Yesterday’s Doctor-Patient talk and small group session were on aging and elder care. We had two incredibly energetic/adorable representatives of the older Philadelphia population come and speak with us, and I think they just might have converted a few peers toward considering the field of geriatrics. Here’s the thing: I think that geriatrics has the potential to create surprise more so than almost any other field…predominantly because we think of the patients as so, well, unassuming. God, it sounds like I’m making them out to be criminals or something.
Far from it, of course. In my very minimal experience with elder care, the patients have been consistently warm and appreciative and, for the most part, open and honest, with a slightly playfully sneaky, rarely devious side at times. One patient I followed in her final stages could hardly eat at the end, yet she still mustered enough energy to hide the overcooked chicken the facility served, fib about it, and then proceed to eat cookies or just the icing off a cupcake for dinner–“I’m 93 years old; I’m not going to live to be 94. I eat what I want.” Things become a little more complicated if the patient is non-compliant with her cocktail of medications for rheumatoid arthritis.
The mystery of geriatrics runs deep. First of all, it’s a pretty new field–only in recent history have we had such a huge subset of the population live to be 70+, 80+, 90+, and so on. Assisted care facilities, first discussed as part of the New Deal, are in reality a product of the last 50 years. Secondly, whereas with most patients we’re looking for one, maybe two chief complaints or causes for disease, the elderly tend to have multiple, often compounding. And then there’s the fact that, even if we’re only dealing with one primary, well-known and understood disease (pneumonia, for example), an 80-year-old will present with completely different symptoms (inability to get out of bed, general confusion and instability) than a 50-year-old (fever, difficultly breathing, cough). You can imagine how a physician or other health care professional might treat the former inappropriately, leading to potentially disastrous health outcomes.
So, geriatrics is new, complicated, and with potential high acuity. Not to mention that it’s a field in tremendous need of physicians. Can anything be more exciting?
For our small group, we read this article by Atul Gawande. If you haven’t read any of his pieces, you’re in for a treat. Then, if you have about 90 seconds, here’s a light read about a woman I had the privilege to know and serve.
Not to stereotype horribly, but if there’s any doubt about how great elder folk are, I turn to this fictional representation of passion, determination in the face of adversity, and compassion–all while living with a number of health-related challenges: