Walking Away

January 19, 2013

English: Centers for Medicare and Medicaid Services – Medicare & You 2010, official government handbook. (Photo credit: Wikipedia)

The Empire continues its decline; the global financial and economic systems the Empire built, the huge healthcare system, the food production and distribution system and the vast, but sputtering global system of cheap energy that sustains them make their wobbly way toward the next step down in complexity.  Climate change affects systems as diverse as food production, tourism and the insurance industry.  All interconnect in ways even the experts did not expect as changes in one system beget changes in another – each change destabilizing the whole in new ways.  And we at the bottom of the Imperial totem pole live in increasing fear that, right when we least expect it, something – big or small – will suddenly give and the whole kit and caboodle will come crashing down on our heads.  In truth, it probably will, though not necessarily in the big, splashy, splattering way we have come to expect.  Not yet, anyway.

My suspicion is that the collapse we all expect will not come (for us, at least) in one fell swoop, but more in the way of the “death by a thousand cuts” many people have endured since the financial collapse – where loss of a job (and insurance) led to loss of a house which led to loss of food/shelter/health security which led to increased stress on family health which led to …

Many of us who see what’s ahead and are working hard to disentangle our lives from “the system”, localize, become more self-sufficient and secure, still depend on the system for some of our needs.  I have a house with a mortgage, which means I must keep homeowner insurance and pay property taxes.  As a senior citizen, I live on my social security and rely on Medicare for my healthcare needs (mainly yearly checkups right now, thankfully), but I still must depend on a Medicare approved physician for my healthcare and a Medicare approved pharmacy for the few medications I take.  Living in town, I depend on the local utility company.  Despite my best efforts at gardening and the availability of local farmers markets, I still depend on the just-in-time system for some of my food needs.

And as hard as I work to cut back, power down and make do, ripples in the various parts of the system seem to have increasing effects on me.  The cost of what food I do buy has gone up significantly in the last few years, as has the cost of utilities – even as my use has decreased.  My homeowner’s insurance, which had steadily risen in cost over the years, suddenly doubled last year as (I assume) insurance companies begin to feel the pinch from increasingly costly natural disasters.  Three years ago, my Medicare-approved doctor quit his internal medicine practice and left me searching for another Medicare-approved physician.  (They’re harder to come by than people realize.)  I found one – finally – although I still have not met him; his PAs conducted the two yearly physicals I’ve had since then.  So far, these ripple effects have been inconvenient, but manageable.  But I have been asking myself, lately, what do I do as this slow collapse continues if the ripples become unmanageable – even with my best efforts to manage them?

I come from a fairly long line of women who, despite having some of the same minor health problems that I do, lived into their late eighties and early nineties.  So, the question is not just a rhetorical one.  And for those of you who are considerably younger than I am, yet find yourselves similarly afflicted by ripples in the system despite your best efforts to disengage, you might want to ask yourselves that question.

Last week, I did something I’d never done before and had never thought I would do.  I walked out of a doctor’s office in the middle of an exam.  I am not particularly proud of that, but at the point I did it, I felt it was literally necessary for my survival.

The nurse practitioner who did my yearly physical in December suggested that, since I have mild “rheumatic heart” from a bout of rheumatic fever in my teens, and had had occasional bouts of atrial fibrillation after I turned 65, I see a cardiologist for evaluation so that his nurse practitioner could be included in my next annual exam.  I really didn’t want to.  I’d had such an evaluation several years before.  Everything looked good and the cardiologist had taught me a couple of things I could do (which worked) to reduce the risk of further bouts of atrial fib.  I’ve had none for the last four years.

Nevertheless, I let her make an appointment for this past week.  I arrived a half hour before my 3:15 appointment, figuring that there would be additional paperwork, and found a seat.  The waiting room, which seated around fifty, was full and stayed that way almost the entire time I was there.

Two hours later, I still had not been called in, so I checked with the receptionist to see if perhaps I’d missed my call.  She checked and said, “Oh, there are only a couple more people ahead of you.”

In the next twenty minutes before I finally was called in, six others went in ahead of me.  And over the previous two hours, those who had gone in rarely came back out in less that a half hour.  Some, who I presumed had lots of testing done, had not come out for an hour.  I was quite tired and angry by the time I did get into the exam room.  I do have moderate hypertension, especially “white coat” hypertension.  Nevertheless, I was flabbergasted when the nurse took my blood pressure and said it was 220/100.  I asked how much longer it might be before I saw the doctor.  “Oh,” she said.  “There are only a couple more people ahead of you.”

I knew there were at least six people ahead of me and realized it might still be another hour or two before I was seen by the doctor.  So I said to her, “I’ll wait another half hour, but my son has been waiting out in the parking lot to take me home for the last hour and a half.  I can’t wait any longer than that.”

She shrugged.  “Well, I can’t do anything about that.”  Knowing that the longer I waited, the higher my blood pressure would go (and that I was already near “stroke bait” levels), after another half hour with no one else coming in, I put on my coat and left.

As I said, I’m not terribly proud of my behavior, but in my defense, after being home and relaxing for an hour or so, my blood pressure had dropped forty points down to 180/60.  And by the next day, it was back to its usual 140/60-160/80 range.

I don’t really blame the doctor.  I certainly don’t blame his nurse.  I do blame a system that has systematically reduced care in rural areas because it is not profitable and forces people in those rural areas surrounding Springfield and other larger towns to come into Springfield for anything other than routine medical care.  It adds to the burden of a growing city when the number of specialists has not entirely kept up with that growth, let alone the overflow from a failed rural health system.  Another ripple, I am sure, in the ongoing collapse of the overall health system in America.

But it has forced me to start thinking this week.  At what point do those of us who, like me, are already feeling multiple effects of the failing parts of this whole complex of intertwined systems, (even when we’re doing what we can to prepare,) walk away?  My entire strategy hinges on being able to stay in my home or one like it, where I can garden, raise a few chickens for eggs and other protein and ride things out for my remaining years.  Given that, do I (or you) wait until my homeowners insurance double again and, unable to afford it, I lose the house?  Do I (or you) hang on against increasingly frequent and stronger ripples that wreck my health and leave me vulnerable just as collapse picks up speed?  What happens when the social security system begins to fail?  How might I start over, if I need to walk away?

There are dozens more questions like that and I don’t know the answers.  That doesn’t terrify me.  I’ve started over more than once in my seventy-two years. But I did realize this week, that those of us who are not fortunate enough to be completely independent of the system, probably need to ask those questions that are pertinent to our particular situations and confront the possibility that, even with our best attempts to prepare ourselves, we may lose what we have. We might find ourselves having to walk away and start again, somehow.  I see it as just one more prep I may need to think through, as collapse progresses.