Louisville Medicine Volume 67, Issue 10 - Page 9

FEATURE get anyone except a bored close relative to take the case. To comply, I arranged an EKG with the hospital cardiology service using my health insurance to pay for the test. In the EKG lab the technician, who was nice enough, put the EKG leads on my chest and did the tracing. She handed me the printout. The printout said, “Abnormal EKG-atrial fibrillation.” “What did that mean,” I asked, as my heart, except for a few premature ventricular contractions, was running at 62 and regular. “You will have to ask your doctor,” was the reply. She gave me no clue. I had images of cardiac catheterization, sore and ecchymotic veins in my groin and then an unsightly pacemaker pouch above my breast, like many other elderly members at the health club. When I got to the gym with the ‘abnormal’ EKG in my coat pocket, Dr. S, a really good cardiologist, was in the locker room. “Can I show you something?” I asked, “Sure!” he said. He looked at the tracing. “It’s OK, the jitters are from your chest hairs. The machine always opines that that’s an abnormal tracing.” The tech must have known – that’s what she does all day. The hours of anxiety were just another part of the conspiracy against the elderly. My next surprise was a letter from the hospital saying that since I was of a certain age, I must make an appointment for and submit to psychological testing. The presumption that the elderly have reduced cognitive function which could lead to significant misadventures in patient care is part of a cultural prejudice against seniors. In some societies, the opinions of older persons are considered as wisdom; in our society these opinions, particularly contrary opinions, are signs of senility, dementia, or worse, Alzheimer’s disease. Alzheimer’s is worse than mere dottiness because it implies a physical change in the brain - tangles, inclusions and other inalterable anatomical features. So, I was led by a nice lady of a certain age past bland painted corridors into depths of the Hospital Personnel Department, asked to sit at a table, required to sign a disclaimer and then was tested (actually, there is no one to share data with if they should find anything, my mother is dead and I have tenure in the university). They proceeded to give me what turned out to be a standard federal government battery of cognition tests. This meant I had to identify the sketch of an elephant as an elephant, a bear as a bear, subtract seven from 100 endlessly, do a timed drawing of a multi-sided box and remember a string of words, the first of which was “violet” or “velvet.” By this time, I was bored and failed miserably. Worried that I might have, at best, age appropriate onset of memory failure or, at worse, Korsakoff ’s psychosis, I later asked a nurse practitioner sitting next to me at medical council meeting what to make of my inability to remember seven-digit phone numbers. She reassured me that she has to write them down too. As the year came around again, I got another letter from my malpractice insurer. This time, it was to be an audiogram followed by an interview. I evaded the requirement for a referral by asking my colleague in ENT to arrange the test – did I have exposure to “loud noises?” Or, “Do you mean like helicopter operations off a naval ship at sea or target practice in the submarine service, perhaps? Or perhaps a recent firing range experience where my practice partner let loose with a handgun next to my head?” The audiogram showed loss – lots of it! If these are the continuing indignities of old age, I’ll draw the line when they ask next year for a colonoscopy. Dr. Seligson is professor in the Department of Orthopedics at UofL School of Medicine and practices with University of Louisville Physicians. He specializes in orthopedic trauma. INTERESTED IN WRITING FOR LOUISVILLE MEDICINE? . Over the next year, Louisville Medicine magazine, a publication of the Greater Louisville Medical Society, will be examining the following themes listed below. We know our physician members have unique perspectives to share, and we want to hear more on these topics from you! If you have an idea related to or expanding on a topic below, your work could be published in an upcoming issue of Louisville Medicine. To write, contact Kathryn Vance at [email protected] Writers should be GLMS members in good standing. » PEDIATRICS (Neonatology, In-Utero surgery) » H  EALTH HAZARDS OF PRACTICING MEDICINE » T  RANSITIONING YOUR PRACTICE » (from full-time to part time, » employed to private practice, » residency to practicing, medical school to residency) TECHNOLOGY IN MEDICINE » U  RBAN LEGENDS & OLD WIVES TALES IN MEDICINE » MOTHERS IN MEDICINE NEUROLOGY (Migraines) CARDIOLOGY Please note that not all articles submitted will be published. The GLMS Editorial Board reserves the right to refuse, edit, and/or send an article back to author for revision. For a list of guidelines to write for Louisville Medicine please contact Kathryn Vance at [email protected] MARCH 2020 7