I can see it everywhere.
In the TCI list for AAU – “acopia.”
In the nurse’s voice “Can you give her some lorazepam please?”
In the SHO’s tone “Another one admitted with falls. Nothing wrong with them.”
In the referral letter – “This lady has no (insert your own specialty here) -ological issues. Please could you take over her care”
Some healthcare workers do not enjoy dealing with older people. Part of me can understand why. It’s hard. Frail elderly patients place a lot of demands on staff. They need help washing and dressing. They need feeding. They need taking to the toilet. They call out. They call out again. About the same thing you just reassured them about. And they don’t tell you what’s wrong with them. They come in “off legs” or confused, the same presentation hiding a multitude of diagnoses – from constipation to cord compression.
But looking after frail, older patients should be, as Francis put it, the “core business” of hospitals and their staff. Whilst I understand that it can be hard to care for such patients, what I don’t understand is the lack of empathy many people have for older people. Empathy is the foundation of compassion, a prerequisite for caring for others.
It is distinct from sympathy where you may feel sorry for someone else. It is the ability to put yourself in someone else’s situation, in their shoes. I think many people struggle with it, and surprisingly, I think, some doctors struggle with it. Why is this patient overweight? Why won’t they stop smoking? Why won’t they stop drinking? Why do I have to clerk the frail old patient who can’t tell me what’s wrong with me?
Imagine the scenario of a frail, dependent patient being treated for a pneumonia. She is sick and her chances of mortality is high. You are treating her with oxygen, intravenous antibiotics and intravenous fluids. She isn’t getting better so you speak to the family to update them. You explain that you are worried that the patient may not get better and may even die.
The family are shocked by what you have said and distraught.
“But what do they expect?” says your junior doctor, “She’s 85!”
She is 85. She is also a mother, a grandmother, a wife, a sister, a treasured friend, a favourite neighbour. She met her husband as a teenager. They have barely spent a day apart since their marriage. She spent 9 months carrying her daughter and 18 years raising her. She was there on her daughters wedding day, at the birth of her grandchildren, at both their weddings.
Two generations have sat on her knee. Two generations have been taught how to read and write, how to cook, how to care for others. Two generations have laughed with her. And now their grief makes us uncomfortable.
We struggle when we see frail, older people in hospital, their current predicament so far removed from that of a junior doctor or nurse in their 20s or 30s. But many of us will have had experience of caring for older relatives. Hopefully, most of us will grow old. How is it possible to not feel empathy for people who are like us, like our relatives?
It is the most short sighted example of a lack of empathy. Rohinton Mistry, in “Family Matters,” one of his several excellent books, tells the story of a family struggling to come to terms with the impact of suddenly having to care for an elderly relative.
“What folly made young people, even those in middle age, think they were immortal? How much better, their lives, if they could remember the end. Carrying your death with you every day would make it hard to waste time on unkindness and anger and bitterness, on anything petty. That was the secret: remembering your dying time, in order to keep the stupid and the ugly out of your living time.”
The next time you see an elderly patient, remember that one day it might be your relative, or even you, in that situation.
As Jarvis Cocker once said, “Help the aged. One day you’ll be older too.”