This week I sent a 50th wedding anniversary card to my cousin and my wife reminded me that we are coming up to that milestone ourselves in 2017. That got me thinking about how we respond when a long-term relationship like these ends due to the death of a spouse.

Some not-too-recent research shows that men are at greater risk of dying after the loss of a spouse than women (1-4). Also, on a happier note this higher risk diminishes over time.

In my current motion picture project, the main character is an older man who experienced the death of his wife. This loss has affected him, not in any tragic way, but in significant ones. For one he has avoided new romantic attachments. Throughout the film, his dead wife visits him and encourages his re-engagement with life. Below is an excerpt from the unfinished film that illustrates one man’s way of coping with loss.

After watching this clip, consider how you will respond should you become the surviving spouse.

References

  1. Helsing, KJ & Szklo, M. Mortality after bereavement. Am J Epidemiol. 1981 Jul;114(1):41-52.

    http://www.ncbi.nlm.nih.gov/pubmed/7246529

  2. Jacobs, S & Ostfeld, A. An epidemiological review of the mortality of bereavement. Psychosom Med. 1977 Sep-Oct;39(5):344-57.

    http://www.ncbi.nlm.nih.gov/pubmed/333498

  3. Martikainen, P & Valkonen, T. Mortality after the death of a spouse: rates and causes of death in a large Finnish cohort. Am J Public Health. 1996 August; 86(8 Pt 1): 1087–1093.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380614/

  4. Martikainen, P & Valkonen, T. Mortality after death of spouse in relation to duration of bereavement in Finland. J Epidemiol Community Health. 1996 Jun;50(3):264-8.

    http://www.ncbi.nlm.nih.gov/pubmed/8935456

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cloudsAs I progress in life I have occasion to visit new and different health care providers. Every one of them gives me a six to eight page form requesting information. It’s the same information every time. It may be formatted differently but it’s still the same information: name, DOB, address, insurance, past history, ROS, permissions, etc.

The electronic medical record was planned to eliminate this endless repetition by putting every one’s information in a “machine readable form” that could then be read by the computer systems at any health care facility.  My colleague, Bruce Niebuhr, and I spent many years following the evolution the electronic patient record or electronic medical record.  Recent years have seen significant advances in the field.

Many hospitals and group medical practices now use some form of electronic record keeping (1). Sharing of information between hospitals and affiliated group practices has increased also. Thus, one can be referred to a provider and that person can access your information on-line. This however does not happen very often. From Thompson, “For example, the [WRJF] study found that 42 percent of hospitals now meet federal standards for collecting electronic health data, but only 5 percent also meet federal standards for exchanging that data with other providers to allow widespread physician access to a patient’s records” (2).

Even with good inter-provider cooperation, I still find myself in the position where one office swears they sent over the data but when I get there that information is nowhere to be found. Again, I offer my own copy for inspection so we can proceed.  This is the interplay of human fallibility with computer systems and it highlights the basic ethical question regarding information. Who owns it and who is responsible for insuring it is available where and when it’s needed.

I think the case is clear that there are many “owners” in this endeavor. The patient owns themselves and whatever he/she can personally report about themselves is theirs. The providers own what they create: test results, assessments, notes on treatments, internal accounting and so forth. Everyone has privacy rights. Patients have the right to control who sees test results owned by the provider. Providers have the right to keep internal accounting and employee data private.  It’s a complicated process.

What about putting all this information “in the cloud?”  The cloud is that transparent realm of distant servers where everything is kept and you can access it anywhere, anytime. It works for your favorite musical selections and family pictures, but how about medical data (3, 4)? Security issues aside (they can always be solved), I like the idea because with a cloud-based information structure there can be many interfaces. There can be one for providers and one for patients. Everyone could review, edit, add and delete information as necessary and stay within their ownership and privacy rights. I’d never have to fill out those redundant “new patient forms” again.

References

  1. Robert Wood Johnson Foundation . Hospitals, Physicians Make Major Strides in Electronic Health Record Adoption, July 8, 2013.
    http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2013/07/hospitals–physicians-make-major-strides-in-electronic-health-re.html
  2. Thompson, D. U.S. Hospitals Triple Use of Electronic Health Records, US News and World Report, July 8, 2013.
    http://health.usnews.com/health-news/news/articles/2013/07/08/us-hospitals-triple-use-of-electronic-health-records-report
  3. Terry, K. Medical Practices Move Health IT To Cloud, InformationWeek, 9-6-2013.
     http://www.informationweek.com/healthcare/electronic-health-records/medical-practices-move-health-it-to-cloud/d/d-id/1111447?
  4. Spottswood, T. Electronic Medical Records in the Cloud: How Safe is It? Northwest Regional Primary Care Association.
    http://www.nwrpca.org/health-center-news/200-electronic-medical-records-in-the-cloud-how-safe-is-it.html

Join us for a real-time discussion about questions raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Blanco County CourthouseSummers can be hot! I remember really hot Summers when I was a teen in Oakland, California. Summers there are often cool but I remember some Summers that were very, very hot.  I’d awaken in the morning and the sun would be bright and the air screamed, “Heat is coming!” My Mother, on those days, would draw all the blinds to keep inside what coolness the night had imparted and in the afternoons we would huddle around our little fan waiting for sundown to bring relief.

I loved to be outside in the heat. I’d ride the bus across Oakland to go to my judo school where I taught children in the afternoons and learned from my masters in the evenings. The judo school was not air conditioned but no one was concerned. We just pushed on. We were like Jack London’s character, David Grief, who “was a true son of the sun, and he flourished in all its ways” (1).

Many people in Texas live through the Summer without air conditioning. How do they manage? In the days before AC, Texas homes were designed to be a little cooler in the Summer by catching breezes and letting the heat escape. Many not-so-old-fashioned houses and apartments are not designed to take advantage of nature and really require AC (2).

The sun can be an unfriendly neighbor. During the California 2006 heat wave, there were 140 confirmed deaths and an additional 515 suspected deaths due to extreme heat (3). Summer’s heat can be dangerous for the very young, the very old and the careless.

Three things I learned recently and that seem relevant: 1) dial 211 for information on community resources, 2) many communities provide “cooling centers” as a place to get a respite from the heat, and 3) the CDC has good educational materials for “safety in the heat.”

Cooling Centers in Texas

https://www.211texas.org/zf/taxonomy/detail/id/650894

References

  1. London, Jack. A Son of the Sun (Adventures of Captain David Grief). Curtis Publishing Company, 1911
  2. Life Before Air Conditioning
    http://mentalfloss.com/article/16842/life-air-conditioning
  3. CDC 24/7 – Saving Money Through Prevention – California’s Success. Centers for Disease Control and Prevention.
    http://www.cdc.gov/nceh/tracking/success/savingmoney_california.htm?s_cid=ostltshyh_cs_029

Resources

Image

The old Blanco County Courthouse has never had air conditioning and makes use of high ceilings and cross breezes to stay cooler.

http://www.historicblanco.org

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Ky Jan home healthIn 1975, I joined a team of educators at the University of Kentucky who were engaged in a very unique form of health science education (See Connelly, Assell & Peck below for further details). We gathered students from across the spectrum of health professions and, along with a faculty member as sponsor, had them live in a rural, Kentucky town during the month of January. Hence the name of the experience: Kentucky January.

The purpose of the three week experience was to allow the students to become more familiar with the health disciplines that were on the team and to study the health care system as it manifested in a rural community. Our premise was that students rarely got to explore all aspects of a community and plot out how they integrated into an efficient or inefficient system.

Our students explored the local hospital from surgery to midnight rounds with the janitor. We visited the coroner, funeral homes, physician and dentist offices, city hall, county health department, local businesses and factories. Since many of our teams were in Appalachian towns, they went down into coal mines and sought out the local moonshiner.

The highlight of every team was travelling with the visiting nurses of the home health agency to remote homesteads in the rugged hills. This is where the students got to meet real people on the fringes of the system and gain an understanding of where the system worked and where people fell through the cracks.

Two weeks ago, I mentioned that my wife, Dianne, was in the hospital with pneumonia. She is home now and recovering but weakened after two weeks in the hospital and the residual effects of pneumonia. Before discharge her physicians suggested a rehabilitation facility for a while as she needed time and assistance for recovery. Dianne had had it with institutions and wanted to get home. So, enter the modern home health agency in a Texas rural area not unlike Appalachia.

This week we have had two visits from a nurse and two visits from the physical therapist. Both have been extremely helpful and of significant benefit.

Home health is a care option that deserves consideration.

Reference

Connelly, T, Assell, P and Peck, P. Interdisciplinary education for health science students in the rural home health agency: Kentucky January. Public Health Reports, 1975, Jul-Aug, 90(4), 325–330.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1437732

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Last Monday marked the centenary of the outbreak of the First Word War. It was a period of bloodletting unsurpassed in history. Nearly 10 million died from combat and probably double that from associated causes. None of the 65 million who served in that war are still alive (1).

It is curious to remember that my mother-in-law and aunt who both died this year at 100 were babies when the war began. My mother was a child of four and in Finland when the war began. My grandmother brought her home to the US before the seas were unsafe due to submarines and blockade.

Wars bring disruption, dislocation, disease and violent death. It would seem a safe assumption to say that war is a health threat and that anyone wishing to live into old age (and hence be a legitimate subject of this column) would do well to work against the causes of war in our times.

I believe war is a mental health problem. While the news is full of apologists for the inevitability of wars due to economic, cultural, social, or political causes, in the final analysis resorting to killing each other is a crazy act and not different from the most demented, psychotic murderer in civilian life. Our inability to stop or cure such violent acts leads to our condoning self-defense and creating a cycle of mutual killing that only now is being seen as a tragedy for both sides.

There was a moment in December 1914, around Christmas time, when the men in the trenches in Flanders put down the guns, crossed into no-man’s-land and engaged in peaceful pursuits. They talked, exchanged food and smokes, played games, buried the dead, and generally behaved in an un-war-like fashion (2). The generals soon put a stop to this foolishness, but for a brief moment there was a pause in the madness.

References

  1. List of last surviving World War I veterans by country. From Wikipedia, the free encyclopedia. http://en.wikipedia.org/wiki/List_of_last_surviving_World_War_I_veterans_by_country
  2. Weintraub, S. Silent Night: The Story of the World War I Christmas Truce. The Free Press, N. Y., 2001. Available from: http://www.barnesandnoble.com/w/silent-night-stanley-weintraub/1111352599?ean=9780452283671

Join us for a real-time discussion about questions raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Rodger Marion, Ph.D. is UTMB Distinguished Teaching Professor and Senior Fellow in the Sealy Center on Aging. Those with time on their hands might want to follow his current film project at http://nudgedmovie.com.

Franklin D. Roosevelt, at his inauguration on Saturday, March 4, 1933 said, “… let me assert my firm belief that the only thing we have to fear is… fear itself… “

In a sense that is so very obvious. The events of life are simply events with no particular meaning of their own. If we are afraid of anything, it is of our own making. That being said, when I’m afraid I’m very uncomfortable and logic rarely comes to my rescue.

I’ve been aware of fear and the anxiety associated with it quite a bit this week. My wife, Dianne, came down with a case of pneumonia and it is seriously impeding her ability to breathe. She has been very anxious, and rightly so, when finding herself unable to take a deep breath or wheezing after just talking with a visitor.

I think we need to be sensitive to when people, who are our patients or our family, are feeling fearful. Logic will not help. Listening does. Prayer does. Appropriate medication will help. Finally, being mindful and caring is the best response.

A colleague and I made a film a few years back that illustrates what can happen when we find ourselves short of breath.

 

I have referred to this film twice is earlier postings: http://wp.me/pH3Dx-3R and http://wp.me/pH3Dx-eY. Obviously it touches on a nerve for me.

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Join us for a real-time discussion about questions raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Rodger Marion, Ph.D. is UTMB Distinguished Teaching Professor and Senior Fellow in the Sealy Center on Aging. Those with time on their hands might want to follow his current film project at http://nudgedmovie.com.

halleys cometHalley’s Comet swings by our part of the solar system every 76 years or so. People have observed it since about 240 BCE. Sometimes when it returns the comet is the brightest thing in the sky and people have often associated it with prophecy or saw it as an omen of import.

So, here’s my story. Mark Twain was born when Halley’s comet was in the sky**.  Twain also died when the comet returned in 1910.  My Dad was born in 1910. The comet was due to return in 1986 and somehow I was convinced that my Father was going to die when Halley’s comet was again visible, just like Mark Twain.

I have no idea where this idea came from but I did worry as February 1986 came around. It was for naught. My Dad was in the best of health in 1986 and carried on until he died in 2003.

These days we make much of the power of thought. People have always felt that the religious practice of prayer can bring about change. Popular books examine the influence of thoughts on what happens to us. See for example The Secret by Rhonda Byrne, Wishes Fulfilled by Wayne Dyer or Expect Miracles by Joe Vitale. Attitudes (which is what you are thinking after all) influence your wellbeing. I don’t think anyone would argue that one can worry into illness (probably from stress) and smile into happiness.

Here’s my quandary. Do negative thoughts (not stress causing thoughts, but cosmic, life-changing thoughts) bring about negative consequences even if you don’t really want the negative consequences to happen. I mean, if I worry about getting diabetes, will I create diabetes in myself? I don’t want diabetes but if I think about it, do I make it become so?

I want to think that positive thoughts are taken seriously by the universe but when I’m scaring myself, well I’d like to think the universe knows better and those things won’t just happen because I thought them.

Or is my assumption wrong?  What do y’all think?

I still might get diabetes (or another annoying condition) but not because I thought I might. In another essay, we’ll look at why bad stuff happens, but that’s a different issue.

Two handy quotes to finish:

“As a single footstep will not make a path on the earth, so a single thought will not make a pathway in the mind. To make a deep physical path, we walk again and again. To make a deep mental path, we must think over and over the kind of thoughts we wish to dominate our lives.”
― Henry David Thoreau, author of Walden; or, Life in the Woods, 1854.

“Much more surprising things can happen to anyone who, when a disagreeable or discouraged thought comes into his mind, just has the sense to remember in time and push it out by putting in an agreeable, determinedly courageous one. Two things cannot be in one place.”
― Frances Hodgson Burnett, author of The Secret Garden, 1911.

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* The title is my mis-interpretation of “I think, therefore I am” (from René Descartes, Principles of Philosophy, 1644). My interpretation here is “If I think, shall I be?”

** The comet was brightest during November 1835 and Twain (S. L. Clemens) was born on November 30, 1835. He died on April 21, 1910 when the comet was back in April 1910.

Join us for a real-time discussion about this essay, or another post that’s more relevant to aging, on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

 

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