This is the first of a series of essays on health, illness, and age that will be posted weekly.
I’d like to talk with you about the intermingling of health, illness, and aging. They have become inseparable for me and, I imagine, for many of you. I spend more time than I’d like or ever thought possible going to doctor’s appointments, trying to decipher what they are telling me, and making decisions that sometimes feel like shots in the dark. My moods swing with the visits, the reports, and the outcomes. Family and friends are almost always compassionate but they also have their own needs, fears, and schedules, and it is only right to attend to them, too.
For the last few years, I’ve been dealing with a hiatal hernia—my stomach moving through my diaphragm and up into my chest—and the hullabaloo that it has created in my life. It has required tests and surgery and recoveries, speculation about how the treatment will go, sometimes obsessive observation of the outcomes, and trying to make meaning of those outcomes. Will I be more limited? Will pain become chronic? Is my aging accelerating? What and who can I depend on? I don’t like all this attention to bodily functions but I don’t know what the alternative is.
Let me offer an example. A few years ago, I began to feel tired, not sometimes but most of the time. My legs felt like they were weighted down. Walking felt effortful instead of easy and joyous as it had for most of my life. It certainly didn’t feel like it was toning my muscles or any other part of my body. It left me exhausted, and I began to nap instead. The weariness was not so dramatic that I thought I was ill. So I turned to the most obvious explanation: I had passed my seventieth birthday and I must be getting old. “I guess this is what it’s like,” I thought, “and I had better begin to adjust to this reality.”
As it turned out, I had iron deficiency anemia. Not good but, treatable through infusions of iron. Within a few weeks of beginning the infusions, I felt like my old—or my prior—self. What an unbelievable relief. Not just that I hadn’t marched too far into old age but that I could do something to effect my health. At least in this case, I could have some say in the matter. I was not a passive victim but an active contributor to my well being. I had conflated aging with ill health, which is easy to do, especially as we grow old. We really don’t know how to interpret changes in our bodies, but we can surely learn to do it better.
For the last three years, I have been writing in my journal in an effort to make sense of the hernia, anemia, and aging processes. I have needed the privacy and perspective that my journal offers. But now I feel a little more comfortable with myself, and have begun a series of brief essays that trace my journey with illness, doctors, hospitals, family, and my own psyche in order to raise a number of themes that I believe we share.
In the spirit of Charles Dickens and all those wonderful nineteenth century novelists, who serialized their work in weekly newspaper columns, I’m going to post these essays over the course of time as an unfolding story. My hope is that this will permit readers to take some pleasure in their own detective work. You have all had direct or indirect experience with illness, injury, doctor’s visits, surgery, gratitude, and frustration with the health care system. When you learn, for instance, that I have been anemic, I imagine that you will bring your own associations to feeling weak or slow or blue. I would expect you, like the Google-infused medical detectives we have all become, will use your own knowledge and experience to begin building a diagnosis. What causes anemia? What impact does it have on the rest of your body and your emotional life? We will travel this path together.
Woven into the narrative, there will be discussions of general themes. How easy it is, for example, to conflate illness and aging. How do we lay people navigate the complexity and, often, the impersonality, of the medical system. The difference in passive and active approaches, acceptance and fighting, “realism” and hope. What is the story we tell and the story we are told about a particular problem? The intersection of personal and medical narratives profoundly affect how we experience illness, health, and aging.
Then there are times when we are caught between the choice of “solving” something once and for all—let’s say, through surgery—or patiently observing the course of a problem in order to build a stronger hypothesis about what’s going on. There are many times when doctors are indirect or disagree among themselves; and we are left to push towards clarity or to make decisions that we are unqualified to make. What to do in these tense circumstances? Sometimes family members, because of their own temperament or schedules, want matters resolved quickly or want to hold off to the last possible moment; and you have to decide how ‘self-centered’ you want to be or how decisive you can be in the face of opposition.
Over the last several years, I’ve gotten to know the routes to the Massachusetts General Hospital and the Newton-Wellesley Hospital at least as well as the route to pick up my grandchildren at school. I know the side routes, the ones that avoid traffic, the ones that feel more relaxing. I know the best places to park, the best way to reach medical assistants. I’ve gotten pretty good at reading my medical reports over my internet portal, where I have my own special password. In short, I’m becoming quite the expert on negotiating the practical side of of the medical system.
I’ve also come to know myself better—probably the main reason I am writing about my experience. What strengths to call on in myself and in others, or which anxieties I can anticipate and not double down on. Getting anxious about the prospect of anxiety, for example, can worsen matters immeasurably. I have learned to let some fears to just flow by, paying them very little mind, and never letting them capture me. I have learned a good deal about the tendency to conflate illness with aging, which sometimes robs me of the capacity to make firm decisions and to thrive in difficult times. There is some wisdom to be had by paying attention during this journey. I want to share it with you and to have you, in turn, share your own wisdom. Let me know what you have learned.