I have been trying to navigate the road to health for some time now, I have lurched one way, then the other, been shocked by open heart surgery and its  aftermath, watched the tortured health care system trying to function while caught in an awful web of politics, bureaucracy, greed and public confusion.

I am getting older, the end is a lot closer than the beginning, it is not a time to dwell on death or be morbid, but it isn’t too early to start thinking about it, if I want to die my own death, not somebody else’s.

I embraced holistic medicine for years until two chronic illnesses  – diabetes and heart disease – roared up and nearly killed me, while I was gulping bottles of pills and hundreds of dollars of herbs and mixes. There is much that is wonderful about holistic medicine, I was, to some extent, hiding in it. And there was nobody to challenge me and pull me into reality. My heart did that for me.

The Western health care system saved my life, twice, I think,  and now I slip back and forth, from one to the other.

But I generally do what my medical doctors tell me, my diabetes is quite under control and so is my heart. Health care is a personal choice, every one is different, every body is different, every bio-chemical response to medicine is different, every family and it’s resources are different. Every spirit is different.

My cardiologist and I have been discussing statins and their impact on me for nearly three years now – they nearly crippled me – and this year, when it was discovered that I am allergic to cholesterol medications, we are finally off on a different path. Today, I started taking a 10 mg dose of a milder statin, as well as some  holistic medications that support cholesterol control. There is voluminous medical date about statins, and it is true that the people who take them are less likely than others to suffer heart attacks or strokes.

They also have a number of side effects, some of them wicked.

My doctor and I talked about his belief that people with my two chronic conditions  – people like me – need to be on statins to best stave off further heart disease and strokes. He said his goal was to keep me alive as long as possible. I told him that I didn’t wish to be kept alive as long as possible, that was a decision for both of  us, and he said he agreed, but he had to make the recommendations he considered best for me, his job was to keep me alive.

I told him my hospice and therapy work, mostly done among the aging, was a continuing remember to me that modern medicine is good at keeping people alive far beyond their natural range, and this is  staggeringly costly and often very  painful. You keep people alive, I said, but you take no responsibility for what kind of life they are living. Often, they suffer terribly, and for many years. That is Dr. Frankenstein’s idea of medicine, I said, not mine.

He nodded and smiled, and  said he understood. It was the most open talk we have had. He is passionate about keeping his patients alive, I could see.  I said I see people in their 90’s all the time, and many are physically alive, but spiritually and emotional drained of life. Their lives are often a never-ending parade of pills and procedures, none of which fulfill them or give them meaning.

You do not have to spend too much time among the elderly to see very clearly how modern medicine fails the people it is sworn to help. So many of their lives are spent in institutions – nursing homes, assisted care facilities, intensive care units – where unyielding routines cut them off from the sight of other human beings and from almost of the things that matter in life and keep most of us alive and connected.

Our refusal to honestly confront the experience of aging and death has harmed people and denied them many of the comforts and meaning they desperately need. Their fates are totally controlled by remote physicians and modern medicine, technology, corporate interests and strangers. In some institutions, more dogs visit than people.

My doctor insisted to me – and it was a good talk, he is a good doctor  – that if I didn’t take the appropriate medications, I could end up with a stroke and perhaps live impaired for many years – just what I did not want to happen.

I told him I know he meant well, but this seemed manipulative to me, I had been presented no real viable choices, the medical system seemed rigid and inflexible to me, drunk on machines and data. We agreed on something of a compromise, I am taking a very mild statin in a very small dose. I said I reserved the right to consider how I could avoid the poor choices being offered to me.

Where does quality of life fit into medicine’s equations?, I wondered. He said he respected it, but that was not in his ability to promise or deliver. He denied it, but i sensed it was not in his calculations or training, really. We  have never discussed it. He said medications were a matter of balance. Some medications cause great discomfort, but they prevent worse discomfort. I took his point, but I didn’t quite buy it. Doctors do not worry much about quality of life, or support the idea of it over prolonging life.

And there are always choices, if you make them early enough.

Some older friends have taken their own lives rather than submit to the American system of aging and institutionalization. One friend simply stopped eating and died three weeks later.

Others talked to friends and family about how they wished to die, and stayed out of institutions and hospitals, dying if necessary to avoid the alternatives.

Others charted their own course of medical care and found their own balance between different kinds of medicine and healing. I know my doctor listened to me, but he admitted he was a physician and was bound by the rules of modern medicine. He would respect my decisions, but could not really help me to carry them out. There was simply no path in modern medicine for people like me. I have to make up my own mind, and muster the strength to act on what it is I want to do, how I really want to die. If you can’t think about it or imagine it, you are unlikely to get what you want. And how I die is just as important to me as how I live.

I am grateful to medicine, it has kept me healthy for some time now, and I imagine it will well into the future. I continue to explore alternative medicines, I don’t have to choose one or the other.  If I have learned anything, it would be that I need to make the most important decisions about the rest of my life right now, before they are taken from me, by doctors or by my own body.

I don’t have all of the answers and will perhaps never have them all, I just have to keep working at it and thinking about it. It does me little good when people send me messages about what worked for them, their mothers and fathers, their spouses and friends. I don’t get my medical care from Facebook.

We are all very different, and what worked for you does not necessary work for me. I do not tinker with the lives of other people, or think I know what they should do, we have to come to terms with our lives, each of us, and make our own decisions.

This week was a good start for me. My cardiologist is now an important person in my life, he knows my heart intimately and thinks a lot about his work and practice. Of course, we see the world differently. He is a doctor and I am a patient, and  that is not an equal relationship. We do not always share the same interests or seek the same results.

If I keep searching and looking, I will find the right path for me, by myself and with Maria and some friends, and in the company of my own mind and soul.