One question I am often asked is, out of any subspecialty field that you could’ve gone into, why do you want to deal with old people? Why go through extra training for Geriatrics only to be paid less as a physician?
Sometimes it’s hard to emotionally understand what older people go through because we’re not in their shoes.
Let me enlighten you
Let me enlighten you
Imagine someday not long from now….
- Your vision and hearing starts to deteriorate. You can’t enjoy conversations or read your favorite book
- You are unable to walk without falling.
- You can’t remember the names of important people in your life
- You’ve lost all independence in your life- driving, cooking, going to the park and enjoying the sun
- You are in pain
- Everyone in your life has left or died
- You’re taking 20 medications that make you feel awful and you still worry about your health
- You’re depressed
- You’re alone
And it seems like no one cares. You question if your doctor truly cares.
I was raised by my maternal grandmother from the age of two. At a young imaginative age, I thought the elder generation were magical, immortal wizards that humans eventually morphed into after years upon years of wisdom and experience. The gray hair was a symbol of their power; the whiter the stronger. The wrinkles represented years of victorious battles and defeated enemies. They were our protectors and guiders. When they eventually left this world, they would move onto another world filled with enchantment and wonder, taking all their hard earned powers with them. My grandmother was indeed magical to me. She was the last grandparent remaining, and I thought she was invincible. Sickness, suffering and death were not options. Not for her, not for anyone like her.
The ignorant bliss of childhood eventually dissipates and reality surfaces; humans don't live forever and death is not always the most graceful process. Throughout the years I had found my calling to become a physician in the broad field of internal medicine and to serve others in times of sickness. During residency I found particular joy in working with the elderly and their families both in the outpatient and acute care setting. It has been pleasantly challenging in a clinical, professional and spiritual sense.
The geriatric population is interestingly diverse. It ranges from patients who can be perfectly healthy and independent to those living with multiple illnesses, severe debilitation and neuro-cognitive disability requiring complicated care. I've come to realize that the traditions of practicing medicine have encouraged quick diagnosis and treatment to acute illnesses in hopes of facilitating rapid recovery and discharge. However, treating complex illness can be extremely difficult and are most often seen in these chronically ill seniors with multifaceted medical, social and psychological problems, many of which are overlooked or ignored. Issues such as prevention of falls, over-medication, pressure ulcers, malnutrition, delirium and depression often receive far less attention and are essential in maintaining functionality. I believe that treating a patient's admitting medical problem is the bare minimum. Taking proactive measures to prevent issues normally overlooked or viewed as insignificant may prevent tremendous functional decline, especially in a population where the complexity of medical and social challenges generally deem them as hopeless. Regardless of the stage of health, there are still a host of opportunities to ensure healthy and productive aging. I believe that effective interventions in geriatric care, whether in the hospital setting or at home requires a certain type of provider. It requires someone who is genuinely involved and skilled in the needs of older persons, with good communication skills and rapport with families, someone who is compassionately willing to provide ongoing continuity of care and health maintenance in a population of patients that may not be the easiest to treat.
I discovered that perhaps the greatest challenge of being a physician is providing care for dying patients and their families. As an intern, the first patient death I experienced as a provider resulted in hours of hysterical sobbing afterwards, convinced that it was all my fault. The patient was an 80 year old man who had been struggling on a ventilator for several weeks with advanced lung disease and pneumonia. Despite maximum efforts to provide care for this patient, he eventually passed away with his family by bedside. During these weeks I was able to get to know the patient through the family, learn about his beliefs and values, communicate with them about the patient's daily progress followed by eventual decline, and pray with them during his last several moments. At the end, I found myself to be more distraught than the rest of the family, who felt completely at peace. Later I learned that it was the daily and constant support, communication and comfort they received that helped them come to peace about the dying process. The value of providing quality palliative care needs and in-depth knowledge of the patient's social supports, spiritual beliefs and family situation is substantial. It takes a tremendous amount of patience, compassion and dedication. During my residency years, I found an ease and passion in relating with patients and their families during the darkest times of their loved ones' lives. It brought me much joy to provide comfort and spiritual support in times of sadness and pain in order to help them understand that death does not have to be a terrifying or painful process.
I chose the field of internal medicine because I enjoy the intellectual challenge of such a broad field. Geriatrics is an enhanced version of this. It allows an opportunity to continue to practice internal medicine in various stages of preventative medicine, acute or long term care, and end of life care with a population of patients I thoroughly enjoy working with. It is a tremendously under-served area of medicine in an ever so growing population of the elderly. As physicians, I believe we are called to serve those who are in greatest need of care.
My grandmother turned 97 last September. She could probably climb more stairs than I can. Secretly I still think she's an invincible wizard, but I know that someday when things begin to slow down and she is called to move on, I would like to be there to make that transition as wonderfully as possible.