Saturday, April 4, 2015

Stories from the ER: Elder Neglect

This post conforms to the blog rules.The ER rotation was four weeks of shifts during interview season, during which I saw the entire spectrum of urgent to extremely-emergent care. I inserted IVs and foleys, I did ultrasounds, I put on splints, and I stitched up lacerations (the highlights of which were a flap closure on a woman's nose and an 11-centimeter arm lac). I also saw patients and attendings work their way through crises, deaths, and long waits for the CT machine. Here are a few of the stories that had the strongest impact on me.

An elderly man with COPD on oxygen came in with vague complaints. He had been to the ER (brought by EMS) several times in the past for similar things. He was cachectic, his lips were terribly chapped, and his saliva was thick and white. As I took his history, it became clear that this was a case of elder neglect: his children didn't visit and he was alone all day. He said he didn't drink much water, because his oxygen tubing wasn't long enough for him to get to the bathroom in time. His teeth were caked in plaque and tartar because of his dehydration. I saw in the medical record that he'd declined home health nursing before, and I knew I had to do something to change his mind.

It was a long history-taking session. I knew my attending would be wondering what took so long, but for once, I decided not to care. This man needed someone to sit down and be quiet, to appreciate his loneliness and change it. At the end of a long monologue of truly tragic complaints, I said. "I'm sorry."

"It's not your fault," he said.

"But it feels terrible to be isolated."

His eyes stayed on me for half a second, because he saw that I'd understood. "Yes," he whispered.

I asked him about his previous decisions on home health. He didn't like that home health nurses made such quick, business-like visits. We talked about more prolonged companions. As I left he squeezed my hand. "Thank you," he said. I smiled, and I went back to my attending and with a very short presentation. "This is an 89-year old white gentleman with COPD who is suffering from a very lonely home situation, and needs a social work consult for an in-home companion." As I moved onto the next patient, social work was arranging something.

I wish we took care of our elderly in our homes. When interviewing out of state, I stayed with one Catholic family who gave me the best example of this I've ever seen. They had emptied their front living room of furniture so that their elderly, demented mother could have a hospital bed and a lift chair there. This woman was nonverbal and could not move by herself, but her daughter kept her at home. The room opened onto the kitchen so that this elderly mother could join in family meals and engage with her grandchildren doing homework at the table, in the very limited way that she could. She could be heard if she moaned, and she could be checked on easily. 

In this case, both spouses were physicians (one a retired, stay-at-home parent), so I know they were competent to do this. But in many situations, competence in caring for an elderly parent is easy to gain from a few weeks of home health visits. It's not competence, but generosity that is frequently lacking. Most don't realize how isolating and miserable life becomes for someone so rich in life experience and so used to social interaction. It takes generosity to place yourself in the position of an elderly person, and further generosity to improve that position by opening your home.

This patient could certainly be cared for in a son or daughter's home, provided that someone was at home for at least half a day. I ask any young professionals or young married couples reading to please remember to care for your parents!

No comments:

Post a Comment