Senior Citizen!

It was no issue signing up for the mature driving course.

The accepted definitions of mature includes “those who are over the age of 18, or 21.”

I’m planning to audit a class or two starting in January at our local state university.

I’m committed to being a lifelong learner and have always completely agreed with a quote attributed to John Quincy Adams: Old minds are like old horses. You must exercise them to keep them in working order.

According to the university academic calendar, the registration for “Senior Citizen Audits” begins at 3:30 pm on January 9th, in person, at the registrar office.

Senior Citizen!

The most common definition is “an older adult, especially one who is age 65 or older,” and I’m of this age.

However, I would prefer to present, in person, to hand in my registration application for an “Older Adult Audit.”

I’ll eventually “get over” the verbiage being used, I’m sure…possibly even by January 9th!

Could have played some ”free” golf!

Just finished doing the 6-hour Florida Safety Council-Mature Driving Course.

The cost was minimal-only $12.50.

I could have taken it over ten-years ago, since eligibility starts at age 55+.

However, I doubt I would have committed to the 6-hours, until now.

It had nine mandatory sections, and you could not advance to the next section until the countdown timer, for each section, was completed.

I passed the final exam.

Haven’t told her yet, but know my wife will be so proud!

My car insurance premium will be decreased by close to 10% for the next three-years (you can call your carrier to find out what your rate reduction would be prior to starting).

At my current rate, the three-year savings is approximately $500 or about $163/year (taking the cost of the course into account).

Man…the things I could have done with the extra dough!

Could have played 3-4 rounds of golf/year with the $163, basically (in my mind) for “free,” depending on the course, the time of the day and the season of the year.

😏.

See-one, do-one, teach-one

Just got back from visiting my daughter and her husband, both of whom are in their 3rd year as Veterinarians.

Neither did a residency after Vet school.

They’re doing well and have acquired significant experience in a short time.

I went to medical school, and did residency, in the see-one, do-one, teach-one era.

I always enjoyed procedures.

Prior to doing, however, there was always a sense of anxiety, apprehension, and questioning of my ability to perform whatever procedure was clinically indicated.

But, the procedure typically ended with, “that was a lot easier than I thought,” as I transitioned to doing more of the same alone, or teaching colleagues when an opportunity arose.

Medical students and residents now keep a careful log of the number of a procedure they have observed, prior to be signed-off to, eventually, perform.

The number required to observe varies, but is much greater than one.

I had no such documentation requirement.

My daughter and son-in-law are doing some amazing surgical procedures, many of which they’ve done after previously observing only one, or in the case of some emergencies, having been talked through by a colleague who was at a remote location or after quickly watching an instructional video.

It reminds me of my medical school and residency days from the 80s.

A change in goals

Arthur C. Brooks (from his book, From Strength to Strength):

-They (researchers) found that goals fell into two basic categories, which they called intrinsic and extrinsic.

-Intrinsic goals centered around fulfillment from deep, enduring relationships. Extrinsic goals centered on earning a lot of money, owning a lot of stuff, gaining power, or achieving reputation and fame…

-If your life goals revolve around lots of money, prestige, and other worldly things, you will be setting yourself up to have exploding wants and low life satisfaction.

-Perhaps you have been a full-on extrinsic goals junkie for many years…

-But if you are mature and experienced in the ways of life-another way of saying you’re getting up there in years, like me-you now know that extrinsic rewards are foolish goals.

-Only a shift to intrinsic goals will give you what you really want…

-Here’s a trick to get started on this: Visualize yourself at a party. Someone asks, “What do you do?” Don’t imagine yourself saying, “I’m a lawyer.” Imagine yourself saying instead, “I’m a wife and a mother to three adult kids.” Don’t worry if you don’t quite believe it yourself at first that this is who you truly are and what you do. You will speak this truth into existence in your life.

-It’s difficult to describe adequately the depth of the rewards that one enjoys when relationships become your official source of meaning and fulfillment. People compare it with finding buried treasure, with the only sadness being that it didn’t happen earlier in life.

Okay, here goes: 

Q: What do you do?

“I’m a husband, father, and grandfather.”

It actually feels just fine. 

Think about giving it a try.

80 sexual encounters, by 3 passengers, on 1 cruise

I read each edition of (General Medicine) Journal Watch.

It reviews recent medical articles and presents them in an abbreviated format-something appreciated by most family physicians.

The most recent had a section entitled, Mpox (Monkey Pox) on the Seas.

Mpox is caused by the Monkeypox virus, is transmitted through close, usually intimate, contact, has symptoms that include fever, malaise, chills, headache, sore throat, cough and swollen lymph nodes, followed by a rash that may be located on the hands, feet, chest, face, or mouth or near the genitals, and typically lasts 2-4 weeks. Treatment is mainly supportive, including pain management.

It noted that on one cruise (that was marketed to gay and bisexual men), 3 symptomatic passengers reported a combined total of about 80 sexual contacts (all of which were verified as male-to-male sexual encounters).

This had to be a typo, right?

I reviewed the original publication.

It wasn’t.

On the cruise, one passenger had 50 sexual encounters during the voyage, another passenger had 25, and a third passenger had 4 (Total of 79!).

The Center for Disease Control (CDC) initiated appropriate tracers (reaching out to those who had contact with the symptomatic passengers).

The effectiveness of the mpox vaccine for post-exposure prophylaxis is greatest if/when administered within 4 days (that’s why pre-exposure prophylaxis with the vaccine is preferred).

If I was a CDC employee, I would have immediately volunteered to do tracers on the third passenger.

But, since I’ve always been a team player, would have (eventually) assisted colleagues who were tracing the other 75!

New power nap

I’ve taken power naps for years.

Within my immediate family, I was “famous” for taking a 10-minute nap, during the work week, almost immediately on returning home.

I would stretch out on my recliner, set an alarm, breathe deeply, acknowledge that I was about to drift off, and then do just that.

10-minutes later I was refreshed, rejuvenated, and ready for the remainder of the day.

There’s a lot written on power napping.

Some feel the ideal amount of time is 10-20 minutes, to obtain the benefits of sleep, without leaving you feeling groggy on awakening or adversely affecting your ability to later initiate or sleep through the night.

There’s even a frequently viewed video, by former Navy Seal Jocko Willink, on the 8-minute Navy Seal nap.

I never tried to do just 8-minutes-I always preferred to remain in double digits!

Since retiring, however, I haven’t set an alarm and my power naps have increased to about 40-60 minutes.

My work was typically stressful, so that’s no longer an excuse for napping.

I’ve been exercising a lot and have had aches and pains.

No one has asked (mainly, because no one has observed), but if they were to inquire, that’s currently my primary excuse.

My dog, Dwight, who always sleeps on my lap, hasn’t minded one iota.

I admit feeling groggy some days on awakening, but haven’t felt inclined to set an alarm, nor have I had any trouble later initiating or sleeping through the night.

I suspect this will continue as my new-retirement-power-nap norm for the foreseeable future!

Hectic work day game analogy

For many years, when things would get hectic during work days, I would always think back to the 1979 Atari video game called Asteroids.

One had to use buttons to try and shoot/destroy the asteroids that were coming from all angles toward the directional triangle, which represented you and your gun.

Daniel Waters, DO, a retired cardiothoracic surgeon, has his own analogy (from a game introduced in 1975):

“By the end of my career, one of the best descriptions I could come up with was that I was playing an endless game of Whack-A-Mole...”

Over the years, I got adept at handling challenges since there was virtually nothing, in the course of most days, that I hadn’t previously dealt with over my career.

Experience allowed me to successfully navigate through chaotic days.

The current medical director is surely dealing with daily challenges from patients, their families and caregivers, staff, medical center leadership, and administrators.

She hadn’t been born yet in the 70s, so Asteroids or Whack-A-Mole may not be something that comes to mind.

When we cross paths, I’ll  inquire if she’s come up with a more current hectic work day game analogy 😏.

Remembering a wonderful role model

I was notified, last evening, that a former acquaintance died last week.

He was a cardio-thoracic surgeon who had an incredible impact on all he encountered-patients, families, and medical colleagues, fellows, residents and students.

I got to know him while he was a surgical resident and I was a medical student.

He was brilliant, intense, yet kind, down to earth, had a great a sense of humor, and basically lived at the hospital.

I saw yet another side of him when I would see him playfully interacting with his family during some dinners, in the hospital cafeteria, of course.

I once asked him how he kept up-to-date with everything.

One way, he said, was to always carry note cards so he could  “review things, even when in the bathroom taking a crap (followed by laughter).”

My post yesterday was about the importance of remaining physically active.

He accidentally died while doing just that-riding his bicycle through the countryside.

I don’t wanna be a sloth

During a family trip to Costa Rica a couple of years ago, we encountered many sloths, those tree-dwelling mammals with the lowest metabolic rate of any mammal, known for hanging upside down in a tree and for their sluggish movement.

In his book, HOW TO RETIRE Happy, Wild, and Free, Ernie Zelenskyy reminds us that:

1. Staying physically and mentally active is the easiest way to retire happy, wild, and free.

2. Slothfulness increases the risk for many chronic disease including colon cancer, breast cancer, heart disease, stroke, and diabetes.

3. Retiring rich, but unhealthy, won’t do you much good. Without good health you can never be rich.

I’ve been exercising a lot since retiring.

Vigor is one of the antonyms for slothfulness.

I’ve noticed that vigorfulness increases the need for intermittent ice packs, heating pads, and ibuprofen 😏!

$600/year less

Have been having some interesting post-retirement flashbacks.

Prior to starting as a family medicine intern in 1985, I narrowed my choices down to two apartment complexes relatively near the hospital. One was brand new, with many nice amenities, in a safe part of town, and the other was much older, with no amenities, in a less safe part of town, but was $50 less a month.

$600 less for the year!

I choose the older, cheaper apartment.

One Sunday evening, shortly after having moved in, I returned home to find I had been robbed-TV, stereo, jewelry, etc..

A bedroom window, that backed to some woods, was used as the entry site.

Of course, I hadn’t purchased renters insurance.

The good news, however, was that the word must have gotten out that I had nothing left to steal, so I spent the next 11 and 1/2 months with no further issues!

When my lease expired, I moved to the newer apartment, even though it was now about $60 a month more, plus the added cost of renters insurance!

Looking back, it does make me smile-not because of the losses, but due to the monetary choice I made at the time.

However, I suspect I would make the same choice if I could turn back the clock. 

I was living pay check to pay check and it represented a significant amount of money at the time.

More (greatly appreciated) wisdom from Daniel Waters, DO

The 3 S’s that you must have in your possession when you retire:

Sanity: modern medical practice can drive you crazy…moral injury, burnout, empathy exhaustion, PTSD, stark raving lunacy, terminal cynicism…The reason you need to carry your sanity with you into retirement is that only through an unfractured lens can you focus and thus make sense of your life’s work.

Sense of humor: some aspects of medicine just lend themselves to laughter-never at a patient’s expense, but at situations that come under the broad umbrella of “well, you certainly don’t see THAT every day.” When you finally decide to close the cover and put the book of your career on the shelf, you’ll want to have a smile on your face.

Self respect: when you shuffle off…what remains of your medical life is your reputation and your contributions. Unlike our dust-faded selves, that never gets old.

Grumpy old man?

Now that I’m out and about running different errands during the weekday, I’m seeing more perfectly healthy looking drivers, than ever before, getting out of a car in a disabled parking space, with the disability placard hanging from the rear view mirror.

I haven’t seen one person yet who has any apparent functional deficit, or who is using a gait assist, or who is on portable oxygen, etcetera, but I’ll keep on the look-out.

I’m always conflicted.

I understand that a disability may not be completely apparent, or may be intermittent, but if currently doing well, why take up one of the few spaces that could be used by someone with a more symptomatic disability?

I suspect many have the placard for when an elderly disabled family member is driving with them, but they are just choosing to use it even when alone.

I’ve been tempted to yell, WHAT THE HECK IS YOUR DISABILITY? but never have.

Hopefully, that will remain the case long-term.

I think it will because we have a bunch of children in our neighborhood and not once have I yelled, GET OFF MY LAWN!

Hoping all goes well

A relative was recently diagnosed with Alzheimer’s disease.

He’s in his mid to late 70s.

He’s planning to initiate treatment with one of the recently FDA-approved monoclonal antibodies.

Monoclonal antibodies have been shown to delay progression of early Alzheimer’s disease but are not curative.

He will be getting an IV infusion every 2 weeks for the next 18 months, and will need follow-up brain MRI’s after the 3rd, 5th, 7th, 14th and 26th infusion, if all goes well. If there’s any evidence for an amyloid-related-imaging-abnormality (ARIA), due to swelling or bleeding in the brain, he would need MRI’s monthly until stability is assured.

The infusion takes approximately an hour, if all goes well, without unexpected waits/delays. The total time, obviously, is much longer due to travel time to and from the infusion center, the preparation of the infusion, and required post-infusion monitoring.

A brain MRI typically takes about an hour, if all goes well, without unexpected waits/delays. The total time, obviously, is much longer due to travel time to and from the imaging center, the possible need for sedation, and the possible need to repeat the entire study if accidental movement results in less than optimal images.

Clearly, this is no where the amount of “medical-care-time” that those on hemodialysis endure (4-5 hours every other day), but is still significant and like hemodialysis, pretty much keeps you anchored close to home.

Total billed costs are tremendous. The amount an individual pays varies depending on many factors.

I’m not sure what I would do yet, if/when faced with a treatment decision such as this.

But, I’m hoping all goes well for my relative.

Quick subtraction and not sucking

I saw a former neighbor at a memorial service, for another former neighbor, last week.

Our families lived across the street from each other for 23 years.

He’s an attorney, but let me know he retired last year.

He updated my will, in 2015, when my first wife died unexpectedly at age 45.

I let him know I retired 4 months ago.

My neighbor: “Did you know my wife died in 2022? She was only 70. That’s too young to die. Nobody should ever die that young. Doesn’t retirement really suck? One can only read so many books and watch so much TV, right?”

Just as I was about to come up with some sort of reply another former neighbor walked up to exchange pleasantries, unfortunately (or…thankfully?).

I’m not exactly sure how I would have replied but quickly:

1. Did subtraction (70 years minus 45 years equals 25 years).

and…

2.  Determined the question of if retirement sucks would never be answered in the affirmative.

We only had a brief encounter prior to being pulled away from our conversation.

I’m sorry he’s not doing well in this stage of his life.

I know he has 3 children and 3 grandchildren, but don’t know the current status of their relationships.

If I can find his contact information, or we cross paths again, I’ll try and share retirement pearls I’ve come across, if he’s seems open to it, approachable.

A retirement sensei

Some quotes by Daniel Waters, DO:

“When you retire, what remains of your medical life is your reputation and your contributions. All well and good to be envied for what you amassed. Better, I think, to be respected and admired for the things you did and the way you did them.”

“Most physicians leave a mark on their community, hospital, specialty, colleagues and their trainees. Some, however, leave a stain. One hopes physicians who exploited their healer’s status and privilege strictly for financial gain will be appropriately judged in the afterlife.”

“Staying sane for an entire medical career is not luck-it’s takes dogged persistence and constant self-reminding that you are not locked in a bank vault in Stockholm.”

“A lifetime of medicine is a chapter book. Page upon page of pathos, conflict, drama, joy, absurdity and humor.”

“A sense of humor is like having a reliable and endlessly renewable source of fresh water while hiking in the desert.”

“Think of it (retirement) like tapering a steroid or an opioid. You want to be clearheaded and unimpaired when you walk out the door for the last time.”

“Retirement is something that evolves because new variables are always being introduced. Health concerns, for ourselves and those we love, marriages, the arrival of grandchildren, unexpected deaths or departures-takes us in new directions, imbue us with new goals, higher hopes and different dreams.”

I could not agree more.

Huge thanks to Dr. Waters for sharing his wisdom.