Ageism
II.III.III
AGEISM
Much can be said about why things were the way they were over at the geriatric hospital. As controversial as this might sound, I think it all boiled down to one thing – ageism.
That old people’s lives seem to matter less. I gotta admit that before starting this rotation, I too was guilty of this kind of prejudice and discrimination. To me, it was largely a matter of accountability. The nerve-wracking, burnout-inducing pressure of being responsible for someone’s life feels palpably less intense when that someone is already nearing the end of theirs. Hell, to many, the words Do Not Resuscitate (DNR) on a patient’s chart are equivalent to a free get-out-of-jail card. Plus, most elderly patients aren’t able to advocate for themselves, and their relatives often have better things to do with their lives. All of this creates the illusion of a safety blanket – one that can be abused time and time again.
Despite sitting comfortably atop my high horse and fancying myself superior to most of my peers at the time, I was still guilty of the very same crime. Sure, I’d never use it as an excuse to deliver subpar care, shirk my duties, or let myself off the hook, but I can’t honestly say I treated older patients equally either. My moral compass had become skewed, its arrow pointing more towards indifference than compassion.
In hindsight, I can understand why it’s so easy to fall into this trap with elderly patients. Unfortunately, age also comes with a whole lotta problems.
First and foremost, most of the geriatric population (especially that in hospital) is riddled with an endless list of medical conditions, their treatment charts resembling polypharmacy nightmares. They present with a multitude of problems – some causing major distress in their day-to-day lives, others completely unnoticeable were it not for the tests we run. We’re asked to review acute issues, often at the expense of chronic ones that have been accumulating for years on end – physical problems like arthritis and hearing loss, and mental ones like dementia and depression.
And that’s where the element of futility kicks in. What could I, a measly junior doctor, realistically do to fix problems that had been brewing for decades when no one else before me had managed to? And as bad as it sounds, if they’ve lived with these issues for years, why is it suddenly my responsibility to solve them? Not to mention that with elderly patients, the moment you fix one problem, another five seem to pop up.
Then there’s the utilitarian argument. Resources are scarce as it is – why invest what little we have in someone who won’t get to “make use” of it? Why not redirect time, effort, and money towards younger, healthier patients with their whole lives ahead of them? Besides, a significant proportion of elderly patients suffer from debilitating conditions that would prevent them from living the lives they’d want to live – assuming they’re lucid enough to realise that.
I think that’s how I rationalised my apathy towards the elderly. Once again, I found myself becoming jaded and indifferent, my thinking clouded by futility and resignation. Of course, it wasn’t just me. In fact, I’d say most doctors I knew shared this belief system. We’d provide the best medical care possible – but nothing beyond that. It took me a long time to see how easily we get sidetracked, how effortlessly the elderly get sidelined, how patient care becomes robotic, and how alienation quietly creeps in.
Fortunately, by that point, I had a few incredible role models to look up to – Dr Sugar and Dr Pops among them. They taught me that all lives are equal and that all patients deserve the same standard of care – one grounded in a biopsychosocial approach. My time in geriatric medicine helped consolidate those lessons, allowing me to carry them into my everyday medical practice.
When all your work revolves around elderly patients, it quickly becomes obvious that medicine isn’t just about treating the physical.
Take Mrs Woe-Is-Me, for example. The first time I met her, she was a bitter, insipid old woman who did nothing but complain. Every single day, she’d list her grievances: “My knees hurt, my sight’s getting worse, my hearing’s no better, no one visits me, I’ve got nothing to do, the carers don’t pay attention to me, the food sucks, and the patients next to me are too loud.” Every morning, we were greeted with the same litany.
We referred her to every specialty imaginable and asked the nurses to help address her social issues, but day after day, the list only grew longer. It became all too easy to start asking closed-ended questions focused purely on her physical health, just so we wouldn’t spend an entire shift on her alone. We began dreading visits to her room, sometimes even leaving her until last. As bad as it felt, it was also a matter of prioritisation. And besides, she didn’t seem interested in helping herself out of the rut she’d dug.
One morning, during a particularly quiet shift, I decided to sit down beside her and talk – if only to ease my own guilt. After some probing, we finally got to the root of it. “I have nothing to live for. I want to die,” she said. She had all three hallmark symptoms of depression – low mood, anhedonia, and reduced energy. She’d hit rock bottom.
Normally, we’d have referred her to psychiatric services, which I knew would take months – months of continued existential agony. So I decided to dig deeper. For years, she’d been confined to that hospital without ever going outside in her wheelchair. Her days consisted of lying in bed or sitting in an armchair beside it. Newspaper in the morning. Radio in the afternoon. That was it. That was her life.
As doctors – especially as junior doctors – we’re taught to hide behind professionalism and codes of conduct, often using them as an excuse not to probe too deeply. But she was far too gone to care. I doubted I could make things any worse. “If I were in your position, I’d want to die too,” I told her. I chose honesty over platitudes. I then asked her a few questions I’d come across in Being Mortal by Atul Gawande, a book on palliative and end-of-life care:
What is your understanding of your situation and its possible outcomes?
What are your fears and hopes?
What trade-offs are you willing or unwilling to make?
What course of action best aligns with these values?
Almost immediately, I saw an opening. She told me she truly had nothing to live for – her friends and relatives were dead, she had no hobbies, and pain was her only constant. She feared enduring this suffering any longer and hoped death would come soon. For a while, I thought nothing I said would pierce her iron-clad logic. Truthfully, I’d have thought the same in her position. “Well, if you’re already resigned, there’s no harm in trying something different,” I suggested. “If it doesn’t work, I promise we’ll leave you be.”
We talked for a long time. She mentioned a long-lost relative she’d lost contact with. I called him on her behalf, and he agreed to take her out for coffee. I asked whether she’d consider getting a tablet or laptop to occupy her days. She said she was too old to learn, but I insisted that if my grandma could manage, so could she. And just like that, she smiled – something none of us had seen before. Over the course of an hour, she transformed from a miserable grinch into a faint ray of sunshine. I was elated, but cautious. I knew better than to celebrate too early. Still, I’d done my job. I’d advocated for my patient, fully aware that it might all come to nothing.
Day by day, Mrs Woe-Is-Me became almost unrecognisable. She started going out weekly with her newly reconnected relative. While she never did get a laptop, she began reading books and engaging in social activities at the hospital. She’d smile and wave the moment she saw our team walk in. She still complained, of course – but her pain was better controlled, and her mood markedly improved. I can’t claim credit for her transformation, but I was proud to have played a part.
Maybe that was the point all along. That medicine isn’t only life and death or curing a disease. That medicine isn’t only about eliminating pain or endlessly prolonging life – it’s about improving its quality.
Helping someone reconnect with loved ones. Reignite old passions. Find purpose again. Over my three months in geriatrics, I met many Mrs Woe-Is-Me’s – people with no apparent reason to live until someone helped them rediscover one. That said, I never found a one-size-fits-all solution. It soon became clear that despite my best efforts, I couldn’t help everyone. Not every doctor has the luxury of spending an hour sitting beside a patient. Some people don’t want help. Others are too unwell to recognise they need it.
I guess there’s no answer beyond doing your very best. And maybe that’s enough. That’s all anyone can ever do.