Rite of passage

Holy cow! I’ve been linked to before, but now Whomping Willow has blogrolled me, right between Frank J. and Mickey Kaus! So I’d damn well better post something.
(The following begins with a couple of paragraphs of medical technobabble, but don’t let that scare you off. It rapidly veers into other areas.)
On March 4, I went back to Dr. Talluto for my follow-up appointment, one month after being diagnosed with glaucoma. As instructed, I had been putting the Xalatan drops in my left eye, while leaving my right eye alone. The result: The intraocular pressure (IOP) in my left eye had decreased from 23 to 12.5. Since the goal had been to reduce the IOP by a third, this was excellent! I was surprised to learn that the IOP in my right eye had decreased to 15, almost as much improvement as in the right eye. Dr. T. explained that Xalatan isn’t just a topical medication — it enters the bloodstream and ends up affecting both eyes, although the effect is greater when the medicine is delivered directly to the target.
So it seems that Xalatan is effective. Dr. T. gave me a prescription for it and told me to come back in six months so that we can verify that it’s working. (She’ll do that by comparing digital 3-D photos of my optic disk from now and six months in the future. If they’re the same, that will mean the shape of the optic disk has stopped changing — meaning that the optic nerve damage has been arrested). Putting drops in both eyes is now a permanent part of my bedtime routine.
When she wrote the prescription, Dr. T. asked me whether my health insurance had a copayment for prescription drugs. I told her yes, and she said she would write the prescription for three-month supply of Xalatan with one refill, instead of a one-month supply with five refills. That way I would only have to pay the copayment twice instead of six times. But it didn’t work out that way. When I filled the prescription, the pharmacist informed me that Blue Cross/Blue Shield only allowed me to purchase a one-month supply. I called BCBS, and they confirmed this. There’s a mail-order pharmacy that I can use instead, but the copayment for that increases for larger quantities, and ordering a three-month supply would cost me as much as three one-month supplies. So there’s no real advantage to the mail-order option.
The actual expense is no burden. But I found this development thought-provoking for a different reason. I have always viewed prescription drugs as a temporary thing; I would get a prescription because I was sick or injured, and would take the medicine until it was all gone or I got better. Then I could forget all about it. But now, for the first time, I have a permanent medication. If I ever stop using it, I’ll go blind. So I have to permanently change my habits, and the cost of the prescription will be a part of my family’s budget indefinitely.
“So what?” you’re asking. Millions of Americans, mostly older folks, have to take prescription medicines daily and allow for it in their budgets. That’s true. But until March 4, I wasn’t one of them. As I headed home from the pharmacy with the medicine in my hand, I found myself thinking that this was a significant transition in my life — one of those lines we all cross on the journey from cradle to grave, but often don’t notice until later. Exactly what this one meant was a little hard to articulate, but it made me think of the letter that (I’m told) everyone receives when they turn 50, inviting them to join the AARP. The Letter is only a wake-up call. It doesn’t mean you have to retire or join the AARP, just that you’ve reached an age at which thinking about such things is no longer premature.
Middle age contains a lot of these reminders. Like the first fallen leaf of autumn, they tell you that a transition is under way, whether you’re ready for it or not. You don’t have to make any concessions to it right away, but you can no longer ignore it. Some of the signs of middle age are gradual things, or happen earlier to some people and later (or not at all) to others: pattern baldness or gray hair, having your youngest child become a teenager, seeing your first wrinkle in the mirror, and so forth. But The Letter is a discrete event that divides your life into two parts: one day you’re not eligible to join AARP, and the next day you are.
Filling my first prescription for Xalatan felt like that. Before March 4, I wasn’t taking any prescription medicines; the next day I was, and would be for the rest of my life. The message seemed clear: You’re not young anymore.
I can live with that.

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