“Getting old is not for sissies.”
Don’t know how many times I heard or thought this in my many years on Earth, but the sentiment really hit home after I moved into my sixth decade. Lately, it seems like everyone I meet–even younger folk–has some sort of chronic medical issue. The conditions range along a continuum from “just annoying” post-nasal drip/frequent sinusitis to major inconvenience (broken bones) and on to life-altering situations like cancers, loss of a limb or sense (vision, hearing, taste, smell, balance), organ failure (kidney, liver, pancreas) or an autoimmune disease (multiple sclerosis, lupus, rheumatoid arthritis, scleroderma).
Think about what will have to change if your signs (observable) and symptoms (subjective) are are confirmed to be what you Googled in the wee hours of the morning when you couldn’t sleep. This bogeyman disease could be anything:
- Type 2 diabetes
- metabolic syndrome (my mom said she was too short for her weight)
- heart disease
- high blood pressure/hypertension
- urinary and/or bowel leakage (male and female)
- abdominal aortic aneurysm
- autoimmune diseases: (MS, RA, lupus, scleroderma)
- cancers of all types
- chronic Lyme disease
The practitioner (MD/NP/PA) knows you will won’t be able to absorb much of anything after hearing, “The tests came back and you have…….” But he or she prescribes new medications and educates you about how and when to take them. Knowing most of all that is said today will go right over your head, but wanting to soften the blow, he/she quickly adds a few words about modifying the disease with life style changes.
There is no way a practitioner in today’s world of medicine has enough time in the 10-15 minutes allotted to your needs to do a thorough job. If you are fortunate and can pay for it out of pocket, the practice has an RN or a clinical nurse specialist (CNS) whose job it is to educate newly diagnosed patients and then follow up (case management) at intervals to keep you on track.
Unfortunately, those practices are usually located in metropolitan areas along the coasts where the money is. Most patients will not receive this high level of support from their health care providers. We, the 99%, have to bumble along as best we can, making do with the internet, popular medical TV shows and friends/family.
When I was enticed by a headhunter to move from Colorado Springs back to my hometown, she described what for me was the perfect medical model. As a nurse practitioner, I would do a complete history and physical on new patients, revisit them in their homes every six months and also make urgent visits, as needed. I would be expected to accompany high-risk or problematic patients to their medical appointments and work closely with their MD/NP/PA to develop a plan of care. The NP would be supported by a social worker and a registered nurse who saw the same patient every month and met weekly with the NP to review how patients were doing.
I loved seeing my people at home because they couldn’t pretend. Working with a poor and homeless population in Charleston, SC and veterans who qualified for VA care in Colorado, I knew some people would dress up and make like everything was fine, but often I couldn’t get past their facade to really help them. Coming back to my hometown in northwest Wisconsin would be worth it (I really hate winter), if my patient visits took place where they lived.
And so it was the perfect position for me…until I got sick myself. Much more about that later.