‘We live in an age where be­com­ing old is seen as a flaw’

It took an in­dig­nant ques­tion from a 93-year-old pa­tient to jolt doc­tor and au­thor Joanna Can­non out of the usual clichéd view of el­derly peo­ple. Here she ex­plains how the en­counter shook – and in­spired – her

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Wwhatho are you,’ he said, ‘to tell me I need?’ He was 93 years old. He wore tired striped py­ja­mas and lay in a bed at the far end of a hospi­tal bay. Voic­ing these words to me took so much courage that from where I stood I could see his hands shake slightly and the line of his jaw do its very best to be firm and res­o­lute.

I was not 93 years old. I was not wear­ing tired striped py­ja­mas. I was a ju­nior doc­tor with a shiny stetho­scope and a very im­por­tant pager that bleeped out its im­por­tance to the whole ward ev­ery few min­utes. I also had a long list of jobs that morn­ing and one of those jobs was to visit the bed­side of this 93-year-old man and ex­plain to him what care pack­age would be put in place once he was dis­charged: the peo­ple who would wash and dress him, make sure he ate and drew his cur­tains, and who would switch on the tele­vi­sion for him be­fore they left. Although I have al­ways thought ‘care pack­age’ was a strange term, as though car­ing should be lim­ited to some­thing ➤

“IT WAS CARE OF THE EL­DERLY THAT I FOUND TRULY DIS­TRESS­ING BE­CAUSE THERE ARE PA­TIENTS WHO HAVE NO ONE”

you could wrap in brown pa­per and tie up with string. I thought it would be an easy job to re­lay all this, some­thing that would only take a few min­utes. I was wrong. ‘Par­don?’ I said. ‘Who are you,’ he re­peated, but with a lit­tle more cer­tainty this time, ‘to tell me what I need?’

I ex­plained to him it would be the same for any pa­tient, that we wanted to make sure he stayed safe and well, that we just wanted the best for him. I hid my shame be­hind a change in per­sonal pro­noun. I had grown very fond of this el­derly gen­tle­man.

Doc­tors are not sup­posed to have favourite pa­tients, but some­times it’s im­pos­si­ble to avoid. From the time we had al­ready spent to­gether, I knew this was a man who had lied about his age in or­der to fight for his coun­try, who had a lit­tle boy who went to school one morn­ing, was in­volved in an ac­ci­dent and never came home.

A man who used to have a car­a­van and a job at the gas board, and a wife he missed so des­per­ately he would kiss her pho­to­graph each night be­fore he went to bed. I knew all of these things, and yet I had stood by his bed­side and failed to ac­knowl­edge any of them. I had seen him, as so­ci­ety sees most el­derly peo­ple, as a prob­lem to solve, a date of birth, noth­ing more than a name on a list.

The first job for any ju­nior doc­tor each morn­ing is to print out a list of their pa­tients. It’s a sim­ple record: name, hospi­tal num­ber and date of birth. As you scan the list, your gaze is al­ways drawn to any­one un­der the age of 65 be­cause (with the ex­cep­tion of ob­vi­ous spe­cial­i­ties) the vast ma­jor­ity of your pa­tients will con­sist of the el­derly.

Peo­ple who were per­haps ad­mit­ted due to a fall or an in­fec­tion, but – de­spite hav­ing re­cov­ered – are now un­able to re­turn home be­cause they have no fam­ily to take care of them and can’t con­tinue liv­ing alone. Or be­cause they’re wait­ing for fund­ing for a care home. Peo­ple who are there be­cause they sim­ply have nowhere else to go. They have turned a chap­ter and the life they once had is no longer ap­pro­pri­ate, so they linger in wards while the world de­cides what to do with them.

As the ward round moves through the hospi­tal each day and en­tries are made in case notes, the only thing writ­ten for these pa­tients is ‘no change – await­ing so­cial care’ (which is of­ten ab­bre­vi­ated to ‘N/C await­ing SC’, seem­ingly in or­der to take up as lit­tle ink, ef­fort and space on the page as pos­si­ble). These are the peo­ple so­ci­ety of­ten calls ‘bed block­ers’ – a vile, thought­less term that some­how im­plies a kind of de­lib­er­ate stub­born­ness on be­half of the pa­tient, when, in re­al­ity, it’s the sys­tem that ‘blocks a bed’, not the per­son.

I have even heard this term used by vis­i­tors or other pa­tients, and some­times, sadly, by hospi­tal staff within earshot of el­derly peo­ple. El­derly peo­ple whose sole con­cern in life is that they don’t be­come a nui­sance to any­body.

Along­side those await­ing so­cial care, there are, of course, el­derly pa­tients who are un­well. When I first started work­ing as a ju­nior doc­tor, I was warned that I would find pae­di­atrics up­set­ting. ‘It’s so trau­matic to see chil­dren who are poorly,’ I was told. Of course it is, but in pae­di­atrics there is (usu­ally) a tribe of fam­ily by that poorly child’s be­side. An army of peo­ple. It was care of the el­derly I found truly dis­tress­ing, be­cause there are pa­tients – like the 93-year-old man in tired striped py­ja­mas – who have no one. At vis­it­ing time, the plas­tic chair by the side of their bed re­mains empty. There is no fam­ily to re­as­sure them. No rel­a­tive to stand their cor­ner. No one to ex­plain things to them.

On a ward round, where a con­sul­tant is of­ten just as pressed for time as the ju­nior doc­tors are, there isn’t al­ways the op­por­tu­nity to go through any­thing in slow de­tail, and so we say, ‘I’ll come back later and ex­plain that med­i­ca­tion’, or those blood re­sults, or that chest x-ray.

The prob­lem with this is that at the end of your shift you find your­self with a list of 20 peo­ple you have said you will re­turn to. But you still do it. Be­cause keep­ing your prom­ise to a pa­tient should al­ways re­main very high on your list of things to do.

How­ever, the hospi­tal only re­flects the wider world, where el­derly peo­ple merge into the land­scape and seem only to pro­vide a back­drop as we go about our hur­ried and very im­por­tant lives. It seems that there comes a point where the only sig­nif­i­cant fact left is your age and ev­ery­thing else is for­got­ten as you are placed in a face­less, generic pool of peo­ple called ‘the el­derly’. It’s a lit­tle like ‘ba­bies and chil­dren’ – ex­cept no one rushes over to an el­derly per­son to tell them how won­der­ful they are. When you be­come old, peo­ple don’t al­ways bother to ask your name. You be­come ‘dearie’ or ‘sweet­heart’. The same peo­ple are also strangely blessed with a sud­den abil­ity to know, far more than any­one else, what is best for you. Your age be­comes an ex­pla­na­tion for ev­ery­thing else in your life – ev­ery thought, ev­ery quirk of be­hav­iour is placed firmly at the feet of your date of birth.

When I worked on a ward for peo­ple with de­men­tia, there was an el­derly gen­tle­man whose be­hav­iour caused all sorts of prob­lems. Each time he was given a cup of tea, he would take a sip and then lean over and pour the rest on to the car­pet. Noth­ing we did could stop him and it got to the point where all we could do was place a wash­ing-up bowl by his bed in an­tic­i­pa­tion. It seemed to be a ran­dom symp­tom of his age, of his ill­ness, un­til we spoke to his daugh­ter. She said her fa­ther used to be a lorry driver. When­ever he pulled up in a layby to drink tea from his flask, he would take the fi­nal dregs, lean over and tip them out through the win­dow.

In the same way, a fe­male pa­tient on the ward would, at the start of each day, raise her skirt and walk around the room, show­ing off her un­der­wear to every­one in sight. We couldn’t un­der­stand why, un­til we found out that she used to be a farmer’s wife, and she would col­lect hen’s eggs in the gath­ered ma­te­rial of her apron ev­ery morn­ing. It all made com­plete sense, but only be­cause we had taken the time to lis­ten to their sto­ries.

The world rarely stops to lis­ten to sto­ries. We live in an age where time and ex­pe­ri­ence are air­brushed from faces, where be­com­ing old is seen as a flaw, a lapse in con­cen­tra­tion, al­most an ill­ness in its own right.

In­stead of cel­e­brat­ing our age, we do our level best to hide it, and mul­ti­mil­lion-pound in­dus­tries feed purely on our fear of grow­ing old.

On the way to a meet­ing about this ar­ti­cle, I

found my­self on a pave­ment, be­hind an el­derly woman with walk­ing sticks and a shop­ping trol­ley and a joy­ful de­ter­mi­na­tion to con­tinue liv­ing her life the way she al­ways had. I was run­ning late. I was frus­trated. I was tut­ting in­ter­nally. I tried to edge my way past to over­take this woman (a woman who, in not that many years into the fu­ture, might very well be me). We for­get, I think, that life can be so very much richer if we stop try­ing to over­take every­one and walk along­side them for a while in­stead.

When I worked in the hospi­tal, I saw the wis­dom and hu­mour in grow­ing old, but I also saw much of the dis­tress.

The woman in her 80s who never had a vis­i­tor, but whose daugh­ter walked on to the ward af­ter her mother had died, de­mand­ing the wed­ding ring. The 102-year-old woman who had buried her hus­band, her best friend and her chil­dren, and who couldn’t un­der­stand why peo­ple still told her she was ‘do­ing so well’. The el­derly man whose wife died sud­denly when he was ad­mit­ted for a rou­tine pro­ce­dure, and who passed away the next morn­ing of what I will al­ways, very un­med­i­cally, con­sider to be a bro­ken heart. You try, as a doc­tor, to lis­ten and to speak out about how it must feel to grow old, but like thou­sands of peo­ple work­ing in the health ser­vice, you won­der some­times if your voice is heard at all.

When I be­came an au­thor, through a se­ries of strange and for­tu­nate twists of fate, I re­alised that my voice might now carry a lit­tle fur­ther. While I would never write about my pa­tients, I could write about the things they taught me. I knew that with my sec­ond novel, I wanted to write about grow­ing old. Three Things About Elsie opens with 84-year-old Florence, who has fallen in her flat at a home for the el­derly and is wait­ing for some­one to res­cue her.

In the story, I wanted to ex­plore how we are all valu­able, no mat­ter what our age, and how the world will for­ever be slightly dif­fer­ent, just be­cause we once ex­isted.

I wanted to write about the les­son taught to me by a 93-year-old man in tired striped py­ja­mas.

Sadly, he will never know any of this. He never re­ceived his care pack­age, be­cause he died with­out ever be­ing dis­charged. I like to think that he is now re­united with the wife he missed so des­per­ately.

I had moved on to my next job when it hap­pened, but know­ing how fond of him I had grown, one of the nurses man­aged to get a mes­sage to me (be­cause nurses not only care for their pa­tients, they care for their col­leagues as well).

Wher­ever he is, I hope he knows just how much his words af­fected me and how I lis­tened as he helped me to un­der­stand what it feels like to grow old. I hope he knows I stitched that lis­ten­ing into the pages of a story and found a way to send it out into the world, in the hope that other peo­ple might lis­ten to him, too. n Three Things About Elsie by Joanna Can­non is pub­lished by HarperCollins, price €20.99

Joanna at work as a doc­tor

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