Tuesday, May 06, 2014

Analogy for assuming I'm going to get sick

I operate under the assumption that I'm going to have every medical problem - everything my ancestors have died of or even been diagnosed with, everything my genetics or behaviour makes it more likely for me to develop, basically everything I have an even slightly greater than average likelihood of contracting.  I assume I'm going to get Alzheimer's, I assume I'm going to get cancer, I assume I'm going to get Barrett's esophagus, I assume I'm going to break a hip and become helpless.

There are people who think this approach is needlessly pessimistic, and who say things like "Why don't you just adopt a healthier lifestyle so you don't end up with these health problems?"

Today my shower gave me an analogy to explain why:

Suppose you want to enter a university program, but you don't have enough money to pay the tuition.

The university offers a scholarship to the very top student in the whole university every year, and this scholarship offers enough money to pay for the whole program.  But only one such scholarship is offered, and it's only available to the one student with the very top marks in the whole university.

So is it a good strategy to decide "Okay, problem solved.  I'll just get the best marks in the whole university and pay my tuition with that scholarship"?  Or would it perhaps be a better idea to assume you won't win the big scholarship, and instead work out a way to assemble the funding from other, smaller, more winnable scholarships with multiple recipients, combined with perhaps a part-time job and some student loans?

To win the one single big scholarship, you have to address and overcome a wide variety of ever-changing factors.  You not only have to be at the top of all your classes, you also have to be aware of what kind of marks other students are getting in other classes and figure out ways to top them.  You  need to keep in mind how various courses are graded, and choose courses (and maybe even a major) that make it more possible to get higher marks. (For example, it's easier to get extremely high marks in a math class than in a literature class, because answers to math problems can be unquestionably and objectively correct, whereas a literary analysis essay is more subjective and far less likely to be interpreted as perfect and therefore worth of a 100%.) You also have to be able to read your profs to determine how to extract the highest marks from them, (for example, I've had profs who give higher marks to essays that prove conventional theses, and I've had profs who give higher marks to essays that take a risk and prove an unconventional thesis, or have a good go at disproving a conventional thesis), and you have to do this early enough in the course so as not to have a sacrificial first assignment.  To say nothing of the stress you'd have to put yourself under and the pleasures of life you'd have to give up to study enough to earn top marks in all things at all times!

This is rather difficult, isn't it?  In addition to doing your absolute best in everything at all times, you have to be constantly and at every moment on top of an ever-changing lineup of factors, many of which are completely beyond your control.  And if you drop the ball even for a second, there goes the scholarship you were depending on for funding.  It's a lot easier, less stressful and more feasible to operate under the assumption that you're not going to get the big scholarship and instead work out a way to get more predictable funding.  If you get the scholarship, bonus!  All your problems are solved!  But if you don't get it, you're prepared for the eventuality.

Similarly, I find the list of things you're supposed to do to prevent Alzheimer's, cancer etc. is large, complex, overwhelming, and ever-evolving.  There is contradictory information out there, some of which is actively trying to discredit each other.  It encompasses every facet of life, some of it involves factors that are beyond our control, and much more of it involves factors that it is possible to control but very difficult to do. There are aspects of it that we don't know yet, and there are aspects of it that may be thought to be helpful but later be discovered to be harmful.

So instead of making myself a slave to all that, I just assume I'm going to get all these diseases and plan accordingly.  If I don't get them and end up dying peacefully in my sleep, bonus!  But if I do get them, then I'm prepared for the eventuality.


laura k said...

I get the opposite outcome from almost the same approach.

"Adopting a healthier lifestyle" won't control whether or not we get cancer, Alzheimer's, or break a hip. There are certain things we can do or not do that will help (not smoke, not be completely sedentary) but I think people imagine they have more control over outcomes than they really do.

I don't assume I'm going to get sick because it would only make me feel anxious, tense, and upset, and the thing I'd be worrying about might never happen. Why feel so bad over a maybe?

Instead, I live how I want to (within reason) and if any of those things happen to me, I'll deal with it then.

I wonder how you could possibly prepare for these negative outcomes? If you really prepared for every eventuality, how would you also live your life?

impudent strumpet said...

There are some ways you can prepare, at least by researching and planning. My grandmother who went on to develop Alzheimer's simply said "I don't want to end up in a home," so she never did research or anything and by the time decisions had to be made she wasn't reliably lucid, so her children had to figure it out for her (and didn't all agree on what her wishes were.)

I know someone else who simply says "I don't plan to get sick," so they're completely unaware of what options are available to them if they should get sick. And it has become apparent in our conversations that they think social assistance provides significantly more sickness or disability benefits than it actually does.

Specific things I have done to prepare is made employment, insurance, financial planning and housing decisions with pessimistic assumptions. I'm assuming I'll have a minimum of 20 years completely unable to work. (I'm still working on saving up enough for this eventuality and getting myself into the position I need to be in - it's not something one can do instantaneously - but I'm on track.) I wouldn't reject a pension like my grandmother's co-workers did. I would choose future employment based on benefits, even if I have to freelance to make up the earnings. I have a plan to clear my mortgage in order to reduce housing costs in my old age, which then leads to a plan to reinvest the money I would otherwise be spending on housing in an annuity, which would fill in the earnings gap I haven't otherwise been able to fill in my retirement plan.

Whenever I see that my parents have to help my grandmothers with something, I figure out how I could handle that myself if I were in my grandmothers' situation. I don't have answers to all the questions yet, but I have answers to some of them. (For example, after seeing that my one grandmother needed my mother's help to do grocery shopping, and learning that she found it a struggle to walk even a long residential block to church, I decided to prioritize condos that are closer to my neighbourhood's shops and services, so my octogenarian self isn't stymied by the need to walk a long residential block.)

Things I can do when I'm older is research retirement homes and long term care (and write down my findings) so I know what my preferences are when the time comes. I would also have to cultivate a relationship with a younger person who could become my power of attorney etc., which might come down to an outright exchange of care for inheritance with a fairy godchild or a cousin's child or a professional protege, since I'm never going to be a mother or an aunt. The people young enough to do this are currently infants and toddlers, but nevertheless I am keeping in mind the advisability of developing sustainable relationships with these small humans.

Politically, I can be aware rather than burying my head in the sand, and advocate for the kind of healthcare and safety net I'll need when I'm elderly with dementia and a broken hip and no caregivers. I can use normal activism channels and my small but highly googleable blog to point out when policy is assuming that people have the natural family caregivers that I will never have, and urge those in power to fix the problem.

And, at every turn, I'm watching and learning from what happens to my grandmothers and, when their turn comes, my parents. So when my time comes, I will have observed and learned from five people's end of life, and arranged my life accordingly.