To Test or Not to Test: My Health Voyage into Old Age
By Andrea Gilats
It was August, a month past my seventy-fifth birthday and time for my annual mammogram. Though I have had annual mammograms for twenty-five years, I always fear them because I feel intensely anxious while awaiting the results. During the day or two following the procedure, I keep an ear tuned to my phone in case the dreaded call comes, and after that, I continue to feel on edge until the all-clear email arrives. Twice in the past two decades I have been sent for ultrasound examinations of my right breast, but both were in response to something my doctors felt, rather than something seen on a mammogram. Neither exam showed an irregularity, but each helped me feel luckier than I felt before I was tested. I cannot help but compare the sensation to the high one feels when an excruciating toothache, perhaps caused by an infected wisdom tooth, is relieved by a good dentist.
Seventy-five marks the age at which some health experts suggest that women who are at average risk of breast cancer may no longer benefit from mammograms. I turned to Google, that indiscriminate portal of sources, and learned that the American Cancer Society says that mammogram screenings “should continue as long as a woman is in good health and is expected to live at least ten more years.” On the other hand, the United States Preventative Services Task Force, which offers health care providers, governmental entities, and members of the public guidance on whether or not to undergo a variety of procedures and tests, says that because of insufficient evidence, it cannot determine the balance of benefits and harms associated with mammography in women seventy-five and older. In other words, they would have no ill effect on health no matter how much longer the affected women lived.
I did not have a mammogram during the inaugural year of the coronavirus pandemic, but in 2021, after being vaccinated against covid 19, I decided, albeit halfheartedly, to have one. All might have been well except that my discomfort with mammograms was not the only diagnostic decision I faced as I aged. Several years ago, my primary care doctor asked me if I would like a free CT (computerized tomography) scan of my lungs because I am a former smoker. The idea was to “catch something” in its asymptomatic early stages. Rather than being strictly diagnostic, it was precautionary. Rather than being preventive, it was—how best to characterize this?— informational, like a baseline mammogram.
It took me no time to answer in the negative. I did not want to know if I had a lung tumor then, and I do not want to know now unless absolutely necessary. What if I had had that scan and been diagnosed with an untreatable cancer? How would it have felt to live with that diagnosis knowing that I was helpless against it, as my late husband did? My remaining time on Earth would have been a death watch, whether for a few months or a few years. Living with such knowledge is also a death knell to optimism: it crushes well-being and kills the spirit even as the body continues to function. As it turns out, in old age, ignorance can sometimes be bliss.
Before I quit smoking, I was so afraid of having a chest x-ray or CT scan of my lungs that when I did need to visit a doctor, I scrupulously hid the fact that I smoked, including lying on questionnaires. This meant that for the first sixty-one years of my life, I never underwent an x- ray or scan of my lungs. That run ended in 2006 when what turned out to be an emphysema exacerbation landed me in the emergency room of United Hospital, St. Paul, Minnesota’s largest. There I suffered through a botched CT scan, which was followed by a successful PET (positron emission tomography) scan that revealed emphysema, but no tumors. I have not had an x-ray or scan of my lungs since, and never will again unless I am convinced that there is a compelling reason why an image of my lungs would be of consequential benefit to me.
Truth be told, I was so afraid of invasive examinations and uncomfortable tests that I did not have regular physical exams until I was almost fifty years old. My doctor-free life came to an end one morning in the spring of 1995, when I awakened feeling so dizzy that I could not sit up. Never before and never since has my head whirled so violently for so long without letting up. In an amazing coincidence of true love, my husband awoke the same morning with his left ankle so swollen that he could not step into his work boots. Though each step burned, he could still walk, so he took charge. After feeding me some Advil, he called my insurance provider’s clinic, told them my tale of dizzy woe, and made an appointment for me at two o’clock that afternoon. After that, he called his healthcare clinic, which was then known simply as the “industrial clinic.” Come right away, he was told, so he got dressed and off he went in his moccasins.
When he returned an hour and a half later, I was still in bed, unable to move my head. Thankfully, he had received a steroid injection to calm the swelling caused by a “mild sprain,” and he was already feeling better. He gave me more Advil, took me to the bathroom, held my head as I emptied my bowels, steadied me as I brushed my teeth, and delivered me back into bed, where I rested for another hour or so. When it was time to leave for my doctor’s appointment, he dressed me, bundled me into my jacket, walked me to the car, and secured my seat belt around me.
At the clinic, a female doctor with an eastern European accent listened to my heart and took my blood pressure: 210 over 110. Heaven help me! With a dangerous bang, I had arrived in middle age. Luckily, by the time I entered the doctor’s office, my headache was subsiding somewhat, which allowed me to open my awareness to the enormous fish I would now have to fry. There and then, I was given medication to reduce my blood pressure, along with two prescriptions for hypertension medications that I would take for the rest of my life. I had avoided the common symptoms of hypertension for months, even years, by attributing my frequent headaches, heart palpitations, and relentless anxiety to work-related stress. Now, all of a sudden, I knew that stress alone could not account for the turmoil inside my body.
Within two weeks, I was free of all these discomforts, but out of that scare had come new obligations. Just in time for my fiftieth birthday, I now had a duty to see my female doctor every three months in order to monitor my blood pressure, thereby averting a stroke, and, at her insistent recommendation, to undergo the gynecological examinations that would help me avoid a cornucopia of women’s cancers as I aged. In one afternoon, I became educated. I am neither ashamed nor proud of my ignorance; I offer my lesson here because it is one of the most salient truths about my health journey into old age: that it is a voyage that begins sooner and lasts longer than I could have imagined.
About the Author
Andrea Gilats, Ph.D., is a writer, educator, and former yoga teacher who is the author of two books published by the University of Minnesota Press, Radical Endurance: Growing Old in an Age of Longevity (2024), and After Effects: A Memoir of Complicated Grief (2022), which won an Honorable Mention from the Forward Indies 2023 Book Awards. She is also the author of Restoring Flexibility: A Yoga-Based Practice to Increase Mobility at Any Age, published by Ulysses Press. Learn more about her at andreagilats.com.