Managing Older

photo from flickr

It's a reflection of how good the Australian health system is that most of its people are now the second longest living people on Earth. A baby born in Australia is expected to live an average of 81 years old, an average currently bested only by the Japanese. It's no wonder then that most of the patients we see at work are elderly - the mark of an aging population. Here it's quite commonplace to see active and healthy octogenarians and even nonagenarians, some just a couple of years shy of the century mark and a dinner with the Queen.

This is something that, as a doctor, is quite new to me, coming from a country where the life expectancy at birth is easily a decade below Australia's and most of our patients are lucky to get any medical treatment at all. Dealing with such an elderly population has been a learning experience in itself, but it has its own share of difficulties and heartbreaks.

Aging inevitably takes its toll on the human body, no matter how well one lives, so it's not surprising that most of our elderly patients have multiple medical problems. While there are also a number of elderly patients who have reached their grand old age with few serious co-morbidities, arthritic pain and reduced mobility is a common problem many share. A good number of them have been living in late-stages or even end-stages of many chronic illnesses for a number of years, the natural course of their diseases staved off by the good health and community support they are given by the system.

I had never seen many patients with dementia - until I came here, where many of my very old patients have it one form or the other. It's profoundly sad seeing someone struggling to hold on to the bits of pieces of themselves and failing. In the span of my three months here, I have seen many people falling into the entire spectrum - from those who are just beginning to gradually slide into short-term memory loss to those who have to be placed in higher level care because they would be otherwise a danger unto themselves. As heartbreaking as it is to watch as an outsider, I can only imagine how it must be for the patients' families and caregivers.

Strange as it may sound coming from a doctor and someone in the general business of prolonging life, dealing with older patients has made me realize one thing: I do not want to live to grow that old. Friends and I often morbidly joke that the best way to go is by sudden cardiac death after you've been old enough to enjoy life and a bit of your retirement - you won't even know what hit you.

Don't get me wrong, I don't mean any disrespect. I do want to live a long and active life, and I hope to be healthy for the most of it. But I don't want to live long enough to feel my knees, hips, and back start to go even with the aid of modern surgery; don't want to live long enough to lose control over my bodily functions; don't want to live at all if living means losing myself mentally little by little. I admit that this mind-set and very personal preference sometimes makes me wonder if maybe some of the patients who we treat full-on feel the same way.

Having come from a system where financial constraints often dictated the extent of what could be done for our patients and the choices were often limited and thus more clear cut, working here has been different kind of challenge. In this health care system where in medical care the sky is the limit, doctors treating these kinds of patients are faced with many difficult questions.

Issues like pre-morbid quality of life and projected quality of life after admission are no longer trivial questions asked for mere completion of a patient's personal and social history but very important pieces of information that are core to the medical team's approach to management.

I've heard it said often that one of the hardest lessons a doctor must learn in his lifetime of practice is knowing when it is best to fight harder and when it is kinder to let go. In this environment of relative abundance in medical technology and resources, I think that maybe it becomes even more challenging lesson to learn. Click here to read the rest of this post.

Breathing Room

I just marked my third month completely on my own, in a city I came to without knowing anyone, on the biggest, bravest, most spontaneous leap I have ever made in my overly-cautious, over-planned life. I know it's an overused cliche, but time does go so incredibly fast - and the year I initially planned on staying here is a quarter done.

I can go on and on about the pros and cons of living abroad. There is so much from back home that I miss - not the least of which are the people I love, the familiarity of home, the lifestyle I am accustomed to. But there is also a lot about being here, independent for the first time in my life, that I am learning to love.

I'm settling into a routine, finding new friends, and slowly beginning to realize that this is not an extended vacation to an exotic place - this is my real life and this is where I live now. Some days I just want to hop on the first plane back home, but some days I also wish could stay here forever. It gets so confusing that I've given up pondering on that for the moment.

I'm living my life out here one day at a time, and I am slowly becoming more comfortable doing it. For the first time in my life, I have room to breathe. Living in the moment has given me space and time to get to know myself better in ways I have never really done before. I may not have done anything drastic or even remotely adventurous, but for the first time in a very long time, I am reveling in an air thick with possibility.

I still have no solid future plans and am still in a free-fall with no clue as to when I will hit the ground. But this early on, I can say that regardless of outcome, deciding to come here and do this was a good decision and one that I do not regret.

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The Last Word on This - For Now

A stuffed up internet connection that went kaput on me just as my friends were beginning to have on-line conversations with me about the two previous posts didn't keep this particular email from getting through.

I've paraphrased some things for clarity and to protect the identity of the writer (but by her choices some will know her ;P), but I asked her if she would be okay with posting her email in its entirety. Here's her argument for the multitudes of women who choose to "waste the pretty" and why it's alright.

Being an avid follower of your blog, I paid close attention to your post about "He's not just that into you." Perhaps this is just me being too predictable - because if there's anyone the title of that book is directed to, it's me. and I'm guilty as charged.

I got a copy of that book back in May, as a gift for myself on someone else's birthday. I went to a bayside nook and kept an appointment with myself just to read it because I thought it would be liberating. But I was not even halfway through it when i junked it and picked another reading material instead.

First of all, it's not applicable for Filipinos! there's a chapter there saying "if he likes you, he'll have sex with you all the time." Bwahaha! Ridiculous in our setting, right? And there are a lot of other things there that just don't apply, and are even contrary to what i think is right or proper. I think it was in the introduction or the preface when both authors cautioned us that the concepts in the book apply to the "usual" males. And I mean, duh! I, for one, wouldn't even bother if the guy is just normal! And I refuse to be plain "normal" myself.

As one of our teachers once said, "normal" is just an arbitrarily derived population-based mean. It's a bell shaped curve. If you don't fall within the interval where most people are, then you are no longer normal. Who wants to be in the middle of that bell shaped curve anyway? As for me, I will not settle for normal. That's the one thing my system just rebels against.

It's not that I'm defending my follies. I agree with the main concept of the book - that we have to love ourselves enough and not settle for someone who can't make us feel as special as we truly are. There are some huge important truths in his ideas. I do think a lot of his examples make women look too stupid. And too normal. hehehe. I really don't think most of them are real.

For me, it's okay to remain romantic and dreamy - but with your feet firmly grounded. And whatever choice you make, it should only bring out the best in you. So in the long run, even if "he's just not that into you," and you took a risk on him, you should still turn out to be a better person. You will still be that fearless, special, fabulous, intelligent female that you truly are. Maybe in the end, you will realize that you were really not that into him either. But having things not work out doesn't really hurt you because that previous delusion actually made you better.

Maybe deep down, I'm still a romantic, quirkyalone who prefers the oyster i picked even if it's an empty one. I'd even keep the shell. So sue me!

As someone who has chosen to "waste the pretty" on some really huge illusions and delusions, this perspective somewhat comforting. And true. I think we all come out of any experience like this a stronger, better person regardless of the outcome. And still hopeful, thankfully. Always still hopeful.

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Variations on the Single Theme

photo by me from the "water" set

An anonymous reader posted a thought-provoking comment to my previous post about the book He's Just Not That Into You and how it's sort of pegged my hopes (not that high to begin with) even lower to a new level of low when it comes to men.

So by accepting the "new all time low" are you deducing it's best to "not waste the pretty" until it wastes itself?

Very good question - to which, at the moment, I honestly have no clear answer.

"Wasting the pretty" is very closely related to the concept of settling. Basically, the premise is that women should recognize what they're worth and shouldn't settle for someone who isn't going to treat them way they deserve to be treated. Neither should they stay in a relationship that is half-baked just so that they can be in a relationship. The book's premise is that women shouldn't waste the pretty because they are going to miss on the opportunity to find someone who is more worthy of the pretty.

Of course those of us who have been more or less single all of our lives know just how easy that actually is. All I have to say about that is one big, "Whatever." But I digress.

I am enjoying my single life enough to know that even if I am single for the rest of it, it wouldn't end my world. It is possible to be alone and be happy. And in that sense, choosing not to settle - ergo, not to waste the pretty - and holding out for the real deal that may or may not come along is hardly letting the pretty waste itself.

I started this year writing about choosing to be a quirkyalone - "a person who enjoys being single(but is not opposed to being in a relationship) and generally prefers to be alone rather than dating for the sake of being in a couple. With unique traits and an optimistic spirit; a sensibility that transcends relationship status."

But to be honest, there are days when I sometimes feel that I am just trying to convince myself that I am happy being single. Having been brought up and socialized the conventional way, I have been conditioned to want the usual things - to meet a decent guy who I'd want to settle down with, get married, start a family, etc. I won't deny that I still want that, even if I am enjoying living my current "out-of-the-box" life.

But I also refuse to settle for anything less than what I could have or deserve to have. There's still a part of me that holds on to the hope that there is someone out there who fulfills all my non-negotiables and is being prepared by Fate or by God just for me, for real, forever. Maybe these are unrealistic expectations for someone like me at this stage in my life, but I still choose to hold on to them.

So, yes, underneath all my cynicism I still choose to be an optimist - at least for now.

Will my answer change in a few years, when those creeping fears about growing old alone come more often in the night? I hope not. It's hard to say with finality what it is that one would choose to make compromises on in the light of trying to get something you really want. I guess it also boils down to what you want for yourself in the long term. But I sincerely hope not.

I guess there really are no easy answers to this kind of question. I know that if I think in terms of odds, they aren't really stacked in my favor. Yet I choose to think in terms of faith right now - faith that no matter how things turn out, whether or not I find a guy who is worthy of the pretty or whether I live the rest of my life as a fancy-free single lady, it will be what really is best for me.

In the end, happiness and fulfillment really depends on how you choose to live your life - and I hope to continue living my life as fully as I can regardless. And, as I have already said, choosing to make the most of every day I am given is hardly letting the pretty waste itself.

Besides, I'm finally beginning to realize that I do, in fact, have a lot of pretty to spare. And that's a pretty great lesson to begin learning at this point in my life, don't you agree? :)

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Feeding the Cynic

Knowing my already ambivalent attitude towards men in the context of a romantic relationship, my friends were the first to tell me to stay away from this book. A long history of disastrous (non)relationships and unrequited whatevers, watching the romantic disasters befalling my friends, and being around "real guys" much of the time have turned me into too much of a cynic as it is. The last thing I needed was more fuel to the flame - and "He's Just Not That Into You" is just that.

Being the contrary person that I am, I read it anyway.

Often times harsh, occasionally laugh-out-lout funny, but always very honest, Greg Behrendt decodes the motives of guys who disappear, guys who don't call when they say they do, guys who just "want to be friends" but with benefits and other variations on the same theme and give us puzzled women the bottom line in no uncertain terms: "He's just not that into you." Liz Tucillo, who co-authors the book and stands for all the other single women who have ever been in this boat, tackles the reason why it's so hard to swallow Greg's advice - and why we should.

It's a "he-said-she-said" approach that is no-nonsense and gets the message across. And, when all is said and done, the real message that they want to send across is that women should not "waste the pretty."

As I flipped through the pages of the book, I couldn't help a wince here and there as I recognized myself not just as a person on the receiving end of "he's not just that into you" behavior, but as the friend who has spent hours on end with another friend analyzing her relationship problems and throwing out myriad, hope-inflating what-if speculations. True, even before the book, I was always more the hold-your-horses-are-you-sure-you-can-trust-this-guy devil's advocate when my friends would gush to me about guys they are excited about, but being a closet romantic, I was capable of optimism.

I may be a master of not getting my hopes up, but this book sort of sets the standard to an all-new low.

I think women have always really known the bottom line, we just haven't been happy to accept it. So there is a certain degree of freedom gained by being slapped all of this in the face and seeing everything in black and white. Then again, there's always something to be said about living in denial - it's a lot less painful there.

Okay, okay, I know relationships are a lot more complicated than that, it's impossible to generalize, blah, blah, blah. Maybe your guy has a good excuse for not calling. Or maybe he really just isn't ready to put a label on your whatever-it-is. But I think that this book's premise is worth looking at specially if you've been putting your life on hold for a good long while - it just may give you a new perspective.

I, for one, am planning on getting some post-it, writing "Don't waste the pretty" on it, and putting it up somewhere I can see it every day. Maybe if I repeat it to myself often enough, I'll get it.

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Discovering "A Fine Frenzy"

I haven't been able to sate my music addiction for quite a while, even if my battered iPod (which I must replace before it completely falls apart) has been my constant sanity-saving companion through this journey so far. But my need for new work-out music (yes, I have gotten off my lazy bum and started exercising again - more on that later) and a reason to procrastinate from studying (can you blame me? I've been studying for something or other for more than half my life) led me to this delightful new sound to add to my ecclectic playlist.

Knowing my fondness for indie/singer-songwriter artists, Jean - travel companion and fellow music addict - first introduced me to A Fine Frenzy while I was marooned in Amanpulo and told me their single "Almost Lover" would be perfect for my beach soundtrack. The song was injected with just the right amount of angst and wistfulness to accompany a solitary sunset with no one but the sea for company - and I loved it.

On the basis of that one song, I've managed to hunt down the rest of the tracks off their album, "One Cell in the Sea," and with the exception of a couple which I chucked out, I have loved most of them. Lead singer, Alison Sudol, has a haunting voice that just grabs at you, and the artful arrangements of piano and guitar provide a great foil for it.

But one of the things I like most about her music is the honest and heartfelt storytelling that comes in every song. I'm a sucker for "I can so relate to that!" lyrics - which means that, on occasion, my playlist does descend into pure sentimental pap. I'm a sap - so sue me!

My current favorite track from this really great album is "Whisper." Aside from the catchy melody and great guitar, it kind of tells the story of my present life in less than five minutes. Other gems for me are "Near to You," and "Ashes and Wine."

I never claimed to be an expert in music, just someone who loves it - so maybe you should take my review with a grain of salt. But if you have time to spare and are looking for a new artist to add to your personal soundtrack, you really should give the music of "A Fine Frenzy" a try.

Whisper

Running the race
Like a mouse in a cage
Getting nowhere but I'm trying
Forging ahead
But I'm stuck in the bed
That I made so I'm lying

But if you keep real close
Yeah, you stay real close
I will reach you

I'm down to a whisper
In a daydream on a hill
Shut down to a whisper
Can you hear me still

Eager to please,
Trying to be what they need
But I'm so very tired
I've stopped trying to find
Any peace in my mind
Because it tangles the wires

But if you keep real close
Yeah, you stay real close
I will reach you

I'm down to a whisper
In a daydream on a hill
Shut down to a whisper
Can you hear me
Can you hear me still

The sound tires on my lips
To fade away into forgetting

I'm down to a whisper
In a daydream on a hill
Shut down to a whisper
Can you hear me
Can you hear me

I'm down to a whisper
In a daydream on a hill
Shut down to a whisper
Can you hear me
Can you hear me still

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