Thursday was a sobering day at my office. A lot of my Medicare patients love to make appointments during my Thursday morning hours. If you ever bought into the Golden Years idea, our Thursday mornings would cure you of any delusions. Many doctors have little patience for seniors. Older folks take time to undress and dress, they like to chatter–sometimes I am their sole social engagement for the week–and they are often opinionated and don’t want to follow anything you have to recommend. In the practice I left last year, we had many patients who had been with us for fifty or more years. For this reason when I decided I could not afford to take private insurance at my new practice, I also decided I would accept Medicare. I just could not abandon these patients. And there was another reason. I really love my elderly patients. They have a lot to teach us if we would open our ears and our hearts.
The morning began with R., an 88 year-old patient who comes in every three months. She has a long history of anxiety and depression. She asks you the same question many times and she has told me for at least eight years that she has nothing to live for, although she has a very loving and attentive daughter who should probably be selected for sainthood. Despite all this, she is a very charming woman who is extremely warm and has a very funny black sense of humor. Since last seeing her, she has lost her short-term memory and on Thursday she seemed frightened and hobbled compared to her previous self. She has started that downhill slide where older people get further and further from the world they inhabit. Despite telling me she wanted to die for many years, she is obviously scared to death of the process she has been sent into. Even for those who like to fly, being whisked off by storm-force winds is frightening. Lucky for me, her GYN problems are a little less daunting than those her psychiatric team has to deal with.
My next patient was D., also in her 80’s. She has macular degeneration and a hearing deficit. She can only read on her Kindle, because it is backlit and she can choose very large lettering. She said her 90 year-old brother was completely deaf and almost completely blind–as is her 92 year-old sister. Her 102 year-old aunt lived her last ten years in profound silence and darkness. She said she could see where things were going and it made her very depressed. She said when she got depressed in her youth she would get a part-time job on top of her full-time job and family duties, just to get her going , but at 85 this was hardly an option. She had mentioned to her primary-care physician that she felt very depressed. His response? “No you don’t!” I sent her to a gerontologist to find some resources for those with macular degeneration and to be evaluated for anti-depressant therapy. I also spent a long time chatting with her.
Anyone who has reached 80 should wear a badge signifying that they are survivors and that they deserve our respect. Many people this age, especially women, have lost at least one spouse and many have lost a child. They have learned to live with a lot of aches and pains and disabilities they never asked to have. And many have taken care of another aging person–either a mate, sibling, parent or child. They have undoubtedly weathered a lot of storms in eighty years. In general, the world ignores or lampoons them. They are not sexy and they are definitely not new or exciting.
But guess what? They are us. We have met the slow, chattery, orthopedically-challenged and they are indeed us. We just haven’t gotten there yet. People are always giving me family medical histories, but amending them so that it appears to them that nothing that happened to their mothers or grandparents will happen to them. “She had colon cancer, but her diet was terrible." "My mother had severe high blood pressure, but she never took care of herself.” Although environment is very important, the implication that none of the ills of humanity will befall us if we exercise and eat right is a bit naïve–especially when other members of our family carry genes for these ailments that will probably eventually afflict us.
Encoded in a lot of “useless” chatter are life lessons. You have to have the patience to listen to the extraneous noise in order to hear them. It’s similar to baseball signals. Most of the signs you see are extraneous. In baseball there is a designated signal that marks the beginning of the true encoded message. Conversation can be much the same. Especially with women, the code can be very arcane. When my 99 year-old great-aunt tells me how much she loves my mom and how good her other niece is to visit her and how thoughtful she is, the interpretation is “I love your mom. My other niece goes through the motions, so I can’t badmouth her, but I don’t love her in the same way.” She knows I can interpret easily as we’ve known each other for 58 years and I trained with my grandmother who was the queen of doublespeak. If she haad given me the right look, the interpretation might have been: “My other niece tries to do the right thing. I don’t really like her, but I am dependent on her visits.”
Now that medicine has become a business and efficiency is valued more than quality, these older patients are not being heard. They do not move fast enough to keep a bustling practice turning over at the pace it needs to keep financially solvent. They are not direct about their needs and often a good practitioner must learn to read between the lines. You might need to hear a lot of lines before you can piece the whole story together. It’s easy to dismiss their problems as just part and parcel of the aging process. I had an 85 year-old patient who used to come to her appointment in a jogging suit. I diagnosed her with uterine cancer and I wanted to do a hysterectomy. Her family initially dismissed the whole idea. After all, she is eighty-five! She had the surgery and is now 102. At the age of 99, she started slowing down and now lives in an assisted living facility.
No matter what age, we all have the same needs and desires. We want to be loved and appreciated. We want to be able to have the ability to smell the roses and see the beauty of the natural world. We want to live pain free. For the elderly, these can be elusive. We should all practice taking a little more time speaking directly with those from generations that precede us. It would be enlightening for us and stimulating for them. Don’t pretend they are in an alternate universe you are never going to inhabit. If you’re lucky, you might live there one day, too.