It is a well known observation that our nursing care facilities are disproportionately populated with women.  A quick survey of the nursing homes in Highmore, Gettysburg, and Pierre, yielded 241 residents of which 76% were women.  Where did all the men go?  One might think that perhaps the men are healthier and don't need to be in nursing facilities.  Nothing could be further from the truth.

         Today while sitting in a local restaurant on a Sunday after church, it was noted that there were two tables with eight elderly women enjoying lunch together. There wasn't even one table with elderly men alone.  Our national statistics will document that the average longevity for women in the United States at this time is around 77 years although for men it is only 71 years.  Where do all the men go?  There are too many widows.

      The answer to this question might be illustrated with the story of a very dear gentleman who recently passed away unexpectedly.  He had been a hard worker all of his life.  He had  planned and saved well.  He had become health conscious in recent years and discontinued his cigarette habit 15 years ago although he had a 40-pack year history prior to that time.  Several years ago, he was found to be diabetic and had been started on pills to help deal with the problem.  Unfortunately, his blood sugars ran substantially high.  His idea was that since the diabetes didn't cause symptoms or make him sick, a blood sugar of 200-300 mg% was o.k.  His glycosylated Hgb was 9%, an alarming value that needed address.  His cholesterol was slightly high but his blood pressure was well controlled.

         His wife was the sickly one.  She had to have two hips replaced and prior to having that done, needed coronary artery bypass surgery done.  After her second hip replacement, she had been somewhat infirmed and her husband had been doing "all of the housework and nursing her too".  He was the most good-hearted person that you would ever meet and behaved in a very caring manner.  Several days ago, he went in to take a nap in the late afternoon and never woke up.  His wife found him with labored breathing. An ambulance was called and full resuscitative efforts were made. They were not successful.  Sixty-six years of age is only one year into his retirement and much too young to pass away.  All of those wonderful years they were going to spend together were irreplaceably gone.  As often happens, the cared-for lost her caregiver.  A story such as this focuses on the tragedy of too many widows much better than some dry old statistics showing 75% of our nursing home residents are women.  What is going wrong and what can we do to fix it?

         The basic problem is men's delusion that they are invincible, that they don't need medical care, and that there is nothing wrong with them.  The story above and the statistics that back it up clearly illustrate that men are vulnerable, they do expose themselves to greater hazards than women  and they have silent health problems that are expressed suddenly and fatally, such as the story above.

         The irony of these stories is that a man would never let his truck, his cattle, his gun, or his dog receive anything resembling the care that he provides for himself.  Trucks receive periodic maintenance, dogs are at least vaccinated, guns are cleaned and lubricated, and cattle are vaccinated, monitored and carefully fed.  Men don't do any of these things for themselves.

       The message from this column is that somehow a woman needs to help care for her man if she is going to keep him around.  Somehow, he needs to be convinced that healthcare maintenance is important for himself.  Periodic checkups are important to pick up disease processes before they result in a tragedy.  Initial health screenings need to be done when a man is 30-40 years old.  Benefits initiated at this time project out to huge returns by the time a man is in his 60's, 70's, and 80's.  Treating cholesterol problems before blood vessels become hardened and brittle far exceeds the benefit of trying to reverse a brittle hard artery that has already occurred in the 30 years from a man's age 30 to age 60 when he received no medical care.  Somehow a man needs to be impressed in how important he is, how much he is loved, and how much he is needed as husband, a father and a grandfather.

       In closing, I am reminded of my uncle's story.  He was captured in WWI after being gassed with chlorine.  He spent six months in a German prisoner of war camp and on his return to the United States was told that he had six months to live at twenty-two years of age.  He and my aunt decided to get married anyway and enjoy the six months that they had.  He died at age 77.  While I was in medical school he told me, "the best way for a man to grow old, is to get a disease when he is young and then take care of himself the rest of his life".  Somehow we have to get our men to begin to participate in basic health maintenance and prevent the tragedy of "too many widows".