As a young medical student I was fascinated by the word ‘decompensation.’ By the time I was a medical student I knew a lot of words; heck that is one of the selection criteria for medical school but I had never before heard the word ‘decompensation’ used in a sentence. The word is easy enough to figure out; just start with ‘compensation.’ Still the paradigmatic medical use of the word ‘decompensation’ was as a description of how the heart changes as it begins to fail; it decompensates. The things it began to do to help begin instead to worsen the very thing the changes were ‘intended’ to aid. Now, remember, all of the changes seen in the failing heart make sense; they are just the things it needs to do to survive just a little bit longer. The changes are interesting in themselves but I am not going to explore them just now.
Well as I looked around in my new garden of delight and leaning, my new field of medicine, I found that word everywhere: old people, in those days you could say ‘old people,’ walked differently as part of the decompensation of aging. They spread their feet, leaned forward, looked at the ground just in front of them as they walked. Why? They couldn’t see as far, were not as strong, had less sure balance. Made sense. They weren’t decomposing but their gait had sure compensated and then, oh no!, decompensated!
Well the idea behind decompensation is an interesting and important one. It turns out even in the case of heart disease that the changes which made so much sense and seemed to lead to an increased chance of survival-compensation- could just as easily be seen as the early part of the problem making the progression of the failing heart more certain. Same with the gait of the elderly. All of those changes that make so much sense out of worsening eye sight, and decreasing balance, and weakness that curves the back; all of those changes, the marks of compensation, make the progression to an even worse gait more certain, more inevitable. The decompensation of their gait.
So my asking ‘how big is your life?’ is to invite you to examine the ways you have compensated for your age, your injuries, you diseases, your bad habits, the cold weather, the sidewalks, the local grocer, the allure of McDonalds or Harold The Fried Chicken King? How have you compensated and then, here is the call to action, how far down the decompensation slippery slope have you fallen?
For my part I have so many injuries, no one to blame but myself, that just sitting here typing this out is associated with an aching right knee, sharply painful low back, retracted right shoulder, tight aching left Achilles; I could go on. Lying down on my back, closing my eyes, heck even taking a nap seems like a great option. However if I were to do that I would not sleep as well tonight, my other injuries would flair: I would be worse off. Well, that is an obvious case when most of the cases that matter are more subtle.
Do you still try to play touch football with the kids or the Grand kids or the, yes, I have them, the Great Grand kids?
Has your world shrunk to the gym, the library, the coffee shop and bed? Just the coffee shop and bed? Bed? You get the idea; don’t let the allure of compensation for injury, illness and aging be the first Siren Song of decompensation! Let me go further: don’t even begin the ‘compensation’ phase. If that right knee hurts be even more certain to walk full gait, to hold your head erect, to avoid the handrail on the stairs. Walk even more beautifully! I know, I know, there are just some realities that must be faced but push back. I promise it will pay off in the coin of a better life and a happier death.
Smile, Have Fun and God Speed,
Dr. Mike
