So, this is free medicine
Rob Tisdall • May 20, 2019
Landed in Chisinau Tuesday for the final day of snow and went to classes the next day. Noted was slightly unwell on Friday morning and it then got worse as the day progressed and by that evening had aches, chills and it seemed like the ‘flu. But I’d had my shots. So curled up in bed for the weekend and was feeling much better by Monday except I was running a temperature. Vladimir got concerned and so brought one of the English students, who was also a physician, and she called the local ambulance. They arrived with flashing lights and a thermometer (forgot to pack one?) and my temperature was 104F. The ambulance crew felt obligated to do something so I got a shot of Chinese made vitamin C in my right buttock and they left. Then it was a private car to the local hospital ER and was shepherded through the system by the physician/student. The chest Xray showed right lower lobe pneumonia and the fun began.
The ER wanted to admit me but they would need to order the antibiotics and they wouldn’t arrive until the next morning. I countered that I could go to the local pharmacy and have the same antibiotics by the next morning. Besides I was drenched in sweat and wanted a shower. So I signed out AMA with dire warnings that I would be responsible for the out-patient bill and I went home. I showed up at the hospital the next morning with a sack full of IV antibiotics, oral antibiotics and an oral antiviral as well as vitamin C: injectable, oral and IV (cost: $40.00). Being shepherded through the system by a physician is embarrassing as you go to the head of the line. I tried not to look at the people I was queue jumping; their faces were curious but accepting. So morning and evening for 2 days I got OP meds supplied by me. The most annoying was holding still for the 90 minute infusion as 2 of the meds were IV push. Found out on day 2 that this infusion was just vitamin C.
On day 4, I am feeling good. All the boxes have checked normal but the repeat CXR showed the pneumonia was now translucent but still present and possibly spreading. The original physician then consulted 2 pulmonologists who, looked at the CXR and back at me and then at the lab work and back at me again and kept asking me if I was sure I felt alright, no shortness of breath, fatigue and all the rest. Every test was back to normal except the CXR. They then decided that they wanted to admit me so they could “analyze” me. For what? I couldn’t see why this couldn’t be done as an OP. Then the head of medicine for the hospital appeared and informed me that I may have an exotic virus that I picked up at some airport in my travels and I was infecting the town. OK, I’ll play nice. Admit me. It took 2 1/2 hours to find a bed in an isolated room in another building and it was memorable.
The room was in an older part of a separate contagious disease building and had been abandoned so it was used to store old beds and equipment. There had been no repair or cleaning of the room since the Soviet empire dissolved in 1991 and the linoleum on the floor was peeling and there was peeling paint on the pipes. The mattress was stained, torn at the corners and had a large sag in the middle which was then covered with a smaller mat, equally stained. A duvet was placed on the top as a cover.
I then got my IV push antibiotic and my 90 minute Vitamin C drip. I was given a bowl of borsht and 2 slices of bread were covering the top of the bowl. This was delivered by a worker who held the bowl with both hands and the bread on top with her 2 ungloved thumbs and she plopped the bowl onto the night stand. The nightstand did have some dust on it. The beet soup and bread were excellent. Shortly afterward, they brought some cup for a sputum sample to see if they could culture the pneumonia. So I did my thing and it was reddish colored from the borsht and I pointed this out to the head nurse. The radiologist/student, some sort of a hospital admin and the head RN drifted into the room and then the head of medicine showed up. He announced that I
had broken an international law by being admitted to the local hospital in Causeni and Americans could only go to an approved VIP hospital in Chisinau. We then waited several hours for an ambulance to show up to transport me to Chisinau. Meanwhile, Vladimir went back to my apartment to grab some clothes and my shaving kit. There was a retired MD in the ambulance who went on these trips to make sure no one died. He proceeded, in a loud voice, to tell everyone what they had done wrong in working up my pneumonia. I made a point of asking him, through a translator, in front of everyone, what he would have done differently, and he got very quiet.
So we arrived in The Pulmonary Institute in Chisinau about 20:30 and they insisted I call the American Embassy and inform them I was there. The watch commander at the embassy didn’t know what to do with the information.
I was examined in admission by a guy (possibly a physician) who found a stethoscope, listened briefly to my chest and said “allergies”. I looked back at him and said “Nyet”. So they loaded me, with 10 kg of my luggage on my lap, into a wheelchair. This would barely fit through the doors but they gave it to the smallest woman to push while the large males walked ahead and pushed the elevator buttons. There was also a threshold at each door that she could not get me over without help and again no one gave her a hand. So I got up and walked behind her.
I was put in the isolation ward and these people take isolation seriously. No WiFi, no English speakers, just the food person and the nurse for the infusions. About this time the cannula for the IV’s clotted and so it was a metallic needle stick twice a day and this kept being displaced as they insisted on using the inside of my elbow. Lots of extravasated infusion. Vladimir tried to visit the next day but was turned away. It then occurred to me that there was no intake history and physical (it was the weekend and everyone in medicine knows nothing happens on the weekend), no ID bracelet and I’m now thinking I was there because of the borscht colored sputum sample which did resemble the hemoptysis of TB. However, someone was writing orders because I was getting twice daily heparin shots into my shrinking abdominal fat. Across the hall were 2 patients on respirators, wasting away.
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I must walk around with a scowl on my face because I am frequently asked if I am “Happy”. My understanding of happy is there is a lifetime happiness curve, U shaped, with the bottom at 50 yo and peaks at 23 and 69. But after 69 it doesn’t point straight down as there is an almost horizontal line on the right. Also, there is a genetic predisposition to happiness with 30 - 40% of a population finding it is easier to be happy. The rest is environmental influences such as traffic delays, winning the lottery and such. So happiness comes and goes daily but contentment levels out the highs of a birthday cake and the lows of a traffic ticket. So I gave some thought to a Contentment Index. I think this needs to be weighted because some points influence the others. 1. Financial. (50%) This is the big one; the foundation of successful retirement and all the points that follow. This subject is so important that most of the megabytes of retirement advice are about finances. Financial independence allows the individual the freedom to be in total control of what you want to do each day. Keep monitoring your finances and live within your means. 2. Health. (25%) A retiree should shift their focus from wealth to health; take up nutrition courses, cooking classes and such. Keep a regular schedule of physical activity and keep your annual physical appointments. 3. Social connections and new relationships (10%) The office camaraderie is gone and there will be a need to find others with similar interests. Accept that the social group will change every 5 years as people move on. 4. Where you live (5%) Will moving change your support system of friends and relatives? Is scaling back going to effect large family gatherings? 5. Brain stimulation. (5%) “Curiosity may have killed the cat, but a lack of curiosity kills the happy retiree”. 6. Adaptability. (5%) There are 3 stages in retirement: go-go , slow-go, and no-go. So …. how am I doing? 1. Financially I am doing well and only spend money on things with the potential of improving friendships. Floating in a large boat by yourself is not fun. 2. My health remains good but I still eat preserved foods, drink wine and participate in other assorted sins. I go to the gym at least every second day. 3. Socially, I am gravitating to younger, upbeat, and mentally stable friends. I am avoiding the grumbling, the narcissistic, and the irresponsible. I am saving myself time, because one strike and you’re ignored. There is someone who calls every week to make sure I am not dead and composting somewhere. This person is also a sounding board who makes sure that I stay fairly main stream in my thinking, as long as we avoid certain subjects. 4. Location. In my travels, have not found anywhere better … yet. 5. Stimulation: I am slowly progressing in learning the Russian language and find the treadmill an excellent place to do my homework; in spite of others in the gym wondering about this strange old guy talking to himself. I also have the wherewithal to try new experiences out of my comfort zone. 5. Adaptability. I am in the first stage. I do have plans but they are not rigid as I am working through the alternatives for the next 2 stages. So, how am I doing? I’m deliriously content.
My retirement date is now in the distant past and I have dealt with my post-party letdown. I now have new routines and a new identity and this works for me at present. I feel productive but am having a slight problem with procrastination because when you have all day to do it ….. I do get some degree of pleasure finishing the laundry - wash 22 minutes, dry 36 minutes, folding and putting away 10 business days - or raking the leaves - which way is the wind blowing today?. I now have enough free time to observe the subtle signs I am aging. Aging is not retirement. One is going to age either in an office or having fun; it will happen. 1. Nobody calls me Bro, Guy or any other term of familiarity. I am addressed as “Sir”. It is not a lack of respect but more that I am no longer a contender. At least I am not invisible. I was on a crowded airport bus and a 50 year old man signaled that I could have his seat. I just pointed to my hair color and then his and laughed. However, the first kid who offers to help me cross a street ….. 2. Several months ago I had a momentary flash of pleasure when I was asked for photo ID when buying wine. He just scanned my driver’s license and told me it was company policy that every alcohol sale has the customer’s ID scanned. Now I am noting if I get more than a brief glance after asking for my ID. 3. My friend group has really changed in the past 5 years as they moved to warmer climates or are spending most of their time monitoring grandchildren. Conversation has changed from party nights and big cars to social security changes, pensions and lots of medical talk. There is a reason for senior hour in the restaurants because we will have time to see all the grandchild pictures and we all have to be in bed by 9:30. Does this mean a totally new group with new grandchild stories every 5 years? 4. When I was about 60, I learned not to grunt when I got out of a chair but now I am getting all kinds of strange pains. I have learned that continual attention to changing posture and daily gym trips keeps them minimal. My hair is thinning in tandem with my skin and subcutaneous fat. Healing is taking longer, so I have accumulated enough scratches and bruises to look like I am being beaten and the family doctor always asks if I feel safe! I am ignoring the age spots and keratoses from a lifetime in the sun. 5. I used to be spontaneous but now activities require meticulous planning. Decades ago I spontaneously jumped on an airplane for a weekend special in London, but now I’m concerned about “how do you get from the airport in Prague to the hotel, how much should it cost and where do you find the ride”? 6. I am noting a vague sense of “survivor’s guilt”. I have arrived at this point in my timeline without too much mental or physical trauma and have complete emotional and financial security. I am noting the large numbers of those who are just as deserving but are not in a similar state. I am wondering about the how and why. 7. Now the good news. My medical numbers have always been in the good range, and I am developing nostalgia for french fries coated in greasy brown gravy or for a binge of eating sticky buns. The actuarial tables say I will not succumb to anything food related because there is not enough time for chronic changes to develop. There are also some cancer screenings that are no longer necessary for the same reason. A peculiar situation. I have no doubt there will be more foreboding perceptions to follow. …. drip by drip, but I am not going to age gracefully. It will be more like fearlessly.
I paid my own way through university and the main reason I have no fond “alumnus” feelings for the experience was the genteel poverty. Not having enough money to experience the concerts, beer bashes and visiting the student union buildings that seem to give graduates the warm fuzzies. One of the English students in Moldova was having a major problem with confidence and didn’t think she could compete with the “big city” kids at university, especially in an IT program. So I suggested and pushed and cajoled, and then overpaid her for doing some translations for me. She’s got the fire in her belly and she graduated last month with great grades. I am now looking for a similar student to monetarily sponsor, but how do I determine if they have Fire in their Belly? This refers to someone’s drive or motivation to achieve success. It is not a passion, as this comes and goes. Fire in Your Belly doesn’t ebb or flow, it is a continuous striving. I decided on several screenings to find the proper candidate. 1. They have a history of drive from a very young age. It seems to be in the DNA part of their personality. I am going to ask about the first job they took for whatever the pay was as a child: cutting grass, shoveling snow, baby sitting. A reliable worker who did a good job. 2. They have something to prove to the world or want to show someone is wrong. They have been influenced by role models or groups important to them and they have a goal as an endpoint. I am going to ask who these influencers were and why they were important. 3. They have overcome real obstacles - life changing events such as loss of parents or major injuries. I am going to find out the details of how they adapted to these setbacks. Additionally: 1. They have a curiosity and really listen to different ideas, read voraciously and test their knowledge or beliefs. 2. They are creative and willing to try something different. They then accept the hard truth, face the reality of failure, and adapt. This is courage. 3. They have character and know the difference between right and wrong, even if nobody is watching. 4. They need to be competent with a large amount of common sense. They are not afraid to surround themselves with people who are smarter than they are and then listen to them and adapt. What about the late bloomers - those in their 30s who finally see the light of motivation? I don’t know as I am interested in the teenagers. Maybe I need a second fund?
They are now measuring age by the number of years left to live. This makes sense because the life expectancy in this country has increased from 47 in the early 1900s to about 80 at present. In 1935, the minimum age for receiving full retirement benefits was 65 and yet the average life expectancy was 60. Now there is 1/4 of your adult life left once you retire. As recently as the 1960s, it was expected that retirees’ health would decline in a straight line until all systems crashed. Today, medicine has granted the retirees a long period of good health with no limiting events thanks to pacemakers, joint replacements and such. The health line is now horizontal and straight with an abrupt, short term, fall at the end. Around five years after retirement, the average American has a 6 to 9% decline in mental health, a 5 to 6% increase in medical conditions, and a 5 to 16% increase in difficulties with daily activities from a combination of the above. This all seems to be from drastic lifestyle changes, not the retirement itself. The curse is the result of the transition from work to retirement, not the advancing years. The key to avoiding the above seems to be to ease into retirement to something and not retirement from something. So, how to do this properly? Slowly change the established routines to new routines or new habits. Phase back the work load and fill the time with other meaningful activities that you find productive and create a new sense of self-identity. Procrastination is not a routine. Replace the social contacts at the office with people from a different environment. An 85 year Harvard study found that the hours of working on all the problems of your job are better spent on keeping up social contacts - virtual or other social connections . Or you could get a pet that would depend on you . Use the new routine to maintain physical activity. Shift your focus from wealth to health. Go to the gym for the physical benefits as well as the social contacts. Continue the routine of regular meals on a regular schedule and don’t have breakfast at noon. If you have a relationship, involve them in the transition. There will be a new equilibrium in relationships; move-not move, travel-not travel, etc. The statistically highest divorce rate is between 50 and 64 years old and one third of these have been married more than 30 years. Use your skills, make your own hours, work part-time or volunteer but find a meaningful purpose. You are not retired; you are a consultant. Having a purpose is more important than all of the above bullet points. Regain your respect. One is not retired, but a consultant. Of course, you could always put the curse on hold and unretire.
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Regardless of its origins in the mid-1900s, woke has now mutated into a plethora of positive or negative connotations, depending on the agenda. However, it is basically a way to divide people into groups with expectations of a certain behavior. I have been grouped as ‘retired’, a mildly stinging but benign label. But now I am also an ‘elder orphan’! A “vulnerable” group of older people who do not have a spouse or children to depend upon. Somehow this differs from a ‘solo ager’ who has never had children. Why? To what purpose? Supposedly, we are 22% of those over 55 years old and we come with a whole list of concerns for the social workers - 23% worry about not having enough money, 25% fear losing their housing, 40% are depressed, with 37% being anxious and 52% feeling loneliness. This is the subject of conversations I have with most of the retirees that I know who do have spouses and kids. So, before we allow the policy makers to look into the problems and solutions, let’s dissect this grouping. You are going to be solo at some time in your life. Anyone can see this coming if you consider that half the population will be a widow or widower at some point. Life is dangerous and none of us are getting out of this alive. You can mitigate this assumption by surrounding yourself with an expanding group of friends and acquaintances; hopefully younger and interesting. You could continue working at any job, volunteer, take courses at a school, whatever, but keep pushing forward. With minimal thought, the fear of losing your housing or not meeting your basic needs ought to make you consider that one should do some financial planning before arriving at this point. It might not be as daring, but job hopping before a pension becomes vested or quiet-quitting or living paycheck to paycheck should require more caution. Fair enough, there is a work - play balance, and there is merit in quitting one job for better opportunities in another, but there are also some long term consequences that need consideration. Ponder this. About 30% of millionaires in this country averaged an income of $100,000 a year and one third of these never made 6 figures in any single year. Sounds to me like this fear is a consumption problem. Depression among the elderly is a consequence of social isolation objectively and a feeling of loneliness subjectively, but is not due to the aging process itself. The group with the highest rate of depression in our culture are those between 12 to 25 years old; well out of ' retired' demographic. Social isolation is a result loss of family and friends, living alone, chronic illness or even hearing loss. Begin with your family doctor to see if there is a need for a possible physical tune up and then get active. Stressful life events cause anxiety but it does keep you engaged. I am not happy that my body shows the loss of elasticity and the triumph of gravity. But face it, my body is becoming antique and I can’t do the physical things I have been used to. So it takes me longer. But with retirement, I have a lot more time to complete the task. I have no fear of losing my independence because that is why they have French maids. And for any other cause of anxiety, there is always the 4 o’clock martini.
It’s raining again, and I need another activity. So I did an inventory and considered all the boxes I tick already: gray haired, gruff, cranky, haven’t handed out candy at Halloween for years, find Christmas carolers annoying, will never be woke, have stubborn resistance to those who think they can change the psychology of people, and have never been a model citizen. I think I’ll work at being a curmudgeon. One of the nice things about the word curmudgeon is nobody can adequately define it. There are lots of antonyms: affable, companionable, cordial and extroverted. But look at the illustrious alumni: Winston Churchill, Oscar Wilde, Groucho Marx. Not exactly antonyms but are still considered curmudgeons. I would include Dorothy Parker and Fran Lebowitz, but the bonus point is that it is a boys only club. A female curmudgeon is called a termagant. In order to stand out from the crowd, I’ll need to specialize . Say, catalog the inconsistencies around me. The United States was founded on no taxation without representation. So why is the kid working at McDonald’s paying income tax when they can’t vote? Don’t work so hard; stop and smell the roses. Well if you don’t work long hours then you won’t have the money to afford the roses. Don’t make a large salary and not get enough sleep. But the Covid mess showed us that you can both make less money and get no sleep. He is homeless because he lives in a tent. Well, hold on, when I was much younger we called that a vacation and I have very fond memories of it. Study harder; you are the future of your country. But as I have said somewhere, the kids in Moldova are studying English harder so they can get a job in another country. The Democrats have funded their social programs resulting in inflation and are desperate for more money. I propose a Happiness Tax on single males because they aren’t sharing in the domestic misery. Call it a “No wife, No strife Tax” I now have the time to consider more inconsistencies.
Retirement is supposed to be a stage in which you have more time for hobbies, more time to try new activities, and more time to do whatever you have postponed. A friend of mine, a keen fisherman, just had a birthday that ended in a 5. We were discussing his planned summer fishing trips and he was lamenting that he wouldn’t be going to an alpine lake as usual because he was too old to walk in, and live rough. On closer questioning: he still remembers why he walked into the room, his heart and knees are good enough to do heavy yard work, his eyes and ears check, check, and he has a good bank balance. He has simply hit a mythical age number inside his head. So, can you be too old to retire and enjoy the benefits? So where does this ‘acting your age’ come from? I have only heard it used as a scolding to quit juvenile behavior and to act more responsibly or maturely. But is there such a thing as hypermature? I suppose there are certain activities where time restricts opportunities. For instance, having a child as a do-over at my age would cause years of social ridicule and it won’t work because I wouldn’t be around to see if I had improved the product. It is also too late to start my NBA career or become an international star surrounded by groupies. But I can still be a musician emeritus (socially approved), be numbered among the world’s better poker players (generally approved) or start a small store (probably neutral). Maybe one should focus on the journey, not the goal, write your own story and edit it as you go. I’m too old to worry much about other person’s perceptions of how I should act. Scoffing ridicule is better than being transparent and ignored. I am trying to surround myself with the younger crowd so I take “You’re too old for that!” as a challenge but I may have to modify some of my behavior to be credible with this younger age group. I have never said “When I was your age …”, nor have I chased the clothing trends of tight pants with a cuff above my ankles and no socks. But I have been known to whistle songs from the 60s and say that something is ‘Cool’. However, saying something is ‘Bad’ or calling someone ‘Bruh’ sounds as if I’m trying too hard to be trendy. So I suppose if one wants to surround themselves with the younger generations there will be some modifications. Finally, if the group doesn’t like it, they will just have to deal with it. So, having no personal cut off time, what is interesting me now that falls within the social norms? I can’t function as a physician, or be any use as an aide worker in refugee camps because I don’t speak the language. However…. 1. I hear frequent stories that speaking Russian in Moldova, Czech Republic or Romania is not a good idea because you will be shunned. So English skills will remain very important in the new order that will follow the Russian invasion. Asia and Europe have a large demand for English tutors, but the Covid restrictions are a checkerboard that changes daily so it is hard to plan ahead. Additionally, the schools want paid workers that they can give orders to and I don’t need the money and I will reject any meetings. If I was to brave the high Covid numbers in South America, all the requests for native English speakers need good Spanish language skills, so I don’t qualify. That leaves on-l ine lessons, maybe from a beach . 2. I like to build things and when this invasion is over, there will be a need to rebuild infrastructure and apartments. I won’t literally carry bricks but I’m thinking more of being a foreman who only has to do physical work for a 5 minute demonstration and then direct a team of young, strong people. 3. There is also the world-wide threat of starvation, so I could get into the fields and change the way things were always done - rebuild the soils, purify the ground water, and grow calories. GMO doesn’t matter when people are hungry. The way I see it, you are either moving forward or falling behind because life doesn’t stand still. Hopefully you have gathered enough experience over the years that you would recognize a mistake and not relive it. So go to the alpine lake and enjoy your retirement. What are you saving yourself for? Do things to outrage your children. You just have to make the decision then just do it and develop selective hearing for the astounded.
Since the time of the Romans, it was commonly known that black swans didn’t exist. And then the Europeans got to Australia. They even found a black necked swan in South America. So now the term is taken to mean an event so unlikely and rare that is is unpredictable. I never considered a Corona pandemic, nor an invasion, into my retirement activities, but both are limiting my choices and options and therefore my fun time. Retirement planning now has several more ponderables. I suppose back swans can be good or bad depending on your point of view. A pig would consider a barbecue bad but the butcher doesn’t care. Lotteries are for people that can’t do mathematics, but my winning the lottery would be a good black swan. That is until multitudes of people find out and try to make themselves my best friend. One can handle black swan events with broad preparation and most of this comes down to money. The financial advisors have thousands of sites full of advice such as having 6 months of readily available cash for living expenses while you adjust to the change, or making a monthly budget to figure out just how much you’re spending at Starbucks. Last week I got a call from the credit card company about some recent purchases, but I just told them I was emerging from my Corona isolation. However, it tweaked my attention, so I revisited my situation. The financial changes haven’t effected me yet but I am still keeping a wary eye on inflation and the tax increases that will result from the government’s increasing expenditures. There is a statistical model called a Monte Carlo Simulation which is used to predict the different outcomes of random variables - in my case, the probability of having enough money to maintain my present life style. I plugged in my age, health, age of my relatives at death, my annual expenses, my government pension and my private funds, etc etc. I pushed the GO button and the program ran through 20,000 variables such as inflation would be 2% or 20%, the market would lose 50% or gain 7% annually, etc. It even included the $250,000 that my terminal health expenses would cost. But there were no black swan events that I could identify in the program eg. cancelling student debt, supply side problems, electric cars only. The result? I am good until I am 92 years old. What was the effect of sitting around having on my health? I went for my annual free Medicare physical and all is well …. except they used the word elderly a lot: remember 3 words, draw a clock, do I feel safe. I was not pleased! Me?! I’ve crossed the geezer line? I’ll show you what this slander means! Time to get a 35 year old “friend”! That should take care of the Monte Carlo results above. I wonder if this would be considered a black swan? Virtual Zoom classes are OK, but I would like to visit my younger friends in real time. But several of them have missiles raining down on them and this is not my fight. So I am limited to spending a fair amount of daily time sending encouraging emails but I am running out of things to say. Practically, there is not much I can do but I have told them that if they should get to a Western country then I will visit them there so they will no longer be refugees. A couple of my English students have gotten into the Czech Republic from Ukraine and I have finally gotten into contact with them and their life is chaotic and the internet is irregular. The English students in Moldova are doing well; discussion with the kids is neutral subjects and the adults are worried about their friends in Ukraine. I now need to see what the Russians are planning for Moldova. That takes care of the big 3 variables of a successful retirement and nothing has really changed for me. Can I find a good black swan … maybe find my fun in a different activity? All I can think to do is to ‘put myself out there’ as the kids say. Expose myself to volunteer in other countries or areas where I have no expertise. Try enough things, long enough, that hopefully serendipity gets the timing right. So I think black swans are manageable. I will survive the Corona virus or an invasion, but now I need a plan so I won’t die overdoing the celebration.