Defying Decrepitude: A Personal Memoir

by Alan Peacock

Overview

One of our most distinguished economists, Sir Alan Peacock, also happens to be a nonagenarian.

As an academic and former civil servant, Peacock is well-situated to analyse the costs and benefits of retirement and the courses of action that we can take in anticipation of a lengthening lifespan.

In trying to make sense of old age by writing of his later life and memoirs, he explores the Maxims of Francois, Duc de La Rochefoucauld, and views life's later stages and travails with a wry and clear-eyed detachment. Unafraid to grasp the realities of the decline of physical independence, he steers us through medical practice, bureaucracy and "healthspeak" as well as loss and bereavement.

His often light-hearted anecdotes reveal a serious point; that the ageing are assuming a growing responsibility for the aged. Opting to defy decrepitude seems the only sensible course of action.

Product Details

ISBN-13:	9781908684257
Publisher:	University of Buckingham Press
Publication date:	03/13/2013
Pages:	140
Product dimensions:	5.20(w) x 7.70(h) x 0.30(d)

About the Author

Sir ALAN PEACOCK is a distinguished British economist, knighted for public service in 1987.

Read an Excerpt

CHAPTER 1

Your life to come

The origin of this work is several conversations with Dr Colin Currie FRCPE, eminent specialist in geriatric medicine and author of two absorbing novels on the passage from medical student to consultant. I met him by chance on the train from Edinburgh Waverley to King's Cross. He was advising the then prime minister, Gordon Brown, on the future of medical services for the aged. As a result I considered that the NHS, whatever government was in power, should know more about 'client' encounters with its services and wrote a pamphlet entitled 'Growing Old Disgracefully'. Encouraged by Dr Currie's reaction to it and that of fellow oldies, I decided to expand it into a book. In the course of examining my own experiences more closely, I discovered that the process of ageing has a profound effect on the relationship between doctor, specialist and patient – even more so if the patient's lifespan becomes longer. The result is a rather different book from the one that I had intended to write.

The prevailing ethos of the medical profession requires that improvements in their knowledge should abound to the welfare of the old through keeping them alive longer. Led on by the succession of headlines in our dailies, this offers good news to counteract the miseries of the world of which we are only too well aware as the result of the modern marvels of instant reportage. I share the wonderment of those who observe the skill, persistence and dedication that pervades the medical laboratories. I have seen my own expectation of life at 60 rise progressively. I cannot have reached nonagenarian status at the same time as all my three children have reached pensionable age without having benefited from the results of scientific progress in medicine.

The allocation of more resources to medical research means that the community must be prepared to pay higher taxes and/or offer larger donations to medical charities. This is widely – perhaps even cheerfully – accepted, although controversy about how this money is allocated between different lines of research and how costs are to be controlled remain. What is less obvious is that the progressive increase in the medical input to achieve this end requires closer cooperation from the client in the form of attendance at clinics, which often leads to both continuous treatment and much more time spent under medical surveillance and care. In other words, the benefits of living longer have to be matched against their 'cost', notably the extra time and energy required of the client in attending surgeries or clinics for advice and treatment. The changing pattern of treatment through time may add the further necessity of greater participation by the client, aided or unaided by helpers, in its prosecution.

As an economist I shall be expected to construct some kind of prognosis of the nature and magnitude of this change in the balance between the input of medical services, including the time input of patients, and the output of benefits (mainly the extra years of life), allowing for how much future time will be taken up by 'repair and maintenance' to the human machine. One might sniff out some interesting relationship between the inputs and outputs, perhaps a version of the law of diminishing returns in which increasing inputs of medical resources, at some point, produce decreasing inputs of acceptable longevity. However, there are enough prognosticators making their bubble reputation from some terrifying prediction about our prospects of survival. Macro-medical prognoses provide excellent copy for broadsheets and popular dailies, although much of it would be better placed alongside the Delphic utterances of their astrological correspondents.

I do not compete with these descendants of Nostradamus. In my professional life I have had quite a lot to do with the development of health economics, but only use this knowledge to suggest a framework for a series of tableaux representing the 'drama' of the dialogue between doctor and patient. My wife Margaret and I considered how we wished to organise our affairs if we were to live longer than expected; our main conclusion was that, whatever effect longevity would have on our quality of life, we would want to remain together and, as far as possible, determine the pattern of our lifestyle. We realised that this was a counsel of perfection. We had seen for ourselves the particular difficulties that arise when one partner becomes less able to cope than the other, as for example if afflicted with blindness or some form of dementia. Our links to the social services would remain being tenants of a retirement flat. We would only too willingly continue as patients at the same NHS practice where we had been registered for over 30 years.

We would at some stage have to face the awkward fact that we would no longer have a car – that is, if we survived beyond the stage where we recognised that we might be a menace to other drivers as well as to ourselves. The list of obstacles to preserving our lifestyle could be extended much further but, being by now well past our golden wedding anniversary, we had learnt a certain amount about how to overcome or dodge them.

No advice is offered and no moral judgment made, although the reader may become more aware of some of the moral dilemmas that we all have to face in our relations with doctors and specialists. Nevertheless, as I have already indicated, there is a bias in my narrative that is meant deliberately to offset tendencies in official policy formation not to take a more full account of the active part that elderly people could take in looking after themselves. Of course, older patients are encouraged to give voice to their reactions to the medical procedures that affect them directly, and regulatory bodies covering social services rely on recruitment among retired persons.

However, any realistic policy designed to improve the expectation of life and its quality must take account of the resource costs. This suggests an extended role for the patient as a 'co-operant factor of production' (to put it in the stark lingo of the economist). Innovations in medical practice are now putting considerable emphasis on generating information regarding the progress of an illness by using new technologies to keep track on changes in the patient's condition.

The presupposition that a patient wishes to remain independent requires consideration as to how far patients can act as monitors of their own health condition. 'Self-tracking' of the remedial effects of medicine on the individual patient is already a prominent feature on the research agenda. This fits well with an emphasis on retaining independence in old age, but this is in no way meant to cast any doubt on the immense welfare benefits of the communal activities that the old develop spontaneously to make life tolerable for themselves. I make no claim that this little book provides anything more than a starting point for the study of the organisation of medical services for the old, but it does take particular account of the wishes of those who in old age would like to continue to look after themselves for as long as possible.

I realise, of course, that having the chance to defy decrepitude is a privilege that many are denied by such foes as illness, injury or war. The fact that I illustrate the challenges of living into one's tenth decade does not mean that I am not grateful to have the opportunity to do so.

CHAPTER 2

Living beyond one's allotted span

I was a patient of the head of the G Medical Practice, Dr A, on only one occasion. I must have been close on 80 years of age. After examining my record and going through that puzzling ritual entailing my attachment to his stethoscope, he remarked that I had had a 'good innings'. I was not sure whether this was meant as a compliment or as an indication that I had had more than my fair share of support from the NHS. My mother would have gone for the second interpretation. In her eighties, she announced periodically that she was living off 'borrowed time'. Asking her to whom she 'owed' this time and how she could repay her debt was not an advisable pursuit. It might have led to an argument about whether she still believed in the tenet of her Christian upbringing that one's entitlement to life was three score years and ten. Actually, she lived four years longer than my father and died at the age of 93.

However, it transpired that, whatever the scriptures may have laid down about the entitlement to living, Margaret and I were categorised by our doctors as among those whom they were determined to keep alive and in good spirits for as long as it took. At least, that was the inference that we derived from their treatment – even if no statement to that effect was promulgated. Let it be said here and now that we could not be anything other than deeply impressed by the results, given what GPs often have to endure from confrontations with patients who expect the Earth and from the meddling bureaucrats at their backs.

For most of us in the UK, the general medical practice (GMP) is the focal point of our personal contact with those who are qualified to ward off disease, cure us of ailments, and alleviate us from the pain of afflictions that will pursue us until we expire. The GMP is both a repair shop and a sorting office. As with relations with the local garage, the GMP can find out what problems bother us, decide whether it can cope with them in-house and know where to obtain specialist advice, and, if need be, transfer control over necessary action to the specialist's department. Of course, one can do without a car temporarily, by hiring, borrowing or owning another. In the case of medical action affecting our person, one has, as a client, to surrender oneself – albeit temporarily (hopefully).

A preliminary understanding of the process of seeking medical support for survival can be offered by accompanying me on a visit to the GMP. It is within reasonable walking distance and requires passage along a gentle sloping path. I know it well but the once-gentle slope now seems to me more like a steep mountain track, so I must allow double the amount of time than hitherto for its ascent. The path comes out in the very road where the GMP is situated. I can now see before me a church that is so trendy it has its website address painted in gold lettering above its porch.

The end of the path is alongside the entrance to a large cemetery; if I go in and follow its north wall I come out by a small gate opposite Y, passing the ornate memorials to Victorian worthies on the way.

Through the gate and crossing the road, I am at my destination. I am nodded into the waiting room by one of the invariably pleasant receptionists. They take one's mind off the reasons for one's visit, but only momentarily. The waiting room dispels any illusion about their greeting, for it seems designed to sanctify sobriety.

Two sides of the waiting room are taken up with notice boards that are festooned with flyleaves of varying size and importance. Today I count as many as 48. Collectively they offer warning of the hazards of remaining alive, and how to contact those who will rush to your assistance; these individuals are recognisable by some symbolic device but are covered by the familiar formula of 'if in doubt, consult your doctor'.

Conscientious study of each and every one of these warnings is enough to induce apoplexy – or whatever it is called today. Perhaps that is why I have seen only one person attempt to read all of them – patients seem all too aware of the dangers of doing so. The doctors and nurses probably know this, but pin the notices up nevertheless (because ... who knows? It may be a statutory requirement). Question: why not pick a 'priority notice of the week' and draw attention to it alone? I suppose that the choice could become the subject of fierce debate between members of the practice, already overburdened by paperwork and now asked to see if the paper can be made to work; a waste of valuable professional time better spent on seeing the oldies get their 'flu injections?

Over the years – as a patient of 28 years' standing – I recall various well-meaning attempts to provide the waiting room with some semblance of friendliness. I can vouch for its no longer resembling a down-at-heel Edwardian drawing room with an empty fireplace and sombre lighting. Instead of old chairs of various shapes and sizes and tattered upholstery, there are now cheerful cafe-type padded seats in pastel shades. Instead of the cast-off reading matter of the medical staff, recently at least one daily newspaper has been available alongside glossies in which our sexual problems are discussed with disarming (some might say alarming) frankness.

However, little seems to change the physiognomy of the patients displaying profound pessimism, although the scene can change quickly if babies chuckle and their older siblings play on the floor with trains extracted from a corner toy box. But anxious parents (frequently alone) seem to sense that sepulchral calm must reign and have recourse to unsuitable forms of bribery such as offering sweets to suck in order to induce their progeny to 'behave'. (I would love to talk to and make faces at these kids, but I have to remember that these days an old man with a runny nose can incur the suspicion of being a sinister paedophile.)

Surprisingly, the young adults, while often handsome or nubile, rarely display evidence of 'joie de vivre'. Their facial movements and body language suggest evidence to the contrary, until one realises that they are predominantly 'wired up' to mobiles churning out their favourite pop tunes. After a desultory look at the back issues of SAGA I retreat to my chair. The side door to the surgery opens and the young family are ushered through it, their chat recedes and we are once more enveloped in gloomy silence.

Now is the time for turning inwards. My reverie is far from reverential. I have difficulty controlling the agenda and I find today that I have caught myself trying to outdo my Fife friends in composing outrageous limericks about egregious citizens of their small towns.

Today I think I can score high marks:

A young mathematician in Ceres Invented an infinite series When filled with elation At his own calculation His colleagues said 'you're ultra vires'

(Not bad – but oh so upmarket.)

I try to think of another way of torturing myself with a puzzle. Try reversing the meaning of hymns, constrained by the 'rule' that the metre must remain the same, as must the tune. I have never got further than the chorus of 'Onward, Christian Soldiers', and only then with a dodgy last line:

Backward, pagan sailors Slouching, seeking peace Hoping the Jolly Roger Will signal our release

Onward, Christian soldiers Marching as to war With the cross of Jesus Going on before

(Mm, last line a fudge, eh?)

I was never much good at reciting reams of poetry, only remembering about two or three lines at a time. I am now almost nodding off, conscious that an elderly couple have sat down opposite me fitting easily into the prevailing pattern of pessimism.

I grow old ... I grow old ...
I shall wear the bottoms of my trousers rolled

('The love song of J. Alfred Prufrock', T.S. Eliot)

No longer applies. Try again, Peacock.

I have grown old ... I am growing cold The trousers round my bottom obscenely unfold.

Huh! A poor attempt at postmodern parody. Read your broadsheets and you will find that in the literary competitions, take-offs of Eliot abound – and most are much cleverer than that.

There is no defence for the enemies of decrepitude against the onset of sleepiness and, changing poetic gear, I nod off to Tennyson's 'Splendour Falls on Castle Walls', hearing 'the horns of Elfland faintly blowing'. Somehow their plangent tones are replaced by the voice of Dr C demanding my presence in the coven of consulting rooms behind the side door of the waiting room; 'are you ok?' he adds, understandably mistaking my somnolence for senility.

I manage to persuade Dr C that I do not require him to prepare a barrage of tests associated with such doziness, which might presage the onset of a heart attack. So, he asks, 'what seems to be the trouble?'. I am discomfited. I am not engaged in an act of imagination. I seek information that helps us in our mutual quest to keep me alive. Of course, I appreciate how much I owe him: getting me into the queue for the fitting of a pacemaker to reduce cardiac 'fibrillation', getting me to agree to stop smoking cheroots, and prescribing Warfarin (rat poison) pills for daily consumption. I know better than to waste his time (and mine) complaining about the odd whitlow or bruise.

I face him with my problem: having a life of itch as a result of Warfarin's side-effects. He agrees to allow me to continue to smear the affected parts with white paste, trade name Fucibet (no vulgar variations please!), only available on prescription and to be used sparingly. Dr C avers that Warfarin will soon be superseded by some potion or other removing the source of my irritation – nous verrons. Well, I suppose that elimination is eliminated and only the alleviation of itch apposite. It is being made clear that there is nothing much wrong with me, but no harm in allowing me to suffer from a mild dose of hypochondria. Or is he really letting me down as gently as possible by using a coded language that, when written en clair, emerges as 'good God man, can't you see that you have exhausted our repertoire of repairs; MOTs are a waste of money for old bangers'? No. I am rather ashamed at taking a conspiratorial view of his advice.

(Continues…)

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Copyright © 2013 Alan Peacock.
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Table of Contents

Introduction by Lord Sutherland of Houndwood,
Chapter 1: Your life to come The costs and benefits of lengthening the lifespan,
Chapter 2: Living beyond one's allotted span The scene is set by the visit of a seventy (plus)-year-old to a medical practice,
Chapter 3: The perils of preservation uncovered. Coming to terms with 'healthspeak' in recommended clinical appointments,
Chapter 4: The questionnaire disease 'There has to be change for things to remain the same': inmates ask the same questions and the answers are often distressingly familiar; the mixed legacy of Florence Nightingale,
Chapter 5: Journey's beginning Decrepitude and plans for retirement,
Chapter 6: The dark shadow of decrepitude Facing the fact that the 'old engine' (the human body) needs a series of major repairs as well as fine-tuning,
Chapter 7: How was it in your day, Dad? The recognition that the old help to satisfy the intense curiosity in the past of the young,
Chapter 8: 'The strife is o'er ... the battle lost' The travails of loss of physical independence; how the old may and do help the aged,
Chapter 9: Defiance gives way to resignation Decrepitude and bereavement,
Epilogue: The changing relationship between doctor and patient,
Endnotes,