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.”

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.)

                                Future parents, Bree and Jade

   Cute baby tree surrounded by parents, grands, and greats

Giving our grandchildren back to God

 Saturday morning we got an alarming message from our grandson Aren. “A large earthquake has just struck. I’m out in the streets with crowds of people. I’m OK.” Aren lives in Marrakech, Morocco.

This earthquake has been in the headlines the last three days, with news of the devastation. The 6.8 quake struck without warning late Friday, the epi-center being south of Marrakech. While the city was minimally affected, many small villages to the south in the Atlas Mountains have been decimated. The 2700 people reported dead (and the number is climbing) are mostly in these villages.

We proudly watched Aren graduate in 2019 From George Fox University with a degree in engineering. He soon found a job with a large business in the greater Portland area, but his heart has always been in overseas service. He spent several years searching for the right organization and situation to go out with in some kind of short-term service, thinking that two years might be enough to get direction for the rest of his life. He wanted to be involved in helping people start small businesses in poverty-stricken areas. 

We always knew that someday he would leave family and be off somewhere on the other side of the world. We knew this would probably be a good thing. And we knew that we'd miss him.

A few years ago he discovered an opportunity with an NGO in Morocco. They were working in setting up a unique business in the city of Marrakech—a climbing gym. Aren is athletic and loves climbing walls and cliffs. It seemed a good fit (and has proved to be so), and so a year of applications, interviews, a visit to the field, and raising support followed.

Finally, in November of 2022, less than a year ago, Aren boarded the plane in Portland for his big adventure. Although we had walked with him through the difficulties and triumphs of the process, praying often and participating in the excitement, it was hard for his family and friends to see him leave.

It’s been a good experience so far and Aren has been faithful in communicating. (Thank God for modern technology that allows for actual conversations and instant messages.) He has focused on language and culture learning, forming relationships and, of course, learning the business. Although missing home at times and experiencing the natural ups-and-downs of this kind of cross-cultural experience, he seems to be thriving.

Friday night, Aren was sitting in his living room with a Moroccan friend when the floor started dancing. They ran out into the streets where people were in panic, the pavement still bouncing around. Buildings in his immediate neighborhood were still standing, although everything seemed precarious. Aren told us that his ADHD helped him and he immediately assessed the situation and began thinking through possible actions. After the ground stopped moving, he and his friend headed on foot for the home of a team member where he was able to borrow a four-wheel-drive vehicle. Aren and a few of his friends loaded the car with as much water as they could buy. They drove through the city, seeing it was only minimally damaged, and headed out to a village where one of his friends lived.

Half the buildings in the village had been destroyed and many people killed. Survivors were dazed, walking around, grieving. The guys spent the rest of the night there, searching for survivors, digging through rubble, comforting people as best they could. By morning they saw trucks of Moroccans entering the village with enough supplies and workers to begin meeting the need. They went home to sleep for a few hours before heading out to another village the next day.

He called us this morning (his Monday evening) and we mainly listened. He says he is not yet ready to emotionally process what is happening to the country and to him personally. There is still too much to be done. He’s especially concerned for the many remote villages without easy access. He wants to take his motorcycle up into the hills to discover communities that need help.

That sounds really dangerous. But we held back on counseling him not to do it. It would be our fear speaking, not whatever wisdom we might have. We have to leave him to his own discernment of what God is asking of him.

But I do fear, even as I am proud of him. Hal and I both have the sense that God placed him in this situation “for such a time as this.”

I’m remembering this morning the message from Kahlil Gibran about children (and grandchildren). I read it and marked it up years ago, before I was even married or had children of my own. It touches me today.

Your children are not your children.

They are the sons and daughters of Life’s longing for itself.

They come through you but not from you.

And though they are with you, yet they belong not to you….

You are the bows from which your children as living arrows are sent forth.

The archer sees the mark upon the path of the infinite, and He bends you with His might that His arrows may go swift and far.

Let your bending in the archer’s hand be for gladness;

For even as he loves the arrow that flies, so He loves also the bow that is stable.

From toddler to totterer

 One of the joys of being older is that many of us can identify life-long friends, people we knew in our youth and who we still consider close friends. Whether physically together or apart, we’ve experienced the different seasons of life together and shared our struggles, as well as our hopes and dreams for the future.

I’m not talking about acquaintances or cousins. Real friends. Soul mates. Kindred spirits, as Anne of Green Gables would put it. I’m blessed with a handful of these, and most of them are still living.

I met Darlene over 50 years ago when we were both young wives, attending, with our husbands, the same small congregation in Arcadia, California. Our first-born babies knew each other, as much as babies can actually know someone other than mother. We’ve kept touch through the years, sometime living on separate continents, sometime living in the same town. We live in different states now, but we keep up on the phone and even with occasional in-person visits. We still regularly pray for each other.

Last week Darlene was the featured writer for the Fruit of the Vine devotional booklet. In the introduction to her week of meditations, she writes, “How did the decades fly by like blurry scenery outside a high speed train? Suddenly we rounded a corner, slowed down a bit, and I stepped off in a different country! Whoa, I’m transported to ‘elder land.’… This week, I’ll share personal experiences from my new platform.”

Darlene’s a thoughtful person and a good writer, and the week’s readings were rich. She gave me permission to share here the meditation from Friday, September 1. It’s called “Everlasting Arms.”

When our great-grandson took his first triumphant steps, everyone cheered, acknowledging this amazing accomplishment! It takes a constellation of brain-to-muscle internal steps precluding that final coordination to success. But there’s still a long perfection process afterwards, called the toddler stage. Lots of wobbling, insecurity, falling, grabbing ahold of something solid, trying to gain better footing—then, confidence.

There are lots of toddler steps throughout life’s journey. We experience them personally in new environments, jobs, and relationships. It all takes time, and we don’t always get encouraging cheers. We learn to walk and then to run, then finally how to slow down.

Eventually, we re-enter another period of insecurity and join the tottering stage! Post-operative hips and knees, weakening muscles, and unsure eyesight make what was once easy traveling now more precarious and mindful. We’re more apt to use the railing, walk closer to the wall, and unashamedly accept an offered arm on unstable landscape.

At any age throughout our journey, we feel insecure when hitting rocky roads like death, disease, or divorce. We may need help getting back up after an emotional loss or physical fall. From toddler to tottering (and all stages between) we need grace. Our Lord promises to walk us through the valleys, over mountains, and through pastures—to guide us with rod and staff, and his loving arms to lean on. Because we are the body of Christ, we need our hands to lift and help others.

Prayer: Lord, please help me to be sensitive to the needs of others who may need lifting up. (By Darlene Graves with references to Proverbs 3:5-6; Psalm 91:9-12; and Psalm 121:3-4.)

I love Darlene’s description of life’s developmental stages: “We learn to walk and then to run, then finally how to slow down.” The journey from toddler to totterer makes me smile. Two things we all need for facing old age are courage and humor. Thank you, Darlene, for encouraging me and for making me laugh.