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| Allen and Sharie Farrell, life-long sailors. |
Don't mind the rain, nor the rollin' sea.
The weary night don't bother me.
But the darkest hour of a sailor's day,
Is to watch the sun, as it fades away.
-- From The Grey Funnel Line
by Cyril Tawney
Sailing at Twilight: Thoughts on Aging Aboard
No one looks forward to getting old, but it sure beats the alternative!
Anke and I are both in healthy middle age - as of this writing, I'm 53, and she's 10 years younger. As women currently outlive men by about five years, on average, our life expectancy gap is roughly 15 years.
We have no health insurance, and no particular prospects for it. We pay our (few) medical and dental bills out-of-pocket. But this means that we have no safety net, as our society now thinks of it. All our insurance is onboard, in our hands and in the good will of our friends.
In this, we join a long Alaskan tradition of old-timers who have lived out their lives in the backwaters.
These are characters of varying tolerance for others. Independant old cusses - male or female - they do for themselves until they can do no more. Most often, they live passably long and healthy lives. As their years go by, their cirque of activities contracts, their pace slows. If they've been friendly and hospitable, chances are they've made younger friends along the way who stop in once and a while, just to see how they're getting on.
Comes a day they slow to a stop.
The watery world has its share of elders whom age did not keep from the sea.
Allen and Sharie Farrell, for example, lived on a shoestring, and sailed the waters of British Columbia, without an engine right up until their deaths in ripe, old age. They were loved and supported by many, but maintained their independence afloat.
There is a clear distinction between the merely aged (who might be hale and spry), and those who have become enfeebled or worse, infirm (persons ill, or in some cases, disabled).
In this, we join a long Alaskan tradition of old-timers who have lived out their lives in the backwaters.
These are characters of varying tolerance for others. Independant old cusses - male or female - they do for themselves until they can do no more. Most often, they live passably long and healthy lives. As their years go by, their cirque of activities contracts, their pace slows. If they've been friendly and hospitable, chances are they've made younger friends along the way who stop in once and a while, just to see how they're getting on.
Comes a day they slow to a stop.
The watery world has its share of elders whom age did not keep from the sea.
Allen and Sharie Farrell, for example, lived on a shoestring, and sailed the waters of British Columbia, without an engine right up until their deaths in ripe, old age. They were loved and supported by many, but maintained their independence afloat.
There is a clear distinction between the merely aged (who might be hale and spry), and those who have become enfeebled or worse, infirm (persons ill, or in some cases, disabled).
Age is not so much the issue as is enfeeblement and infirmity.
Enfeeblement - the loss of strength - is most often a long, slow decline from one's prime of life. Being slow, there is most often time to work out solutions, alternatives and compromises.
Pace may be slowed; expectations lowered. Mechanical advantage may be introduced or increased. Safety margins widened, with more time spent at anchor. Efficiency is favored, avoiding wasted motion. Forethought and planning supplant the impulsive action of youth. Physical care becomes habitual as the strength to recover from imbalance and injury wanes. Tasks may be more often shared, or delegated, in cases of partnership or community. It takes ingenuity and persistence to keep on in the face of enfeeblement.
Past some threshold in the decline of strength, enfeeblement becomes infirmity.
Infirmity - illness, a chronic condition or disability - is little different whether young or old. If it is treatable, we treat it. If not, we live with it as best we may; succumb if we cannot.
Not so long ago most folks handled the
vast majority of their own health issues. Near towns, a General
Practitioner might have contributed some higher level care or advice.
Since that time, medical advances have done much to prolong life. Some of these are accessible to us, DIY, as individuals. Others are only available through the medical establishment. Up to a certain point, we can cover the cost of medical assistance, out-of-pocket.
Prior to 1920, the state of medical technology generally meant that very little could be done for many patients, and that most patients were treated in their homes.
--Melissa Thomasson of Miami University
Since that time, medical advances have done much to prolong life. Some of these are accessible to us, DIY, as individuals. Others are only available through the medical establishment. Up to a certain point, we can cover the cost of medical assistance, out-of-pocket.
Beyond that point, these interventions come at price.
Debt is a form of enslavement. To prolong one's life in this manner, one must trade a portion of that life to servicing the debt incurred. This might be directly, or previously in the form of insurance premiums. While in debt, no one is free.
This is not to say the bargain may not be struck on behalf of one's self or loved ones. In many cases, the return of life outweighs life invested in covering the debt. At least we hope it does, and many have good reason to hope. Each must find their own way.
Here is ours...
Death lies in wait at the far end of age. Sooner or later, death welcomes us. This is the current of years, the concomitant of age, entropy. No insurance, no intervention, no prevention will save us from it.
Because death is coming, my life is in short supply.
Because my demand for life is high, I value my life.
Because my one precious life is precious, I choose not to trade quality life for poor.
Because I will not trade, I accept my death in its due course.
Because I accept death, I am free to live.
Accepting death, Anke and I choose to forgo the bargain which exacts much life in hopes of a little more.
We bet our lives on health, so long as it may last... it's a bet we cannot lose.
For us, it means joining most of humanity, past and present, in living day to day. Each as fully and deeply as we can. Each day like the wheeling gulls, gleaming and golden against the onrushing dark.
Until such time as our sun fades away, and we go, gently, into that good night.
*****
PS. Just 'cuz this all sounds so somber and serious, which I don't intend it to be, I'll leave you with this:
How do I know that my youth is all spent?
My get-up-and-go has got-up and went!
But in spite of it all I'm able to grin
When I think where my get-up has been!
But in spite of it all I'm able to grin
When I think where my get-up has been!
-- Anonymous
Great post, Dave, and a good summing up. I am 4 years older than you and have been amazed, as my 50s have progressed, at the exponential decrease in metabolic function. Your summary of decline fits this well, as well as your coping strategies. All this was written with the american medical system in mind. These past years I've been researching expatriation and thus foreign medical systems. My father, who is now, 81, classically told me "At my age it's patch, patch, patch." Patching and repairing sometimes requires a good mechanic for those repairs one can't quite pull off themselves. I'd put major stitches, a minor broken bone, maybe fighting off one of the new virulent staph germs, a tooth extraction, etc. in this area. What we lack here in the USA due to a entrenched medical establishment is what places like Nicaragua have: very affordable basic "mechanics" for these mid-level tune-ups. Fir instance a doctors visit in Nicaragua runs about 25 bucks and a house call (what's THAT?) runs about $35. Procedures run a 1/4 to 1/6 of U.S. costs. A general practitioner in the U.S. pays, on average, $60K in malpractice insurance and his Nica counterpart pays zero. The average GP here makes $140K a year and his Nica counterpart $25K. We need some of that here!!! A Alaska initiative to train dental techs in such common procedures as extractions and fillings has been attacked by the American Dental Association alththough it's worked fine in Australia where outlying small villages get badly needed attention. Same here in Alaska: some poor gal with a toothache can't even get to a dentist and the ADA is busting chops to deny service. We could use, nationally, a bunch of army medic types who provide basic health care the average person just can no longer afford. How about a $25 office visit for a case of jock itch gone around the corner? Or a ingrown toenail that is risky for the common guy to carve on? I agree totally with your premise regarding debt and medical care. The U.S. system is set up inequitably and unfairly and needs a tune-up!
ReplyDeleteHi Gomez,
DeleteI totally agree.
Even in the USA, even with runaway malpractice, it is claimed that 10% of medical costs cover 90% of services. The remainder of services constitute 'heroic' measures near the cutting edge. Much of that involves end-of-life interventions and intensive care.
As you say 'mid-level' services, geared to the 90% of need, would be an order of magnitude more affordable than under our present system.
In effect, the 10% heroic measures are being subsidized by those who, insured across the spectrum, won't require or won't accept them.
Overlaps and blurry distinctions hide and qualify this basic situation, but bottom line, if one cannot opt out of that end of the spectrum, the cost of any healthcare may be out-of-reach. That 10% ramifies throughout the entire system, reflected in cost to both the insured and uninsured.
Heroic measures can and do generate examples of significant and valuable extension of lives. In too many, however, they merely prolong a life from which quality is long since fled.
We, as individuals and as a society, need to weigh up the costs and benefits of raging against the dying of the light, lest that rage consume us.
Dave
Warning: Political Rant
ReplyDeleteFor those trying to live a low-budget life, on the water or off, the much-reviled ObamaCare may be a boon. However, a Republican-controlled Congress threatens to eviscerate the Affordable Care Act. When you vote in November (you are planning to vote, aren't you?) consider which party you vote for, both for President, Senator, and Representative -- as well as your State and local leaders.
Gomez,
Nurse Practitioners and Physician's Assistants sometimes ably fill the position of local medic.
John
Hmm I think anonymous is named Pete Seegar. Plays a mean ban-jo too.
ReplyDeleteGlenn
Hi Glenn,
DeleteI thought so to, but double checking, heard and interesting story:
According to several internet sources all of whom cite Pete Seeger, himself, he ran across it in a newspaper. He contacted the paper, the writer turned out to be one of their reporters. He gave permission to use the song, but preferred to remain anonymous.
I didn't check any further, but it makes a good yarn!
Dave
I like a day when I learn something new. Now I feel the urge to dig out that album and listen to Pete again.
DeleteGlenn