A Little Old Lady

Among the unglamorous tasks involved in the renovation of our apartment was the choice of toilets. In pursuit of this goal, my wife recently set out to visit the distributor of the toilets she was considering. Their showroom was at 5 Mercer Street, in Soho. When she arrived at Mercer Street, a personable and most presentable young man stopped her and told her she couldn’t enter. “But I need to go to number 5 and I believe it’s on this block.” “Yes,” he told her, “it’s at the end of the block and that’s where we’re making a movie. But I’ll call my colleague there and tell him that you’re coming, and when there’s a break in the filming, he’ll let you through.”

The young man picked up his walkie-talkie, established connection with his colleague, and said “I’m sending a little old lady through.”

“I may be old and I may be little,” my wife told the young man, “but I don’t like to be called ‘a little old lady.’ That’s not a nice way to talk.” The young man looked abashed, but my wife didn’t give him a chance to say anything. In a hurry as usual, she stalked off. When she arrived at the end of the block, she told the young man’s counterpart there, “Your colleague was not very nice to me. He made me feel bad when he called me ‘a little old lady.’” Said the counterpart, “I hope you gave him what for.” Indeed she had. She might be little (4’11”) and old (74), but she’s’ not to be underestimated.

Unfeelingly, I laughed when she told me about the encounter. “But you are a little, old lady,” I said. “Yes,” she said, “but it’s such a cliché. It’s like saying that I’m harmless, a nonentity, a person of no consequence.” It’s true. It is a cliché. We’ve all heard of the used car advertisement asserting that a car was formerly owned by a little old lady. The cultural assumption here is that a little old lady would be likely to drive slowly and not very far. This may be true of some old ladies but not of my wife, an excellent driver. Fifteen years ago, she drove all over South Africa, New Zealand, much of coastal Australia, and only last weekend she drove up to Kingston at five or ten mph above the speed limit, while her elderly husband mainly looked out the window or snoozed. She loves to drive.

When I put myself in my wife’s place on Mercer Street, I understood how she felt. If the young man had referred to me as “an old man” or even as “an old gentleman,” I wouldn’t have liked it. First of all, it’s irrelevant. More important, the cultural view of old men, not counting the few who have continued as titans of finance, commerce, or politics, is that they’re used up, useless, good for nothing more than playing golf or sitting on a park bench and watching the world go by. This attitude seems particularly prevalent among the young, to whom the old often seem invisible.

Of course, many old people aren’t up to much and don’t do much, but many others are still vibrant and active, like my wife. As in so many other matters, I’m doing my best to follow her example.

Infantilization

During my most recent hospital stay, I was considered at risk for falling. The nurse who brought me to my room cautioned me to never get out of bed without a nurse or nurse technician at my side. To put teeth into her warning, she inserted a device into the bed which would set off an alarm - absurdly it played "The Farmer in the Dell" - should I get out of bed alone. At first I obeyed the nurse’s injunction, even though I believed it unnecessary. I’d ring for help, a nurse or nurse technician would arrive, disable the alarm, and accompany me to the bathroom. But after awhile, I became fed up with the restriction, since I would often have to wait ten minutes or more for someone to come to me, so I would get up by myself, the alarm would sound, and as soon as I could, I’d disable it.

Such restrictions may be necessary – I don’t believe this one was in my case – but necessary or not, they lead to the infantilization of the patient. But that is only one of the devices that lead to a state of childish dependence. The sponge bath, administered by a nurse or nurse technician, was another. I had to remove my gown, sit down on a toilet seat, and allow my female bather to pour water over me (the water would fall into the toilet’s basin), soap me up all over (and I mean all over), and then pour water over me again to rinse me off. I felt as if I was four years old.

But in my recent 15-day hospital stay, I only received two of these ministrations. I guess I wasn’t sick enough to merit more. By the tenth day, I felt grungier than I did at the conclusion of my third-class passage on the Trans-Siberian Rail Road from Beijing to Moscow, when the only parts of me that I could wash were my hands and face. So in a rebellion against the rules, I took myself, with my catheter following, into the shower, where I luxuriated in hot water and soap, emerging clean once more. Part of the pleasure in that shower was the independence it represented. It was an absurdly small act, but it meant such a lot to me.

I was prodded and poked at intervals determined by the institution. From six in the morning until nine at night, I could look forward to periodic monitoring of my blood pressure and blood oxygen level, to giving a blood sample, and to the insertion or removal of an IV infusion. These assaults were necessary of course but I had no say in when or how often they were administered, another infantilizing feature of a hospital stay.

Hospitals need bureaucratic controls and regulations if they are to function effectively and efficiently. Even so, the reduction of the patient to a state of childish dependence is one of the most demoralizing features of a hospital stay. How much worse in that respect must be those nursing homes that are warehouses for the old, in which the patients have no hope of leaving except feet first. I suppose that such residents can still find pleasure in their existence, but to do so must require a strength of character that I’m not sure I could muster if by misfortune I had to enter one of those institutions. I thought about that a lot while I was in the hospital and that made me feel better. After all, I could look forward to being released from the hospital, even if not for good behavior.

Hospital Gowns

Among the humiliations inflicted on hospitalized patients are the short-sleeved gowns that they must wear. These are fastened in the back, with ties at the side and sometimes around the neck, and most of them look as if they’ve been rescued from a dump truck. The oldest ones create the holes for the arms and neck when you bring together a series of metal snaps, which require a mechanical engineering degree to figure out. Some gowns are torn and some have a tie missing. Clean gowns are provided every day, but even the best of them make me look terrible. Ordinary clothing disguises some of my physical defects, but these are painfully apparent in even the newest hospital gown.

If that’s the case, why don’t I bring my own nightshirt to the hospital? I once did just that when I went into the hospital for an operation. The evening before, in preparation for the surgigcal procedure, I drank two quarts of a horrible liquid and then was given an enema, after which I fell into a coma, never to be explained, that lasted for several hours. Before being rushed to an MRI of my brain, the nurses ripped off my nightshirt in an effort to revive me, and so I lost that nightshirt forever.

I had bought two of them, both in a fine cotton, both with what I viewed as a subtle, handsome, masculine design, and I was fond of them. And while I don’t look my best in a nightshirt, these were minimally damaging to my appearance. Obviously, the ruination of a nightshirt in the course of a lifesaving maneuver hardly matters. But stupidly it does matter. I still mourn its loss, for I lost the surviving nightshirt a few years later. I left that one on the back of a bathroom door when I checked out of an Italian hotel. I’ve never seen another one I liked as much as those. So in the half dozen or so hospitalizations that followed, I left my nightclothes at home. I’d rather look like a scarecrow than lose another nightshirt.

Of course hospital gowns are more practical than pajamas or nightshirts, for they permit easier access to those parts of you that must be prodded, poked, and pricked. Also, if you’re bleeding, as I was during my last confinement, you don’t want blood all over your own garment. But the hospital gowns have another function as well. They are one way in which the institution depersonalizes its inmates, all now dressed alike, as if they were soldiers or prison inmates. Such blows to the patients’ autonomy make it easier to control and regulate their lives in the hospital. It’s just something you have to put up with, along with all the other indignities imposed by a hospital stay. After all, if a hospital stay keeps you vertical, it’s worth the temporary loss of autonomy and the ensuing assaults on your dignity and vanity. Still, I don’t have to like it.

The Roommate

The new patient, who was to be my hospital roommate, arrived at about six in the evening, shortly before the beginning of the Jewish festival of Shavuot. He was a large young man, tall and verging on obesity. He was wearing a black suit, black shoes, white socks, and a black skullcap, but instead of a dress shirt, he was wearing a white tee-shirt, which scarcely covered the huge belly that hung over his pants. His beard was wispy and he needed a haircut. His little cupid’s bow of a mouth looked strangely lost in his large face. The young man brought with him a big suitcase and a bundle of some sort, as if he were going to a hotel instead of a hospital.

A nurse accompanied him to help him settle in. Almost immediately he turned on the television set by his bed. Images appeared but they were out of focus. The nurse explained that if he wanted to watch television, he had to pay for it privately. It was not working because he had not yet subscribed to it. He seemed not to understand her because he continued to complain that the television was out of order. After the nurse left the room, I told him that his television worked perfectly well the day before when his bed’s previous occupant had watched it. I repeated the nurse’s explanation, but I was clearly beating my gums in vain, for my words made no more impression on him than did the nurse’s.

He looked around the room and then pressed the bell for a nurse. “Nurse, nurse!” he hollered. When no one came immediately, he called the hospital on his cellphone. “I can’t stay in this room!” he shouted. “The television doesn’t work, there’s no bedside table, and there’s blood all over the floor.” (The patient who had preceded him, evacuated to a private room because of an infection, took the table with him. I was still bleeding heavily and my catheter had not caught all the drops. There were a few next to my bed and one next to his, where I had been standing a few hours before.) Again, he pressed the bell for a nurse and again he called out “nurse, nurse!” When a nurse appeared, he loudly repeated his assertion that he couldn’t stay in this room because the television didn’t work, there was no bedside table, and there was blood all over the floor.

What an expletive deleted he is, I thought to myself. He’s acting as if he found a dead rat in a $500 a night hotel room. But then I caught myself and was ashamed. What did I know about this young man? Perhaps he was simply frightened. The nurse asked him to wait in the room until she found another one for him. He sat down on his bed and looked at me. “Are you homeless too?” he asked.

My irritation turned to pity, yet I must admit I was relieved when he, his suitcase, and his bundle left the room. “Good luck!” he called out to me as he was going out the door. I needed it, but surely he needed it even more.

A Blueberry Muffin

The late sociologist Erving Goffman coined the term “total institution” to refer to an organization in which people are isolated for long periods of time and which controls and regulates most aspects of their lives. Examples are prisons, mental hospitals, and boot camps. New York Methodist Hospital, where I was recently confined for a bit more than two weeks, may not fit the definition completely, for most inmates spend only a few days there, but during that time patients’ behavior is strictly regulated by bureaucratic rules and their autonomy is severely constrained.

My chief opportunities for autonomy were in the choice of reading matter (The New York Times, The New Yorker, and various novels) and the selection of items from the next day’s menu. Each day we would be asked to choose what we wanted to eat for breakfast, lunch, and dinner the next day within the constraints of the particular diet which we had to follow (mine restricted sodium). One day I selected for breakfast oatmeal, chamomile tea, and a blueberry muffin, and for the rest of the day I looked forward with particular intensity to that blueberry muffin. When my breakfast tray arrived the next day with the oatmeal and the tea but without the blueberry muffin, I was intensely disappointed.

About twenty minutes after my breakfast tray arrived, a young volunteer came into my room and asked if there was anything she could get for me. “What I want is the blueberry muffin I ordered but did not receive,” I told her. I was simply ventilating my frustration, with no expectation that the young woman could do anything about it. But a few minutes later, she returned with a blueberry muffin. My thanks were profound. The object of my desire was in my hands at last, but not for long, inasmuch as I soon consumed it.

The blueberry muffin I received was not one of those 300 calorie monsters that you see in coffee shops but much smaller, perhaps 100 calories at most. But it was delicious, especially so because I thought I was to be deprived of it. The whole affair was most ridiculous – how could I be so upset by such a trivial matter? – but as a rare opportunity for autonomy, it assumed outsize importance within the quasi total institution in which I was living.

Now that I am sprung from durance vile, I have no opportunity for blueberry muffins at breakfast, which is just as well, since I have gained twenty pounds, most of it from water retention. I’m now taking diuretics to rid my body of the excess water, but until that is accomplished, I’m pretending to be an ascetic. In the meantime, I treasure the memory of that blueberry muffin.

An Organ Recital

When I began this blog a year ago, I vowed that I would not make it an “organ recital,” a catalogue of the aches and pains that accompany old age. Instead, I wanted to provide a view of life from the vantage point of an old man. But it has become increasingly obvious to me that if I don't write about my various medical problems, the view I provide will be dishonest. It would be like describing a room without mentioning the elephant standing on the middle of the carpet, swaying his massive head from side to side.

Just as Lady Bracknell approved of Algernon’s smoking, on the grounds that “every man needs an occupation,” I too need an occupation and I’ve found it in helping to support the medical profession. During the last year I’ve consulted a cardiologist (low and irregular heart rate), hematologist (anemia), pulmonologist, who is also my primary care physician (chronic bronchitis, bronchomalcia, electrolyte imbalance, swelling of extremities, hypertension, acid reflux), urologist (tumors in urethra), radiation oncologist (recurrent prostate cancer), gastroenterologist (spreading pancreatic cyst), dermatologist (periodic checks for skin cancer), and endocrinologist (osteoporosis).

And to top off these visits, a few days ago, a combination of these problems forced my incarceration in a hospital for 15 days. At the hospital my sodium level was brought up to normal, my heart was monitored, with the decision not to implant a pacemaker, my hemoglobin count was raised by a transfusion of two units of blood, and bleeding from my prostate, its blood vessels weakened by radiation and two partial prostatectomies, was stopped. A few days later I was released from durance vile.

Any tendency to feel sorry for myself while in the hospital was checked by seeing that some of my various roommates suffered from much more severe problems. And even as I lay in bed, reading, snoozing, submitting to infusions and periodic checks of my “vitals”, I was thankful to be alive and grateful for the extension of life that medical care has granted me.

When I look at some of my friends who are at least my age, I see that they also have many medical problems. The piling up of such issues is probably unavoidable as we age. If we view them as the price we pay for longevity - after all, we were built to last only long enough to produce children and to raise them until they could survive on their own - then we must recognize that any years after forty are a bonus. I've lived twice as long as that. Still, I'm greedy for more and if endless visits to doctors and technicians is a requisite for remaining vertical, it's a price well worth paying.

So now that I have engaged in this organ recital, with full orchestral accompaniment, I hope to return to other topics in future posts.