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Sunday, April 5, 2009

Health Score Revisited

Day + 23 Health Score 83


My son, Samuel, asked me about my health score and where I thought it was going. It gave me pause to wonder how I daily arrive at this arbitrary number. As a physician, I have always been a bit suspicious when research papers attempt to quantify and statistically support data that is based on the subjective reporting of patients; which is inherently biased. It is, however, done often and there are many models which have proved the 'test of time' as statistically significant.

I can say that my approach to reporting a health score for myself is completely biased and is a daily melange of what I feel physically, emotionally and psychologically at the moment that I report it. It's more of a gestalt; (I would say gut feeling, if my gut would cooperate).

That does not mean that it does not have value. It truly reflects how I am feeling. What I find interesting is that as I reflect on the course of events over the last month I see a pattern emerge.
I made the scale from 1 - 100; 1 being dead and 100 signifying perfect health. What I experienced was as follows:

40-50 Body systems malfunction, can barely get out of bed, feel horrible
50 - 60 Can walk to bathroom, no appetite, somnolent but feel OK
60 - 70 Feeling better, but still want to be in bed, able to eat, no motivation
70 - 80 Stronger, eating well but not hungry, able to function well, limited motivation
80 - 90 Motivated, want to be out, active, can enjoy activities.
90 - 100 Back to work, Riding my bike up hills, don't remember being sick

My lowest day was 49. When I started, I said subtract 8 for unbridled optimism. That still hold true.

I would imagine the lower brackets as follows, (thankfully, I did not experience them).

1 - 10 Comfort care preparing to die, can still talk if awake.
20 - 30 On life support, ventilator, dialysis, confined to bed
30 - 40 Breathing on oxygen, on nutritional support, in pain, bed ridden, delirious


What always amazed me was that I always felt better than I intellectually knew that I should. I never really worried about how bad things were. Except for the second day of mouth sores, I never felt any pain. I realized, however, that if I was my doctor, I would have been really worried about me. As a patient, I was not. I do remember the look of concern on my doctor's faces, not reflected in their words to me when I was septic. I also remember, the look of relief only a few days later.

I don't know what it is about me that has to minimize the crisis of the moment. Even when they told me that the CT scan showed bilateral pneumonias; I had to add that they consider the pleural effusion after the heart transplant, as that made have caused chronic scarring and masquerade as a pneumonia. I had to find some explanation for it to make sense in my mind.

Samuel asked if I could ever be 100. Healthy people are 100; personal illness is not part of there thought process on any given day. I responded that, given the side effects of my medications, I can probably hope, at best, to be 95 some day. But, with me, you never know.

Kevin


1 comment:

Aunt Renie said...

Dear Kevin,
In reading this blog, I see your underlying optimism thru it all. We know that there is more than the science of the body and the intellect of the mind; the spirit is the foundation.
There's a lot of room between 83 & 95. But there was even more between 49 & 83!
love, Aunt Renie