Many of us have crossed the hurdle where we are now referred to as “senior.” Thus, we have lived long enough so that we are able to embark on the journey referred to as the “golden years.” That term connotes that we will enjoy a life of leisure and pleasure which we have worked long and hard for. A bit of reflection perhaps will open our minds to what lays ahead and why the future may be not quite as smooth as we had expected. We have heard that being healthy will allow us to enjoy the many activities during retirement of which we have dreamed. However, pause for a moment and ponder as to how much health care spending goes to the elderly. I could list incessantly some of the problems that we may face – prostate, gynecologic, visual, musculoskeletal, mental health, gastro intestinal, and there are many more. Perhaps we may be fortunate and not develop the myriad of conditions which may afflict many senior citizens. Allow me to spend a few moments describing how and what I learned about the seniors in my life and practice.
I am the youngest of nine children. I spent most of my early adult years in locations other than Pittsburgh pursuing my education and satisfying my military obligation. When I left home my parents were in their late fifties and fairly active. I chose to return to Western Pennsylvania because of a practice opportunity, and I recall an awareness that my Mother and Father were close to twenty years older than when I lived at home.
Although they occupied the same house, there were changes in them which I gradually became aware of. They certainly did not move as briskly. Mother was always a bit hard of hearing, but it was now more obvious. Having noted diminution in my Father’s visual acuity, he had cataract surgery which at the time was followed by glasses with thick lenses. We were fortunate that their mental status remained quite sharp, but there were lapses of memory which are not uncommon in the elderly. Having made these and many more observations, I can look back and recall how it affected my demeanor with the older population in my practice.
I am often asked about my residency training, and how surgical teaching by various mentors affected my skill set. I find myself more often speaking of the lessons which I learned by observing the interactions which my teachers had with their patients rather than what I may have learned from them in the operating room.
I look back on a morning early in my residency when I was rounding with a surgeon who seemed to spend more time talking about relating to patients than operating on patients. I specifically recall him as one who seemed to devote more time to the older patient. To this day I remember his encouraging me to sit when I would enter the room. I asked him, “Why?” He responded by telling me that it may convey that I am taking the time to listen.
I also have a vivid memory of a technically gifted surgeon who was very “type A” and always in a hurry. We had entered a room to see an elderly lady whom he had operated on. It was 6:00 A.M. and as she fumbled with her hearing aid I could see that his boiling point was rising. I am sure that her concerns were not addressed, and as we exited the room his nurse was told that her room should be avoided during future rounds. I sheepishly visited her later that day to address her concern about how she will manage living alone in a two-story home while her weight bearing status was limited. I expect that this issue would have been dealt with by nursing or social service (in hospital rehab was not available when I did my residency), but I feel certain that she would rather have had the issue addressed by her surgeon.
Unfortunately, I was occasionally told when I was seeing a post- operative patient in the office that I neglected to adequately address few points inherent in the recovery process. I do not have to spend much time figuring out why. I was in hurry, regrettably subjecting patients to frustrations that could have been avoided. As I look back on those situations I realize that I was insensitive to the needs of the patient, treating them differently than I would have if they were my parent.
I remember having operated on an elderly but very active lady who, during the evening after her surgery needed assistance and soiled the bed when no one arrived to help her. She then related to me how her dignity was ignored when she was chastised by the nurse’s aide who apparently was insensitive to the limitations with which she dealt with on the night of her surgery for a fractured hip. Her final comment was, “Someday she will be old.” Perhaps we do not give this enough thought when dealing with the elderly.
Reflect for a moment that an elderly patient who is widowed and lives alone in a free-standing home is admitted to the hospital. Her children live in faraway states, she has a pet, and no close relatives to contact. She is overwhelmed by concerns as to how will her bills be addressed, who is going to look in on her pet, and who is going to attend to the problems that may occur in her home. The above is, unfortunately, a relatively common occurrence. The patient feels isolated in these situations, and although we may offer the appropriate medical or surgical solution for the physical problem with which they present we must not lose sight of the social problems with which they are dealing. We become their “support system.”
Some of my fondest memories over the years are associated with how the intervention by a social worker enhanced the recovery of a patient. As I became a more senior physician I developed an awareness that the healing of a physical problem was but a small part of the recovery of a person. I became more cognizant of depressive states (patients can be overcome by the concerns mentioned above), and concomitant to that was an awareness of the many additional services that were not available when I first started practice, mental health counseling and home care, just to mention a few.
Not infrequently I am called nowadays by friends of acquaintances (most of whom are “senior”) who are seeking medical advice or an opinion about the physician whom they are seeing. I remind them that I have been retired for several years as is the case for many of the physicians with whom I worked and referred to. I find myself usually spending a few moments attempting to get a sense that the person whom they may be seeing is someone who has taken the time to answer their questions and concerns. Perhaps the most frequent negative response that I hear is that the physician spent more time focused on the electronic record than with them. I was recently told by a physician whose wife was evaluated for kidney stones that on the trip home from the hospital she confided that she was never touched by a human being. The challenge for a physician presently is to not lose sight that they are dealing with a person whose diagnostic dilemma may benefit from the technology available, but compassion and communication with the patient is still a significant factor in the practice of medicine.