The Other Side

I was doing “full service” when I started out in general practice, including delivering babies. Obstetrics was a not-too-challenging routine part of my work (except having to get up in the middle of the night), but I never dreamt what having a baby meant
until we had one ourselves. I was astounded at my attitude and behaviour at 3
AM when a delivery room nurse tried to stop me from going with my thirty-minute-old
daughter to a “transitional” nursery, which the rules said she had to spend 24 hours in because of her score on some numeric scale. They had to call the administrator on duty and ended up making an exception, because nobody was going to take my baby away from me!  My attitude to delivering babies changed that night.

My parents both died years ago and neither of them was ever frail. But now my in-laws are both dependent: Nigel is in an extended care facility after a stroke, and Liz is forgetful and recovering from a complication in the hospital. I, who have done decades of medical care of the frail elderly with what I thought was sensitivity suddenly understand what it means to be responsible for partially helpless people, and to feel helpless myself.

Watching Nigel being admitted to the facility, I got more and more paranoid with the odor, the scatterbrained administration, the medication mistakes I thought I detected, the gaunt immobile inmates staring from their wheelchairs, and the rough technique of care aides transferring him to his bed at 1 PM in a dark institutional room.  My wife Robin was in tears and so was I, giving Nigel the best reassuring hug around the shoulders I could
manage after he told me he was scared and wanted to go home.

Nobody seemed impressed at my credentials. Moments after she told us everything was going to be just fine, I passed the staff lunchroom and heard the chief care aide laughing and chatting over coffee. Our guilt, bewilderment, frustration, and whimpering were Monday afternoon business as usual. And I knew it had been just so for me hundreds of times over the years, and how I must have appeared to so many honest worried people.

“Ve grow too soon oldt und too late schmart” says a fake-German motto on a bumper sticker.  And too late kind, and humble…

About John Sloan

John Sloan is a senior academic physician in the Department of Family Practice at the University of British Columbia, and has spent most of his 30 years' practice caring for the frail elderly in Vancouver. He is the author of "A Bitter Pill: How the Medical System is Failing the Elderly", published in 2009 by Greystone Books. His innovative primary care practice for the frail elderly has been adopted by Vancouver Coastal Health and is expanding. Dr. Sloan lectures throughout North America on care of the elderly.
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2 Responses to The Other Side

  1. The first clue when we admit an elderly loved one is how we feel, isn’t it?

    Yet how many of us ignore that awful grief?

    Ah, our modern minds – our minds with their practicality, sensibleness, narcissism, habits of worry & belief-in-impossibilities, or belief at least in our own unsuitableness for the jobs of care! Yet if it’s our hearts that temper our minds, what message is the heart trying to get through to us when we can feel it breaking because we’re leaving someone in a place neither they nor we want them to be? And why do we think it’s okay to ignore or overlook that message, as if the brain alone is the superior decision-maker?

    Listening to the heart does not discount the mind – it merely adds further wisdom to the discourse. Decisions which are a collaboration between head and heart are most likely, not only to work best in the long run, but to feel best in the long run.

    I’m firmly convinced that when we learn this and begin to practice it, we finally become fully human. Not perfected – just fully human.

  2. Judith Hunt says:

    Dear Dr Sloan,
    You were plenty smart enough to be the difference for my family between my parents ending their lives together in their own home instead of in institutions. I couldn’t have kept them at home without your care. I will always be in your debt.
    Caring for the very old in our society is extremely and profoundly challenging. Sometimes devastating to the family. You have just learned a few more ways in which this is true. I am sorry.

    That said, your post raises several other important issues:
    — the lack of choice for temporary or permanent placement of someone who needs 24 hour care;
    — what some see as the downgrading of the care aide vocation. Wages have fallen, there are few steady jobs, most jobs are ‘casual’. Many people from other countries use the government programs to start a life in Canada as a care aide, whether or not they have the heart to do health care. (I have spoken to quite a few of them.) Institutions are understaffed; many have been converted from union workplaces to lower paid and lower staffed for-profit organizations.
    — how can we be sure our loved ones are not being drugged into quiescence? This is a complex issue closely related to understaffing. Ditto your concern about the possible medication mistakes. The first part of the answer is meaningful communication with senior people in the facility — you experienced the opposite of this.
    — I too am troubled by the ‘gallows humour’ of the staff in the cafeteria. Sensitive carers wouldn’t do it, although it may be a sign that the carers are overstressed. Sensitive management would make sure that families and residents couldn’t hear it if it did happen.
    — perhaps most importantly, your offers of help (like your questions) had no place in this institution. Letting loved ones of residents ‘in’ might be the most significant change our health care system needs.

    Thank you for this post.

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