percent of hospitalized adults, or that patients over sixty-five are the group most likely to be harmed by medical care, that knowledge will be tempered not only by medicine’s predilections for saves and cures but also by comments from their teachers and mentors such as “Unless you really like changing adult diapers, don’t waste your time” learning geriatrics.” (5-6)

Aronson goes on to show how this kind of discrimination in training carries over into medical practice, with many doctors treating and medicating older persons just as they would younger adults, without considering that the aging body has different needs and reactions. She claims that “The second-class citizenship of older patients is entrenched and systemic” in the health care industry.

At this point I need to stop and say that all of my doctors have treated me with kindness and respect. (I can’t say the same for some of the PAs). I’ve detected no obvious ageism.

Yet there is something subtle going on, an uncomfortable itch that only gets worse as I scratch it.

About eight years ago, just as I was entering retirement age, I began experiencing symptoms of head-pressure and dizziness. (I’ve told this story in other blogposts.) I began reporting it to my doctor. Aronson notes that “When a patient uses the word ‘dizzy’ most clinicians will tell you that something inside them clutches, if only for a second.” Even more so if the patient is older. After several years of my mentioning this (probably not forcefully enough), my doctor began ordering tests and referring me to specialists. Lots of them. After two years of exploring the options, every doctor involved told me they found nothing wrong. One even said, “Don’t worry. Most old people have some degree of dizziness. It’s aging.” My PCP said, “I’m sorry. I can’t do anything for you.” And smiled sympathetically.

It felt like no one believed me. So I changed insurance plans and found a neurologist at a research hospital who finally gave me a diagnosis. Like I said, I’ve already told this story.

I really don’t know how many of the obstacles in my journey were due to my age. Probably not all of them. Even so, having read Aronson and made my own observations, I recognize that age discrimination is widespread.

Here are some preliminary conclusions I’ve reached:

1.     I am thankful for people like Louise Aronson on the forefront of a change of attitude in the health care industry, a positive change I believe is coming.

2.     I will prepare myself better for each medical visit, reminding myself that I am a person of value, that my health matters as much as anyone’s. I will gently insist on being heard.

3.     I will prepare to treat my doctors with respect, no matter how young they are, a respect I trust will be returned, no matter how old I am.

The quote at the beginning of Aronson’s book is by Cicero. Apparently ageism has been around for a long time. He said that “Old age will only be respected if it fights for itself, maintains its rights … and asserts control over its own to its last breath.”

Windows, waterfalls, and a beautiful view

 My first thought was an unannounced partial eclipse of the sun, so quickly had the shadow entered the room. I turned to find it wasn’t an eclipse but a man outside my window, pressing up against it.

   I would have screamed had I not then remembered that it was window-cleaning day at the retirement community. It surprises me twice a year, even when it’s announced a week ahead of time. This is partly because we live on the fifth floor, with no balcony. The sudden appearance of the cleaner always catches me unaware.

Actually, I’m grateful that this establishment provides bi-annual window cleaning. One of the reasons we moved into this apartment was the north-facing wall of windows in both rooms. It makes the small area feel spacious and open. We never tire of the view. After the cleaning, the far hills seem especially clear and lovely.

A clear view is so important to personal well-being. When choosing and moving into a new place, my first questions were always, “What will we see looking out the windows? How much light gets in?”

Another type of window cleaning common to people of retirement age is cataract removal/lens replacement surgery. I’m still amazed at the thought of an operation on the eye and that it’s become so quick and routine. “Don’t worry,” my doctor told me. “I do dozens of these each day.”

“Dozens a day” makes it seem like minor surgery, and so it is. But for the person undergoing the procedure, me for example, it’s huge and life-changing. Hal and I had the surgery several years ago. I was thrilled with how sharp and clear my vision was afterward, much better than a window cleaning. I could actually read road signs. The greens were greener, the reds redder.

The name cataract interests me. It has two meanings in English: 1) a clouding of the lens of the eye and 2) a waterfall. The latter is an older usage. But in Spanish the word catarata is the common word for waterfall.

Just before my surgery I wrote the following poem:

I’m having my waterfalls
removed. It will be good
when all the mist
that floats between me
and the sun is gone.
Even so, I’m going to miss
the rush and swirl of moving
water, the mad leap over the edge,
the plunge and crash and all
the lovely daily drama that goes
with having my very own
waterfalls somewhere
inside my head.

Clarity of vision is indeed important to human flourishing. I find my soul frequently needs a window cleaning. Cataracts of fear and discouragement need the surgery of the Spirit so that I can again see the beautiful reality of life in God’s kingdom. The Apostle Paul prayed for the new believers in Ephesus that the “eyes of their hearts” would be opened so that they would clearly see all that God had provided for them.

Clear vision.

Eyes that see truth and beauty—in myself, in other people, in God’s world.

A requirement at any age.

Four older women and me

Bess was the first one. I was just home on my second furlough from mission service in Bolivia. I was in my mid-thirties, a mother of young school-age kids, all of us feeling the awkwardness of being strangers in our own home country. Wondering if we belonged anywhere.

A friend told me about this woman who, at the age of 76, had just discovered that she was a poet. She had self-published two chapbooks of her poems, one of which was titled “Wise and Otherwise.” I loved that title.

My friend told me that this woman wanted to meet me as a sister poet. Still under the spell of reverse-culture-shock, wanting to keep to myself, I, nonetheless called this perfect stranger and asked if I could come over for a visit. Her yes was most enthusiastic.

Thus began my friendship with Bess Bulgin, a friendship that I’ve been grateful for ever since. Even though we were strangers, after that first visit it was as though we had known each other all our lives. Although mentally alive and vibrant, her aging body was beginning to betray her, so she was house-bound. Our weekly visits were at her house, in her cozy favorite room, full of books and memories from her exciting and very full life.

We talked a lot, back and forth, shared life stories and struggles, discussed relationships and the mysteries of knowing God. We read poetry to each other, of course. My friendship with Bess became the stabilizing anchor of that year at home in the US. I went back to Bolivia knowing how much I would miss our weekly times together. We exchanged a few letters, but then her health took a sudden turn for the worse. I never saw Bess again.

I met my second older mentor on another furlough home from the mission field. This was a strange furlough, not on the Mission Board’s schedule. After just one year into our fourth year of service, Hal became sick with a combination of typhoid, amoeba, and hepatitis. His Bolivian doctor didn’t know what to do with him, so, not wanting him to die on his watch, insisted he go back home to the US for treatment. The Board deemed it a medical emergency and had him flown home immediately. That left me and the kids to finish out their school year, pack up the house, and fly home to join him. It was a scary time.

It turned out to be an entire year of recuperation. His doctor took Hal off all medications, and outlined a regimen of rest, nutrition, and gradual exercise. My job was to take care of him (and the kids, of course).

Catherine Cattell had recently moved into Friendsview Manor (where I now live). I knew of her and her husband, Everett, by reputation only. They had served a life-time as missionaries in India and were widely recognized by Indians and Americans alike for their contributions. So I was naturally hesitant (introvert that I am) at imposing myself on her, but I called and asked if I could come over for a visit. The house we were renting was just a block from Friendsview. Again, her yes was most enthusiastic.

Our friendship was instant and, as with Bess, became a highlight of each week. We shared our vocations of mission work and writing. We both had faced the challenges of being mothers on the mission field, not an easy task. All this became regular topics of conversation and I learned much from her experiences and wisdom. We laughed a lot and prayed together. She was a life-line during that difficult time. And I sensed I served in that role for her, too.

Catherine died turning my following term of service in Bolivia.

Inez Smith was number three. Having temporarily retired from the mission field for further education, Hal and I found ourselves at Fuller Theological Seminary in Pasadena, California. We were both enrolled in Ph.D. programs in the School of World Mission, as crazy as that sounds.

Inez was a well-known figure in Fuller circles. Having served for years as executive secretary to long-term seminary president David A. Hubbard, she was now widowed and retired. But that didn’t slow her down. At the time Hal and I were there, she was president of the Fuller Women’s Auxiliary. One of the main contributions of the Auxiliary was raising funds for scholarships for women in doctoral degree programs. After being at Fuller for several years, I was thrilled to earn one of those prestigious (and very helpful) scholarships.

Inez had made it a custom to meet personally with each recipient. So one evening it was my turn. I managed to find her small house on Green Street by her famous large rose garden out in front. I was a little nervous about this meeting (being me), but she put me at ease. She served me tea in beautiful old-fashioned cups (with saucers, of course) and she asked me the usual questions. Somewhere in the conversation, we clicked. She asked me to come back so we could get to know one another better. I did.

At first my visits were occasional, but when Hal left for a five-month research trip to Bolivia, Inez told me I needed to come over one evening a week. So I did. She cooked dinner. Then we talked or watched movies. That year we both celebrated milestones—my 50^th birthday and her 80^th. Our friendship was a life-line and a great comfort during my time as a single wife. Inez has been gone several decades now.

Shortly after moving into this retirement community, I met Harriet Fowler, who became my next older “best friend.” I’ve written about our friendship in other blogs (May 2022, June 2023), so won’t repeat the details here. She died this year just short of her 105^th birthday. I still miss her.

None of these four older friends—Bess, Catherine, Inez, and Harriet—were mentors in an intentional sense. They didn’t deliberately set out to teach me stuff or guide me along the path of life. They befriended me. They were all around 30 years older than me, and because of the difference in age and life experience, I had more to gain from the relationships. And I did learn, more from their stories and examples than any formal lessons they might have taught.

One important thing all these older friends taught me was that it’s possible to be vibrant, alive, creative, caring, beautiful, and, at the same time—old. I remember thinking, shortly after I left Bess to go back to Bolivia, that someday far off in the future, I also wanted to be a beautiful old lady.

They all helped me face growing older as something to actually look forward to, with a sense of adventure and of hope that God would keep on using me.

Now, of course, it’s my turn to pass on this vision to those younger than myself. God grant me the privilege. 

How weighty do I want to be?

In this time of life, the word “weight” has a double meaning. The most obvious refers to poundage. It seems that the older I grow, the easier it is to put on the pounds, and the harder to take them off. And what’s here on my body is distributed in strange configurations. It’s like a heavy weight (that word again) is pressing down from above, making me shorter and spreading me out. When buying new clothes, it’s not just color and style I consider, but what the garment is able to hide. I tell myself that at this age, none of that should matter. But for some reason, it does.

The second meaning of the word “weight” has to do with a serious dose of wisdom some older people exude. We respect these older gentlemen and ladies, not just for their white hair and slow deliberate manners, but because the experiences they’ve lived through seem to have given them a perspective worth heeding. When they speak, we listen. The weight of wisdom.

Quakers have a special take on this kind of weight. They refer to certain people as “weighty Friends.” As a young Friend, I observed that these awesome creatures were mostly old and mostly men. Since then, my perspective has shifted and I recognize many women who gained this reputation, not all of them elderly.

Quite a few years back, in an elders meeting, someone referred to me as a weighty Friend, and everyone solemnly agreed. No one even snickered.

My first reaction was shock (unexpressed in typical Quakerly fashion). My second reaction was laughter (silent, of course). I thought of “Fat Quaker” as a likely synonym, but my need to diet was not extreme at the time. If the pudgy-cheeked man on the oatmeal box were only frowning, he would be the perfect model.

My third reaction has been a lot of pondering and reflecting. I still don’t have it all figured out. I realize that although “weighty Friend” is a uniquely Quaker term, the concept is universal. There are those in every denomination, social group, or extended family whose wisdom is obvious. They are people who have earned wide respect through a life well-lived. They carry a certain moral weight.

But I am a Quaker and “weighty Friend” is one of those delightful Quaker terms that’s fun to say, although the exact meaning slips and slides around a bit. I ask myself, is this remnant from early Quakerism still meaningful? Helpful? And what does it mean in reference to me?

I love the old traditions, even the archaic words. Some of them carry an ambiance of holiness, order, and, yes, Quaker culture. Some still manage to be useful, even after all these years. Maybe “weighty Friend” is one of them?

How am I to hold this term in reference to myself? To be honest, I don’t feel ready to adopt this as part of my identity. Perhaps this just shows my occasional resistance to growing older. Do I also have to grow more solemn, stern, and stereotypically Quaker? I certainly don’t always feel wise.

Actually, I’ve known some older people who were not only wise, they were funny as well. Sometimes hilariously so. Maybe humor is a part of wisdom? If asked if I wanted to be known as funny or as wise, I think I’d answer, “Both, please!” Could one be both weighty and light-hearted at once? I hope so.

As to whether or not I’m really becoming “weighty” as I age, some words from the Apostle Paul come to mind. (By the way, if Paul had had the foresight to have become a Quaker, he would have been a weighty one.)

Here are his words: “By the grace given to me, I say to every one of you: Do not think of yourself more highly than you ought, but rather think of yourself with sober judgment, in accordance with the measure of faith God has given you” (Romans 12:3). And, “Do nothing out of selfish ambition or vain conceit, but in humility consider others better [weightier] than yourselves” (Philippians 2:3).

This gives me perspective. I think “weighty Friend” or even “weighty older person” may be a helpful concept, as long as I apply it to other people. But I don’t need to wonder whether I am or not. It’s not for me to say. If anyone ever calls me that again, I’ll either chuckle out loud or keep my chortle silent, depending on the sensibilities of the person addressing me.

Having worked that through, I feel so much lighter.

Babies and other cute beasts

 A friend and I took a brief retreat on the Oregon coast last week. One morning we were just sitting and looking out the window at the ocean and the people walking the path just a few yards away.

Then Francie exclaimed, “Oh! How cute!”

I responded with, “Yes! A fluffy puppy going poop in the grass!”

She came back with, “What?!” (She didn’t actually say, “You’re crazy!” but she communicated it with the look on her face.)

It turns out that we were looking at the same scenario but seeing different things. She was looking at the bundled-up baby in the man’s arms, and I saw the dog who was, indeed, doing its business on the edge of the path. Two different perspectives. Both kind’a cute.

I have a life-time of memories of cute dogs, most of them named Mokey. When I was two-years-old, Mokey was a small cocker spaniel my parents considered an appropriate pet for a little girl. What I remember about Mokey comes mainly from black and white photos. My parents told me that one day I did something terrible-two-ish to the dog. He bit me, and they took him to the pound that very day.

Mokey #2 was a black and white springer spaniel with long ears and a playful sweet disposition. We all loved him. In my teenage years Mokey was a golden collie and my special friend during the times I needed one.

During the Bolivian years we lived in the city of La Paz with little yard space, so we decided not to have a dog, until the day our daughter brought home a fetching terrier puppy (saying the neighbors gave him to her, which wasn’t exactly true), and we couldn’t resist. We named him Mokey.  After Mokey’s untimely death (ant poison) we adopted a Pekinese and named her Cindy-Lou-Who (who was not more than two); we couldn’t name her Mokey so soon after the death of her beloved predecessor.

We loved all these dogs. Dogs can be the most affectionate and cutest critters ever.

The same for babies. I must humbly admit that both my children and all my grandchildren were over-the-top super cute babies. When pushing the baby down the street in a stroller, people passing us would stop and gasp. (My memory may be a little faulty on that point.)

But—and here I come to the main point of this blog, the cutest of all cuties is yet to come. Our granddaughter and her husband have just informed us that we are going to be GREAT GRANDPARENTS! For the first time ever! Wow!

Good writers don’t use many exclamation points. And they are parsimonious with adjectives, but that announcement has just got to be the most Phenomenal! Splendiferous! Fantastic! Amazing! Incredible! Exhilerating! and Exponentially Outlandish! news of all time!

Can you tell this is my first grandchild? Can you tell I’m excited?

Get ready! Cuteness is coming.

(Maybe they’ll name him/her Mokey.)

The soon-to-be-parents, Bree and Jade

                        cute baby tree surrounded by parents, grands, and greats