Golden Moments: The Life Lessons I Learnt from My Older Patients
Unfortunately, with older patients we encounter at the hospital, we are often too stretched to really connect with them on a personal level. But when we do, there's a great deal we can learn from their wisdom and experience.
"I don't want to spend the rest of my life in a hospital gown. Everyone can see my bottom!"
Not the reaction I expected from Beryl, a 97-year-old great grandmother who had just been diagnosed with metastatic lung cancer. What had started as a non-urgent chest x-ray to investigate some rib pain had blown out into a month-long gauntlet of ever more invasive testing, culminating in a bronchoscopy. My consultant had laid out every conceivable treatment pathway before her. She had opted for "none of the above." Palliative chemotherapy, intractable nausea, malaise and weeks of revolving door hospital admissions didn’t interest her. What was she interested in? Her son was turning 75 on Sunday, and she intended to be at the party. She was discharged home that afternoon. "I'll see you when I'm properly dying," she exclaimed irreverently as the porter wheeled her off the ward.
I learnt a lot from Beryl, most crucially, the importance of patients having autonomy over their health, even when our medical culture pushes a paternalistic, "we can, so we should" approach. The dignity that comes with facing life and death without fear. The fact that, while we often view our older patients as a collection of problems with limited solvability, they are, above all else, people. People who have lived lives and learnt lessons, and from whom we can learn a lot. I think about these moments with Beryl a lot. As healthcare workers we are afforded a great privilege — to be trusted by our patients and be let into their lives. Allowing ourselves to connect with our patients can be incredibly rewarding, and older patients, whether knowingly or not, are incredibly generous in allowing us into their lives, and sharing their wisdom.
It is unfortunate that due to the volume and complexity of older patients we encounter in inpatient medicine, we are often too busy, stressed or burnt out to connect with them on a human level. We are depriving ourselves of a great opportunity; to be offered a glimpse into the lives of our patients, and to learn from their wisdom and experience.
Below is a collection of moments I have been fortunate to have had shared with me, each unknowingly a masterclass in the art of living. Names have been changed to protect patient privacy.
Lesson 1: 99% of success is showing up
I looked after Rose a 70-year-old woman admitted with melaena. Rose had a laryngectomy 2 years ago and was now non-verbal. Rose’s husband John was 66, and still working as a truck driver. After his early morning route John would drop by the hospital in his hi-vis work gear. He brought her the daily newspaper, he cleaned her trache filter and helped her administer her PEG feeds. My team quickly discovered John’s knack for translating Rose’s small gestures and facial cues, and he became a vital part of our ward round. When John wasn’t around Rose would communicate with us in writing. When discussing discharge plans I enquired about whether she needed extra help at home. Rose wrote:“John looks after me. He is there for me when I need him. That’s why I love him.”
I mentioned this off hand to John the next day. His response: “it’s all part of the job.”
Lesson 2: Grief wears many masks
I met Mary in pre-admission clinic, she’s 81-years-old and was having a BCC excised from her nose. I asked about her family. She spoke about her husband, Bill, and their grandchildren. Their granddaughter who did squad swimming at 5am every morning and their grandson who had just started school. I asked if Bill would be caring for her after the operation but was told that Bill had passed away 2 years ago. Mary apologised, she often spoke about Bill in the present tense, “I still talk about him as if he’s here. I keep saying ‘our’ grandchildren. I’m not ready to call them just ‘my’ grandchildren yet. They’re still ‘ours.”
Lesson 3: There’s always room for dessert
In ED this year I met Richard, a 90-year-old man with severe COPD and an aspiration pneumonia. Richard was getting sicker despite our best efforts, and we were running out of options. He did not want to wear a BiPAP mask, and he certainly didn’t want to go to ICU. I was candid with Richard, “I think we’re approaching the end of the road here,” I told him. “Can we just stop?,” he asked. I called Richard’s son to explain what was happening, then handed the phone to Richard. “It’s ok mate, it’s my time.”
Richard was admitted for comfort care, his son would be at the hospital in 2 hours.
Richard had been charted a thickened fluid diet. I asked him if that was what he wanted. “Can I have some ice cream instead?” I managed to source 2 single serve tubs of ice cream from one of the wards. One for each of us. We shared the ice cream in silence. He fell asleep comfortably after that. I’m not sure if it was the morphine or the ice cream, but something had done the trick.
Of all the patients I have cared for as a junior doctor, it is these human moments that stand out to me. I have a poor memory for abnormal results or complicated medical histories, but I remember my quirky, sweet and lively older patients vividly. Elders have a lot of wisdom to offer, and in healthcare we are uniquely privileged to bear witness to that.
Every one of my colleagues has many “beautiful older person” stories – no doubt you probably have a few of your own. There is great value in sharing these moments with our patients – establishing a therapeutic relationship, allowing for a more holistic understanding of our patients and their needs, and enriching our own lives through the lessons we learn from them.
For one reason or another, many younger people do not have any older people in their lives. Those of us with older relatives, have spent the better part of 2020 isolated from them for their safety — a reality which many of our older patients have been on the receiving end of. Now, more than ever, it is vital we maintain cross-generational connections for our patients and ourselves. It can be as simple as sharing a tea, joining them on a 4-wheel-walker assisted lap of the ward, or simply asking a question that isn’t directly related to their presenting complaint. You would be amazed at the stories they have to tell, and you might learn a thing or two.
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