The Art of Losing

A sum of one day’s problems. Better listed, and then lost.

If you have medical issues, and are feeling the gradual ebb of youthful vitality, you are not alone. Actually you are in great company.

I thought about taking stock of the total diagnoses I see on one day. So I finally did that below. These are the diagnoses I evaluated, monitored, or treated on one random day this week. This assortment is typical for a primary care doctor I’m guessing. Not included are phone calls, messages, test results, and the like. I’m listing these diagnoses in the order in which they were seen, with the most simple patient having one diagnosis, and the most complex having 15 to discuss in one visit. Numbers in parentheses are for unique people with the same issue:

• Liver cysts

• Pancreatic mass

• Colon polyps

• Ovarian mass

• Mixed hyperlipidemia (3)

• Gastroesophageal reflux disease (5)

• Asthma - including mild, moderate, severe (4)

• Spinal stenosis of lumbar region with neurogenic claudication

• Polyneuropathy

• Bilateral optic neuropathy

• Traumatic cataract of left eye

• Depression (2)

• Anxiety (3)

• Preoperative clearance (2)

• Essential hypertension (4)

• IFG - impaired fasting glucose (2)

• Covid-19

• Routine medical exam (3)

• Borderline hypertension

• Smoking history

• Idiopathic thrombocytopenic purpura

• Tubular adenomas of colon (2)

• Irritable bowel syndrome

• Erectile dysfunction

• Colon cancer screening (4)

• Atypical nevi

• Lightheadedness

• Leg paresthesia

• History of Covid-19 with long haul symptoms

• High cholesterol (2)

• Barrett's esophagus without dysplasia

• Abnormal mammogram

• Bilateral breast cysts

• Immunization counseling (5)

• Chronic interstitial cystitis

• Squamous cell carcinoma of skin of left cheek

• Platelet clumping

• Vaginal discomfort

• Chronic obstructive pulmonary disease

• Gallstone pancreatitis

• Postoperative state, cholecystectomy

• Age-related cataracts

• Type 2 diabetes mellitus (2)

• Transaminitis

• Allergic conjunctivitis of both eyes

• Bipolar affective disorder

• Collagen disorder

• Post nasal drip

• Bilateral hearing loss

• Fatigue (3)

• Vitamin D deficiency

• Varicose veins

• Prostate cancer screening

• Nocturia

• Post ablative testicular hypofunction

• Breast cancer screening (5)

Breathe. Insert food into mouth. Chew and swallow. Check news headlines, make sure nukes are not imminent. Breathe again. And now for the evening session:

• Hypertension (2)

• Covid-19

• Pleurisy

• UTI

• Urinary retention

• Asthma - including mild, moderate, severe (2)

• Covid-19 long haul syndrome (2)

• Psoriatic arthritis

• Erectile dysfunction (2)

• Paraganglioma, carotid body

• Anxiety (3)

• Allergic rhinitis

• Migraines

• High cholesterol

• Depression

• Multiple sclerosis

• Lung nodule

• Pedal edema

• Family history of prostate cancer

• Leg pain

• Pulmonary embolus

• Rotator cuff tendinitis

• Lumps under the skin

• Fibromyalgia

• Gastroesophageal reflux (2)

• Colon polyps

• Colon cancer screening (3)

• Blood in stool

• Secondary adrenal insufficiency

• Abnormal mammogram

• Fatty infiltration of the liver (2)

• Opiate addiction

• Pituitary microadenoma

• Hyperprolactinemia

• Lesion on tongue

• Tinnitus

• Chest pain

• Palpitations

There were a lot of other questions about pills, health topics, recommendations, the evolving pandemic, and most importantly - where to get the best Thai food in Philly (the answer is Kalaya, hands down).

Also, this list does not include the problems that people endure silently. For example, when I think of my own medical chart, there are only a couple chronic medical problems listed. But as a physician I am aware of many more problems, imperfections, and degenerations. If I were to make a head to toe honest accounting I could probably find over 50 diagnosable issues.

Vision deteriorates. Joints hurt. Collagen degrades. Pumps and pipes leak. Things may grow as they shouldn’t. Pain becomes a constant, waxing and waning as we slowly switch from running, to walking, to just puttering around for exercise.

But as the honest tally of our medical problems grows, we should realize that we are not alone with the pills and the pain and the general frustration that comes with an aging body.

I’ll end this accounting with an Elizabeth Bishop piece entitled One Art. I read this poem with an awareness of the many losses we bear, and how an accounting of each takes an exhausting toll. Learning to accept aging, to let go of things, and to be at peace with losses trivial and catastrophic takes real effort. Despite what Bishop writes about the art of losing being easy to master, the cracks in her facade grow larger as the poem progresses - and by the end I think it’s more the art of self-deception that allows her to keep on going. We are all artists in this. We have to be.

One Art

The art of losing isn’t hard to master;
so many things seem filled with the intent
to be lost that their loss is no disaster.

Lose something every day. Accept the fluster
of lost door keys, the hour badly spent.
The art of losing isn’t hard to master.

Then practice losing farther, losing faster:
places, and names, and where it was you meant
to travel. None of these will bring disaster.

I lost my mother’s watch. And look! my last, or
next-to-last, of three loved houses went.
The art of losing isn’t hard to master.

I lost two cities, lovely ones. And, vaster,
some realms I owned, two rivers, a continent.
I miss them, but it wasn’t a disaster.

—Even losing you (the joking voice, a gesture
I love) I shan’t have lied. It’s evident
the art of losing’s not too hard to master
though it may look like (Write it!) like disaster.

~

What we subtract from life, or add in problems, may we also gain in the courage to endure, in the compassion for others similarly afflicted, and in the affirmation of our own character and human dignity.

And after we leave the doctor’s office, it’s OK to lose those diagnostic labels for a while, to not make our diseases and losses and catastrophes the foundations of our identities.

Lost and Found Sign Art