Ernest Hemingway famously wrote in The Sun Also Rises that one goes bankrupt gradually, then suddenly.
Of course, Hemingway was referring not only to how money is lost, but to the way many things work and how humans fail to perceive those things until they’re done deals.
Which brings me to this burning question: How does a 74-year-old man, who just 3 short years ago was faring quite well with the modest ministrations of a primary care doctor and a dermatologist, find himself awash in ‘ologists?
In my case, a pulmonologist, urologist, cardiologist, ophthalmologist, neurologist, endocrinologist, and gastroenterologist, for openers. Toss in an orthopedist, a neurosurgeon, a hand specialist, a podiatrist, an ENT specialist, an oral surgeon, and a parathyroid doctor. Two players short if you’re choosing up sides for softball.
I can’t help but wonder how this came to pass for a relatively healthy adult male, with no underlying conditions, or any conditions that keep him from walking 4 miles at a clip without breaking a sweat. Aside from the symphony of snaps and crackles that provides the daily soundtrack for my morning rise out of bed, I feel just fine. Too fine to be spending half the remainder of my life trying unsuccessfully to tie the back of a hospital gown.
The Magic Number
It happens that way, noted my former neurologist, while taking me on a guided tour of my cervical spine MRI, which looked a lot like Georgia O’Keeffe’s rendering of a cow skull and was nearly as haunting.
Three score and ten seems to be the magic number when it comes to his particular specialty. That’s when new patients start showing up en masse with radiating sciatica, disk herniations, and ancient compression fractures, the result of 7 decades of spinal wear and tear that goes unnoticed until suddenly flaring into soul-crushing pain. I saw it play out in the neurologist’s overcrowded waiting room, a wailing wall of alter cockers.
“I’ve also heard it called the ‘organ recital,'” says Charlie Paikert, an old friend who is about to turn 70 and has added a half-dozen medical specialists to his own active-duty roster. “Seniors can’t help themselves from launching into a laundry list of their ailments.”
Supporting such anecdotal accounts are reams of data. In 1980, about 62% of seniors saw primary care doctors vs. specialists. By 2013, those numbers had flipped. Today, nearly a third of US seniors see at least five different doctors every year. According to one study done at the dawn of the new millennium, among the non-elderly, about one in three patients each year were referred to a specialist. Among seniors, it was two referrals per patient per year. Still another study places the average senior in the New York area in a medical setting 25 days a year – a trip to the doctor every 2 weeks.
No Shortage of Specialists
The reasons are obvious. For example, seniors tend to have problems with balance, resulting in more falls and lots of new patients for orthopedists, neurologists, back specialists, hand specialists, and trauma care doctors. Likewise, spinal columns shrink as cartilage grinds down, while prostates enlarge with age. There is no shortage of specialty doctoring to go around.
“I think the data will generally point to a magic age when seniors suddenly need specific kinds of medical care,” says James Brandman, a friend and retired oncologist (thankfully, one of the few remaining ‘ologists whose services I do not require).
“But when you get into the details, it gets more complicated. Someone like you, with good health insurance and the wherewithal to [navigate] the ins and outs of the medical world, is going to be seeing far more specialists than someone with fewer financial and mental resources who lives somewhere where medical options are limited. ”
That is no doubt true. The building complex on the swanky North Shore of Long Island that houses many of my doctors makes the Pentagon look like a one-room schoolhouse.
There Are Notable Exceptions
All that being said, not every elderly medical patient goes through the same cycle of discovery. For some older Americans, there is no gradually, only suddenly.
The oracle in these cases is not Hemingway, but rather Henny (as in Youngman).
“Doc, it hurts when I go like this,” goes one of his classic one-liners.
“Then don’t go like that,” replies the doc.
My wife’s cousin, May, lived the first 96 years of her life in Henny’s joke. No doctors, no medications save an occasional aspirin, no significant medical issues.
Just 96 years of not going like that.
That is, until May went bankrupt, gradually and then suddenly, and had to go into a nursing home.
Within 48 hours of entering the facility, May was on a dozen prescription medications: treatments for hypertension, high cholesterol, diabetes, hyperthyroidism, and osteoporosis, with a Lasix kicker.
And, just as I expected, the prescribing nursing home doctor, under questioning, cited seemingly valid reasons for putting the formerly med-less May on a panoply of new meds.
None of this mattered much to Cousin May, as her last 15 months on earth were filled with music and the company of others.
When she did pass away – quietly and suddenly – having beaten the odds and the ‘ologists, it was as if she’d just taken a final victory lap.
Mark Mehler is the author of He Probably Won’t Shoot You: Memoir of an Adult Protective Services Case Manager (McFarland Publishing, 2021).