2 months ago
48
Of the many patients over age 75 on my medical unit, half are what providers describe as “young old” and the remainder as “old old”. Admittedly, this delineation is somewhat arbitrary and the subsequent assessment provides more nuance, but it helps us triage patient needs.
Before the actual round, my team does a paper round. We run through the bread-and-butter issues of any internal medicine ward: heart failure, bad emphysema, rampant diabetes, cognitive decline, frequent falls, frailty.
Besides the medical details, we scrutinise the social circumstances. Does the patient live alone? (about 35% of people over 85 do).
Is there any home help? (the waitlist for services is painfully long).
Who takes them out and how often? From the time patients enter the hospital, we need to know what it will take to get them safely out of hospital.
The first of five nonagenarians is sitting expressionless in his room. He is cognitively impaired and has had a fall. To help him, I need more history.
“Sir, do you have any family?”
“My children.”
“Where are they?”
“I don’t know.”
It will be three full days before we manage to contact someone.
An 87-year-old lady complains bitterly about “rattling” from all the pills but can’t name even one. For safe prescribing, we ask if someone might bring in her medications. She starts crying that her children are too busy to care for her, and we hastily say we will call her pharmacy.
We weave our way through patients, all elderly and almost all alone, even though it is the weekend. Some are too sick to talk or sound asleep from exhaustion. Most of those awake look forlorn and trapped. A patient asks if we can rub her feet like her husband used to. Another asks who can trim his toenails. The best we can do is nudge their food closer or stick a straw into an array of unopened drinks.
One patient looks especially dire on paper. Age 90, lungs decimated by years of smoking. A respiratory episode that may just spell the end of his life. In case there is no interpreter, I prepare myself for a Google Translate encounter.
But we are astonished to see the man sitting up brightly, no oxygen in sight. Three amicable men flank him, dressed in attire ranging from a suit to paint-stained overalls, laughing and joking with him.
One son provides a history, the other furnishes his medications, the third serves up mouth-watering Turkish fare to put the hospital food to shame.
They all confirm that their dad feels fine and jump at the thought of taking him home. One son will spend the night with his parents, and the others will take turns. Their confidence is infectious. When he understands what’s happening, the patient attacks his food with gusto and gives us a high five – the sickest patient has the best outcome!
This happy scene on an otherwise sombre round feels like a gift. We see how the most useful “intervention” was the physical presence and moral support of the patient’s children.
In the empty stairwell, out of earshot, a young doctor sighs, “It’s so sad to see all these lonely people with no visitors.” Another observes that this treatment of elderly people seems a particular feature of western culture, recounting that our elderly Vietnamese patient has been attended day and night by his two children and the Greek lady had so many concerned nephews and nieces that we had to beg for space.
Then, as if discomfited by our observations and not wanting to “be judgy”, we reach for reasons why the children of our patients might stay away. They are working, raising children and grandchildren and grappling with competing demands of their own. Some children can’t face a parent’s vulnerability. Others are tired of caring, and the hospitalisation is their break. Conflict and estrangement also fray family ties.
But what we also know for sure is that loneliness makes elderly patients get sicker and stay sicker for longer: doctors can’t medicate the way out of this societal malady.
I treat this issue with added interest, the product of an Indian tradition that has observed filial piety without necessarily stating such a notion.
When my grandparents were ill, the men did the earning and the women (all) the caring.
By the time illness visited my parents’ generation, the responsibility was spread across their sons and daughters, although not always evenly.
My extended family is like any other modern family, pressed with the usual obligations, but we will crisscross continents to be at the side of parents without being asked or told. In this, we are not unique.
But there is a sense that, in this age, only the economically privileged, flexibly employed or uncommonly devoted can afford to take time off to help their ageing parents. I question this when I see some of the most personally tested and socially disadvantaged adults being the most selfless providers to their parents.
No one I know finds attending to the needs of ageing parents convenient or necessarily desirable. After all, it is surely a rite of passage to drive your parents nuts and then be driven nuts by your parents. But it seems to me that those who show up don’t frame it as a matter of choice but, rather, priority. And if you consider something or someone your priority, you are more likely to make the time.
I don’t know the answer but I see the dilemma. Hospitals packed with elderly people whose every problem is magnified by loneliness and a dearth of love and attention. Our costliest medicines don’t touch them and the fleeting kindness of strangers is unfortunately just that.
I have begun to think that one of the greatest acts of love is simply bearing witness to the vicissitudes of ageing.
Better social policies might help but they will never replace individual obligation.
