I used to be quite liberal. I’m not so sure anymore.

My older brother, Rudi, who is wiser than me in all things and a true liberal of the old school, tells me that he’s also becoming more conservative. He says it’s because we’re getting older.

Never mind the fact that our governor is taxing the middle class into oblivion and that good friends with great skills and others with thriving businesses are moving out of state. Or that my wife keeps telling me we have to move to Texas.

But what gets me really grumpy is when my hardworking secretary who couldn’t afford the copay for her X-ray when she had pneumonia, gets sworn at in the filthiest language by a patient with essentially free medical care from Medicaid. He was furious because when he showed up an hour late for his appointment, he was told that I had already left for the hospital and he’d have to reschedule. He was entitled, he said in between expletives, to be seen. In the old days, I would look past these things and just treat the patient. Now I insisted he find a different doctor. Is it that I’m grumpy because I’m old, or is it that I’m feeling old because these things make me grumpy?

My wife just became grumpy and old. But only for about 10 days, and it was her own fault. When I suggested she get a flu vaccine last October, she insisted that she didn’t need it, that the flu vaccine only makes her sick. I pointed out that when thousands of study patients were randomized to either flu vaccine or placebo, the same number of people with placebo “got sick from the shot” as did the subjects who got the real vaccine, while the patients with the flu vaccine had far less illness. She just said, “Ma, va la,” which is the Italian equivalent of “yeah, OK, whatever,” but maybe a little stronger. When she got the flu, I had little patience.

Every day while I was at work, she texted me selfies with her swollen eyes, red nose and puffy face. She looked absolutely horrible. She even texted photos of the trash basket filled with discarded Kleenex. You think she was looking for sympathy? I admit to a small amount of sympathy, but then I reminded myself that she did it to herself and my compassion evaporated into a grumpy “I-told-you-so” kind of attitude.

I decided to make a photo essay on the theme of “Marriage: Before and After.” In it, I used a picture of my wife 28 years ago, before we got married — a smoking-hot Italian woman who easily could have been on the cover of any fashion magazine. For the “After” photos, I used the ugliest pictures of her with her swollen face, red eyes and in her frumpy bath robe — the selfies she sent me when she had the flu. I texted the photo essay to all our friends and family. Face it, she had it coming.

And what about these patients that come in and tell me that they won’t take any medications because they are morally opposed to putting chemicals in their bodies? And yet, they are on every manner of alternative pill — extracts of roots from trees only grown in the deepest jungle. They have no idea what the chemical is, but only that it’s “natural.” So are poisonous mushrooms.

Some even have the audacity to refuse the most carefully studied pharmacotherapies because they’re afraid of the side effects and tell me this while still stinking of the cigarette they just finished.

Today, one guy told me he won’t have recommended neck surgery and won’t take any pills for pain in his neck. He asked me what his other options were. Without much thought, I answered loud and clear.

“Suffer.”

I wonder how I’d look in a Texas cowboy hat.