Monday, July 29, 2024

Coffee, Old Men and Fighting Depression

 


Bright, warm Saturday mornings are nothing short of a blessing. Me, on most Saturday mornings at 10 am I get together with some guys. Out on Duque de Avila about 40 of us gather at a padaria[1] for coffee drinks and Portuguese pastries. I like these folks.


Over espressos and galaos[2] we talk about anything and everything. Normally people talk about what they did before moving to Portugal. At most of these morning sessions probably half the table will talk about where they have just returned from or where they are traveling next. Others will talk about bureaucracy, for it is said there is no bureaucracy like the Portuguese bureaucracy. Obviously we talk about how troubled America seems to be. But we all try and keep it light and positive. 


Our coffees are always lively. Laughter punctuates the air as stories and jokes are shared. Jokes may not be the right word. Humorous stories or anecdotes from our lives are recounted. And we all have those WTF was he thinking tales. The scent of freshly baked pastries mingles with the rich aroma of coffee. Under the umbrellas out of the sun on a weekend day, it's a good place to be.


Our coffees provide a sense of community and belonging. I personally think these wide-ranging conversations provide a valuable support network for all involved. They allow us to share experiences, navigate the challenges of living abroad,and share who is the doctor to see for what and what hospital they work at. It is a time to celebrate our lives and the choices we have made. This includes the one we made when we moved to the Iberian peninsula. In many ways, Saturday mornings are a vital part of our social lives. We are friends.


One recent Saturday morning coffeetime conversation focused on the struggle between a desire to write and the interruptions that travel and social events had on one individual’s process. All the guys listened and made suggestions. However, it was clear that the writer’s frustration was not solved by this informal group therapy session. The writer was certain that only he could come up with his own viable solution.


Was this depression? I don’t think so. Listening to the tone and tenor of the conversation the speaker was simply feeling aggravation and frustration, cousins of depression, but not actual depression. I think he will eventually be able to figure out the balance he needs between his craft and his daily routine. But for another person this conversation might have been a statement showing the tip of the iceberg that is depression.


The world gets colder as we grow older, or so it seems. It is sad really. According to WebMD, 1/3rd of retirees suffer from depression. Another source, an NIH publication from 2022, pegs the number of retired individuals with depression at about 28%. So, depending on your source for information, somewhere between 1/4 and 1/3rd of those people who have aged out and left the work force suffer various levels of depression.


It is clear to me and the doctors and researchers generating this data know that it isn’t simply separation from work that causes post-retirement depression. If only 30% of your heart is working, or if you are in stage III of some cancer, you got other things to be depressed about, existential things. Thinking hard about this I looked at a couple of sources talking about retirement and its correlation with depression. I grabbed a paragraph from an NIH article abstract and ran it through an AI grammar checker. This easily understandable statement got regurgitated.


Retirement almost always involves major changes in social roles and social networks. At the same time, changes are occurring to tangible assets like income and health insurance. These changes all impact the risk and management of depression. Addressing late-life depression is challenging. Often older adults with depression have co-occurring medical problems which complicate both the appropriate diagnosis and apt pharmacologic treatment.[3] 


Health care providers know strategies to fight depression in retirees. By reading something like an AARP tabloid paper or clicking on a newsfeed item with the keywords retiree health, you will see the list of action items. These strategies include engaging in regular physical activity, participating in social and community groups, and practicing mindfulness or cognitive-behavioral therapy. 


In most cases, a paragraph below the one containing the above suggestions will provide additional tips. Retired people are urged to develop hobbies and interests to provide purpose. The final lines in the article will reference establishing a consistent routine and maintaining strong social connections. This is because “experts” find these are critical components of supporting emotional well-being. 


One of the things we discussed on Saturday is the wall retirees hit when “the checklist” is done. Coming to Portugal we all had checklists. There were the basics, easy to state but challenging to accomplish like obtaining a visa to enter the country and then applying for a residency permit. To accomplish these, we all needed residential leases or purchased apartments. Then there were things like bus passes and medical cards. When you get a place you have to furnish it too. Yeah, all these things were on the checklists and kept us busy. Note that even if you remain at the place where you were upon retirement you most likely have a checklist. It usually involves updating the will, fixing the back porch roof, weeding what used to be the garden, etc. And yes that checklist will also come to completion.


A year may pass. Maybe it will take eighteen months. Completing the lists will probably not take more than two years. But there will always come a day when the checklists are ticked off. Then what? At that moment you face the massive wall of what’s next. At that point where you are headed and what you do next become acute questions.


I retired in January 2020 just before the world stopped and took a two-year breather. I spent two years like everyonetrying to stay alive. I ordered tons of supplies online. Got groceries delivered to my car trunk.  Took gallons of paint and redid my living room. Yup I had a I am stuck here in the middle of America checklist developed in the early months of the pandemic. But prior to retiring I created the “Let Us Move to Portugal” checklist. While 85% of what I did during the pandemic was stuff around the house, I kept plugging away at the Portugal checklist.


***

[Two days have passed.]


Going to be hot today.  According to my phone it will hit 85 F. Thing is I can handle a dry 85 but the humidity is way, way up there. In order to get my exercise in I decided to take a walk early. Covered 1 .3 miles at 3 mph and I got a little glow going. Yeah, yeah I hear the snickering out there. A half hour walk ain’t nothing I hear you thinking. True. But…I do it almost every day. And I do it several times a day. By day’s end I will have racked up five miles and 12,000 or more steps. And yes I know 10k steps is an absurd and irrelevant number.


In a few minutes I will hang the laundry out to dry.  When I came in from my walk the washing machine said there were13 minutes left to go. After that I will read a downloaded book on my iPad. Maybe later I'll watch a little TV, maybe binge a noir drama. No matter what, I will write. Oh yeah I will purge my email. Over the years I have accumulated way too many people who want my money. They all write to me for their causes almost every day.


Truth be told I struggled with how to end this piece. Although my checklist was done some while ago I am not depressed. Existential angst I have by the boatload, but depression I don't have.  I can lay awake at night wondering if anything I have done has meaning and for that matter whether humanity and life itself have meaning. But in the morning I wake up looking forward to brewing coffee, taking a walk, writing, trying to come up with a trip somewhere that doesn’t break the bank. And then I get to say mean things on Facebook and watch the turmoil brewing over the election. And then I can check my news feed and be repulsed by all the shit going on in the world. And then I write to people and we talk about kids and life hacks and memories.


These things are enough for me.  They keep darkness at bay. I am sorry that a large number of my fellow retirees are suffering. I really don’t know what will improve their lot but as long as I can walk, read and type I think the monster will stay away. If it gets really bad for me there is always macrame. Oh yeah my wife is somewhere painting rocks today. 




 

 


[1]  A business where pastries, cookies and coffee drinks are produced and sold. There is often outside seating available at tables all under broad umbrellas.

[2] A hot drink from Portugal made by adding foamed milk to espresso coffee. Similar to caffè latte or café au lait, it consists of one quarter coffee and three quarters foamed milk. It is served in a tall glass.

[3] Dang L, Ananthasubramaniam A, Mezuk B. Spotlight on the Challenges of Depression following Retirement and Opportunities for Interventions. Clin Interv Aging. 2022 Jul 7;17:1037-1056. doi: 10.2147/CIA.S336301. PMID: 35855744; PMCID: PMC9288177.

 

 

 

Friday, July 26, 2024

So Many Thanks to Give But I Will Start Off with Really Just One


Sometimes there are moments of grace in this world. Sometimes you get lucky. Sometimes the stars align. I have had my share of the better things in life. Shamefully I have not celebrated the events or the people who made them happen enough.

Maybe I will someday write up a list of people to thank for the good they have brought into my life. From my mother who urged me to always try and achieve the most I could academically to my father who insisted I live by time tested principles of honor and integrity various people gave me gifts some tangible and some intangible. I owe both my late parents many thanks. Also, I owe my wife thanks for giving me great kids, incredible support when things got rough, and three-square meals a day for almost forty years. Oh yeah, and I owe her thanks because she loves me.

I mean there are odd people like John Dorsey who introduced me to jazz, one of my musical passions.  From the Mahavishnu Orchestra to Miles Davis those late nights sitting around Butterfield Hall listening to jazz changed how my brain worked. In the vein of thanks owed it would be impossible not to mention one of my former girlfriends who shamed me into being much, much neater. My old roommate Nate actually called me out when I stopped throwing my dirty clothing into a pile in the corner of our room and started using a laundry basket. Thank you, you know who you are.

There are three doctors I owe my deepest thanks to. These are first Anthony Meier. M.D., second the gent at LIU whose name I cannot spell, and finally Dr. Sam Kaffenberger at U of M Taubman. Tony Meier found evidence of prostate cancer in me way before it normally comes to light. He handed me over to the guy at the Lansing Institute of Urology who DaVinci machined my ass and rendered me prostate cancer free for a full 18 years after diagnosis. The same LIU doctor when I had a slight bladder irritation sent me for a CT scan and found a small tumor in my left kidney. He sent me for a biopsy and viola it was renal cancer.

Because the doctor at LIU was about to retire, I decided to travel to the University of Michigan for treatment. I asked one of the ladies who know in East Lansing (a subset of the ladies who lunch) who was the pro from Dover for renal cancer at U of M. I got a referral to him but his staff bounced me to another guy. Seems my tumor was too small for him to work on. The second one bounced me for the same damn reason. My tumor was too small for his standards. He sent me to the next guy, the new guy. I checked the new guy out and with a path running through Sloan Kettering I decided to trust Dr. Kaffenberger with my life.

From the get go Dr. Kaffenberger was compassionate, understanding and very, very real. He made me feel confident in my choice to let him do the cutting on me. Losing a fifth of my left kidney hurt but the care and follow up I got from this fine doctor gave me hope.

Today after five years of annual visits my annual conversations with this good doctor about life in Portugal and raising challenging children have ended.  Five years out the tables and charts say I have less than a 1 % chance kidney cancer will recur. So, the insurance company will no longer pay for that once a year drugged up MRI and the following ½ hour chat between me and the good doctor. We said goodbye today, a good goodbye and the doc said if I needed anything medical, fire him off an email and he would match me up with the best out there. I believe him

I celebrate you Dr. Kaffenberger and your team at U of M.

 

Tuesday, July 23, 2024

May You Be Born In Interesting Times, or….

 

My Level of Anxiety

23 July 2024

May you live in interesting times. I don’t know which is the correct phrasing. Both have appeared in fortune cookies over the years. Supposedly the saying comes from an ancient Chinese proverb. Unfortunately, I do not know the phrase’s provenance and am unsure about the philosophical or experiential underpinning of the maxim.

For all I know the folksy bon mot was made up by some eastern European immigrant while working in a bakery in Passaic. Maybe he crafted it while working in a place supplying restaurants in New York’s Chinatown with specialty treats. According to the fortune cookie wiki (and we all trust wikis, right?) “They most likely originated from cookies made by Japanese immigrants to the United States in the late 19th or early 20th century. The Japanese version did not have the Chinese lucky numbers and were eaten with tea.”

Origins aside the key words about when one should exist that being “interesting times” seem to have some salience for me regarding the past several weeks. I mean a botched debate, an assassination attempt, and a sitting President dropping out of his run for reelection are all momentous events that took place together to produce an "interesting time" in the world.  I mean this is the macro level of interesting times for me.

For me, there is also a micro level of "interesting times". During my visit to the US, I watched the aforementioned political drama with my young adult children. These young men are shaking their heads at what they perceive are the wrong directions America is taking again and again. But my interesting times also include a fiftieth high school reunion (damn I got old), medical visits, taking care of the old family home, shopping for various odds and ends to bring back to Europe and then enduring the circle of Dante’s Inferno that is modern air travel.

Having watched six days of nonstop political ads running in Pennsylvania back in June, seen Trump’s RNC show, and then observing Biden falling out of the race for the presidency, I can say I am more afraid of the prospects for our democracy than I was during the Watergate scandal last months. And I was scarred shitless then. Interesting times/strange days indeed.

I have to tell you hearing things like this comment from people like Ohio state Sen. George Lang, a Republican representing the West Chester district at a rally featuring the Republican’s VP nominee that if Republicans don’t win it in the fall that a civil war could be necessary to save the country is deeply frightening. Now mind you Lang has apparently been taken to the woodshed by the national Republican party. He now deeply regrets his “divisive remarks” and understands he must be more circumspect in his language going forward. But he is not alone in these kinds of remarks. It strikes me as similar to an experienced lawyer asking a highly prejudicial question during a trial only to “respectfully withdraw” the question when the judge and opposing counsel rage. Once the comment has reached the jury’s ears any instruction to disregard the question is pointless since the seed has been planted.

I am not afraid for myself. I have had a good life.  Hell, I just showed up to my 50th reunion with my aching knees and all. Also, I don’t live in America anymore so the threat to my personal integrity should things turn sideways during this election is greatly diminished. But I am worried for democracy when such language and ideas as offered by Mr. Lang above permeate election races and bubble just below what is openly said. I am afraid for my children. My boys live in a diminished world. But now they have to fear potential neighbor-on-neighbor violence when this election draws near. Unlike in previously highly disputed elections that potential is not null but actually has a value that is a whole number. We live in frightening times.

 

Take a Little Walk With Me

He placed his cereal dish and coffee cup in the sink rinsing them both. Time for his morning  walkies.  He  tries to walk  for forty minutes...