An oppressive winter has finally given way to the happiness of spring. Pretty flowers are in bloom and the bare trees promise to be in leaf again. As I walk into the weekend round, I feel happy for my patients who might be discharged, or simply set foot outdoors.
“You can go home!”, I congratulate my first patient.
“Don’t rush, love”, he replies, and I think after two weeks as an inpatient, he is joking. Who likes hospitals?
Then I remember. He is the widower with the always busy daughter. He talks about her loyally, but also with a finality. “She is not the type to drop by.”
What will I write in the notes? Loneliness as a cause of failed discharge? Disengaged family? He makes up my mind by developing a panic attack. I prescribe an anxiolytic. The daughter has already made it clear that he is not her “business”.
It’s lunchtime. Food trays lie untouched and drinks unopened. We lift a lid here, open a juice there while nurses scurry from one patient to another, feeding, cleaning, soothing. No one mentions it but the elephant in the room is the nearly complete absence of family members or visitors in spite of a weekend. Not to do the heavy work but to simply sit, talk, and offer the greatest medicine of all, distraction. But on this beautiful afternoon, the patients stare vacantly and the corridors are empty. We see this, but ill-equipped to help, we keep moving – charting antibiotics, adjusting fluids, offering sedation, until our hands cramp and our heads hurt at the motion of treating without truly helping.
We are standing at the bedside of our 94-year-old patient with “all over pain”. I want to tell him that like everyone his age, he is riddled with arthritis and it’s nothing more serious but his eyes have grown moist and I am battling my own despondency at the fact that the longest-staying patient is the least visited by family. His nurse comes to the rescue.
“What’s the matter?”, she smiles. “Everything hurts, doesn’t it?” His arthritic fingers are bent and twisted, his vulnerability evident.
“But guess what, even if no one comes, I will feed you.”
At this he bursts into tears. We stand frozen, and mortified. To think that this happens at every mealtime and that for all the dollars spent on largely futile care, all he craves is a dose of humanity.
But the greatest shock of the day is yet to come. A widow clings to my hand and sobs, “Just give me a pill to die.”
“You have gastro. Gastro is treatable!” I exclaim.
“I feel awful.”
“Where is your son?”, I ask, longing for a family member who can sit with her and put her misery into perspective.
I sit down at the desk, reflecting on an entire weekend of taking histories, postulating diagnoses and prescribing drugs when all the while, the greatest enemy has been the loneliness of patients, who feel ignored, neglected, or outright abandoned by their family. I count that during the entire weekend, we met only a handful of adult relatives and not a single child.
Few things console the elderly and give them more purpose than knowing that they matter to someone. It’s moving to see how pain dissipates and anxiety fades in the presence of loved ones. But when you look down the vacant corridors of the hospital or tally vain attempts to engage family, you reach the unavoidable conclusion that as a society, we have stopped valuing our elderly. In the pursuit of happiness, getting the kids to soccer, meeting a deadline, and finding time to keep house, we have let slide our obligations to the elderly, and worse, relegated them to being a burden. Awful as it sounds, we deny our elderly intrinsic worth.
Since hospitals are witness to remarkable stories of sacrifice, we regularly meet exhausted, disadvantaged and disabled relatives who struggle to care for an ageing relative. Such carers are seldom recognised and deserve our admiration and assistance. But increasingly common is the story of those who ask not how they can help but how the hospital can fix the problem of their ageing, chronically ill, dependant elderly relative. Yes, we could have more nurses, better nursing homes, and accessible aged care services but you just have to talk to a patient to realise that none of it is a substitute for the investment of family. Fancy interventions and newer drugs will never be a proxy for the attentive kindness which is the strongest medicine of all.
My two decades spent on ward rounds have been a sobering lesson in the erosion of our consideration and respect for the elderly. The ageing population is not an invisible entity – it is our elderly relatives who deserve a presence in our lives. They should be valued in their advancing years as we valued them when they were young, productive, and had a voice.
In our increasingly busy and acquisitive lives we will all grapple with how best to honour, respect and care for our elderly relatives. Many of these relatives will become patients but of one thing I am sure – the answer to a societal ill will not come from medicine. Medicine will do what it does best, treat disease, often around the edges. What it cannot do is instil patients with a sense of belonging and intrinsic worth. Treating pneumonia or mending a fractured hip is not the same as restoring dignity and meaning to a life. This is a distinction for us all to consider – for how we treat our elders today is how we might expect to be treated by our children tomorrow.
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