Doctor: Learn from your elders!

As a teenager pining for a career in medicine, I had thoughts of curing the world. Little did I know that the best parts of my medical education would come from people in their fifties and beyond. Elective rotations in orthopedic surgery and internal medicine allowed me to meet older patients who smiled when I walked into the room despite wearing casts or residing in a gray hospital room. How can you smile, I asked one lady in her late seventies. She coughed and replied with a scratchy but coherent answer: “Feeling my pain in the morning reminds me that I am alive.”After that encounter, I realized that many elderly live in pain or with some other chronic medical condition. How do they do that? How does anyone keep smiling with all sorts of pain and worry? I needed to delve into this further.During the summer of 1989, I spent 12 weeks rotating through the Baycrest Centre for Geriatric Care in North York, Ontario. My mentors included Drs. Michael Gordon and Mark Cheung, both of them internists. Read: Dr. Eric Grief: Five to 10 minutes saves $1,000One night on call, I was called to treat a lady with a moderate nosebleed. I had to use silver nitrate sticks that hurt. At first, I hesitated to press the stick firmly and repeatedly onto her thin nasal lining. Her bleeding persisted. So I doubled up on the sticks and her bleeding stopped shortly thereafter. Blood had splattered onto my eye glasses and lapels of my white coat, although my name tag remained clean.An hour later, I was called to see an 85-year-old lady who was vomiting blood. With a long list of documented health problems, we honoured her do-not-resuscitate order and she quickly took her last breaths. I stood by her bedside and watched an elderly person die quietly. Three years later while in family medicine residency, a similar situation replayed itself with a lady in her eighties who died of septicemia after chemotherapy for her underlying cancer. My mentor, a senior female internist, remained calm throughout the entire 24 hour decline of my patient. Fast forward another seven years, I worked at the Oakville Trafalgar Memorial Hospital (O-T for short) and I cared for a lady in her eighties who was post stroke with a dense hemiplegia. I admitted this lady and consulted a neurologist who prescribed ASA. This lady had poor dentition but she was not afraid to show her gratitude to my calm and concerned caring by smiling her toothless grin. Her younger daughter smiled and shook my hand. One week later, this lady died from an upper GI bleed, despite the administration of I.V. antacids.One year later my elderly patient George came in smiling and short of breath. “George, how are you able to smile with difficulty breathing?” He replied, “There is no sense in scowling, it only turns my wife off.” I had met George and Marcia after I had attended their daughter’s home while she lay dying from Acute myelogenous leukemia. It only took George six months to die from his mesothelioma. Only months after his death, Marcia came to my office complaining of a screaming in her ear. My initial reaction was that she was suffering from a delayed grief reaction—first her daughter had died and then her husband. But due to the training I received while at Baycrest and throughout my family medicine residency, I examined her physically, searching for the source of her “scream.” Moments later, I heard the “scream” coming from her aortic valve. Two weeks later, I was visiting her in the hospital after her aortic valve replacement. She smiled at me despite being in pain and lying in a gray hospital room.Dr. Eric Grief is a medical psychotherapist in Vaughan, Ont.

Doctor: Learn from your elders!

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