Lucky to ride away — a thought on mountain biking among the elderly — and on the concept of "against medical advice"

© 2016 Peter Free

 

20 December 2016

 

 

 

A couple of days ago, I took a header over my mountain bike bars — deep in the gloomy German woods

 

Landed on my head at more than trivial speed, broke my glasses and a couple of ribs.

 

I was lucky to ride away from this one, given that I was riding with the long-term aftermath of a previous traumatic brain injury (TBI).

 

I had also been riding with vestibular balance problems that showed up off the bike. These were the result of a recent respiratory virus attack that left me permanently deaf in one ear.

 

Looking down at the fall's aftermath, the sharp metal end of the spectacles' broken nose piece reminded me that the fall could easily have put an eye out.

 

 

Don't be a dope?

 

A sane 70-year old (under similar circumstances) would not have been out riding alone in the unpopulated woods. And certainly not experimenting with risky positional ways to make his overly stiff hardtail bike more athritically bearable over bumpy terrain.


My nurse practitioner daughter explained all this to me, in her tonally finger-wagging way. "You're a bad patient!"

 

Nothing like years of nursing experience to spot idiots in a group of patients. My long-suffering wife, a highly experienced medical supervisor, agreed.

 

 

But maybe there is another way to look at it

 

One of the things I noticed early in my own medical training is that people's personalities ultimately direct their care. At one end of the spectrum is the group that never does anything they're told. Whining unmotivated folk.

 

At the other end of the spectrum is the risk-taking group — comprised mainly of extremists —who will faithfully do what they're told, but only insofar as it does not long prevent them actively engaging with life.

 

These are the folks who will go home and do all their physical therapy exercises and then some. But they will then (too early) venture to test their progress by doing something medically outrageous.

 

We in this group seemingly cannot help ourselves. Our internal balance is skewed toward aggressively pushing the sensible.

 


Is there justification for being a risk-taking old dope?

 

At my age, I probably don't have much time left. My mother died at 72. Whether I have 2 or 18 years doesn't matter. Mountain biking is the last main outdoor activity that arthritis has not removed. It is my last key to the natural world. Every day away is a loss.

 

The unpleasant alternative is riding a stationary bike and blowing my brains out from boredom and Nature withdrawal.

 

We can only change by so much, before we entirely lose who we are.

 

 

The moral? — As we age, we choose the style that is most probably going to carry us out

 

The best that a medical provider can do is help patients know their options and mold those appropriately to their personality and lifestyle. Keeping in mind that few people will comport themselves in a medically sane way.

 

Perhaps that's point. Sanity, as appropriate to the person exhibiting it, legitimately varies in its definition.

 

As a primary health care provider, perhaps the best that one can say to a patient is:

 

 

Tell me why you want to do this.

 

I'll assess whether I can responsibly assist you in achieving your goal.

 

 

Primary care medicine is still an art, best practiced with intelligently nuanced hearts. The scope of excellent practice is wide. Just as patients do, providers vary in reasonably held vision. We are all in an ambiguous boat.