Maintaining the Body/Mind

In zooming around healthcare settings, I’ve noticed that many people approach illness as a weakness or a betrayal of their body and mind. I’ve even noticed myself having a similar feeling occasionally when I must visit my own doctor. This way of thinking is like how I think about my car: I expect my car to get me from A to B every time I ask it to, with minimal effort on my part, and no upkeep.

To further outline the analogy between bodies/minds and cars:

  • The hospital is to the body/mind as the auto shop is to a car after a crash. If something gets damaged, we usually must fix it to run again.
  • The primary care setting is to the body/mind as an oil change, tire change, and alignment are to a car. For optimal performance, we must continuously do some upkeep and occasionally get a tune up.

As we examine the analogy between cars and bodies/minds there is an essential difference. If we have the money, we can buy a new car periodically to avoid all the upkeep that inevitably comes with the wear and tear of use. However, we each only get one body/mind and, therefore, not even money can spare us the required upkeep that comes with the wear and tear of life.

Considering that we each only get one body/mind and life is hard, I’d like to propose the viewpoint that going to a primary care provider isn’t a visit with the enemy. It’s not intended to be a place of judgement or punishment. Instead, think of primary care appointments as tune ups that include chatting with an expert on the human body/mind. In this chat, we can uncover what aspects of our body/mind are optimized, what aspects aren’t optimal, and how we each can make our body/mind run better. By optimizing our body/mind, we may prevent many diseases from occurring (prevention is better than treatment, why get sick if there’s a way to avoid it completely?). 

In a similar fashion, no one wants to stay in the hospital, but needing the hospital isn’t unique; it’s part of the human experience in places where hospitals exist. Hospitals can save lives and fix big health problems. They might not be the most pleasant places, but without them we might not get the care we need to recover when things in our bodies/minds break. If we can think of our hospital care team as a bunch of people on our side who are looking out for our bodies/minds, it might make the whole experience a little better.

 Just as we know our cars require a certain amount of upkeep, I challenge all of us to remember that the body and mind also require a certain amount of upkeep without considering a need for that upkeep a shortcoming.

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The Ocean

I’ve never lived by a sea or ocean before. But for a few weeks this winter I am. And not just any salty expanse but the Caribbean Sea and Atlantic Ocean around Puerto Rico. It’s not hurricane season so, in the few days I’ve been here so far, the waves have crashed with careful, well-mannered regularity. Right now, I’m on the Atlantic Ocean coast. The water is warm and blue. Walking along the beach I find myself covered with a salt film both from the lapping waves and the salt in the air. The temperature has been perfect and the sun a beautiful gold. Proximal to the sand and rocks that meet the water are coconut trees, marking where the beach ends and the rest of the island begins.

As I walk along the rocky bits of the shore crabs scuttle so quickly that they’re hard to see – their shell patterns match the sea plants and the design the sunlight creates as it dances with the waves. Pelicans hover above the water, make a diving plummet with a smack as they break the water’s surface, rest on the ocean’s surface to swallow the fish they caught, and then take flight to follow the wind off the water to only scoop around like a boomerang and head back out to fish again.

People sit on the beach and hangout in the water. They listen to their loud music, dig holes in the sand, throw rocks, and drink alcohol (mostly beer). I walk along the junction between the water and the sand – sometimes more on the side of the sand and other times more on the side of the saltwater. The waves fill the gap between me and the seemingly infinite ocean. Sometimes I’m taken by surprise when a large wave barrels to shore and splashes up against my legs and catches my shirt in its spray.

Where there are tidal pools, I look down at the ruby red sea urchins with deep crimson spikes – their colors remind me of the colors of fresh and dried blood or, perhaps more appealing, the colors of red I’d expect royalty to wear. There are little fish that dart around in the tidal pools; they’re the color and pattern of sand. There are sea plants that look like little green balloons. There are shells hiding live creatures whose names I don’t know. Some of the bigger pools have sea anemones. I peer into each tidal pool, eager to see what it keeps in its mini-sea haven.

I love the sound of the waves and the smell of the salt water against the sand. It’s new to see coconuts. But, in this serene backdrop I can’t help but notice the broken glass and plastic bits, bottles of all varieties, cans, and all the other trash humans on the beach have failed to pick up…or humans elsewhere tossed in such a way that their trash found its way to the beaches where I wander now. I walk barefoot in the sand, but it’s almost a bad idea because so many people have broken their beer bottles.

The creatures and features of the ocean are no less beautiful with the trash present, but I imagine how it would be paradise without the plastic bottles there as a reminder that so many places I love are being filled with trash. Will this beach be swimmable when my grandchildren are alive? There must be a better way. There must be a way to keep this beach with its crabs and sea urchins for the generations to come.

As I turn up the road between where I’m staying and the ocean I see heaps of bottles, cans, Styrofoam, plastic bags, and other discarded single use items on the side of the road. They create a scattering of litter among the snake plants, palm trees, mango trees, papaya trees, pothos vines, and other plants of the tropics. Is there another way or is it already too late to return our natural spaces to paradise?

Back In the Operating Room

The patient was undergoing emergency surgery for an aortic dissection (when blood gets between the layers of an artery wall) with an aneurysm (dilation/ballooning out). The aorta is the largest artery in the body. It comes off the top of the heart and then travels through the chest and abdomen until it splits into two big arteries that feed the legs. It has many branches along its path. Because this patient’s dissection and aneurysm were close to their heart, without surgery the dissection could spread and damage their heart. Further, if the aneurysm wasn’t fixed and then ruptured, the patient would likely bleed to death.

Conducting this surgery was one surgeon and one physician’s assistant (PA); they were supported by an anesthesiologist, a resident anesthesiologist, 3-5 nurses, and 1-3 surgical techs. Surgeries are always a team effort. This surgery was complicated, the stakes were high, and bad outcomes were more likely than for many other surgeries (but without surgery death was almost certain). For the first 6 or so hours of the surgery the surgeon and PA worked without a break – no water, no bathroom, and no food. After the most time-sensitive part of the surgery was done, the surgeon sipped some water through a straw that a nurse carefully threaded behind his mask. The nurse joked that he was like a gerbil – no one argued with that analogy.

In all, the surgery would take about 11 hours. As the surgeon was finishing up his work, he looked around the room and thanked each person there for their help. He then looked up at me. I’d been watching the surgery for the better part of 8 hours. “What are you? A resident?” the surgeon asked.

“No, a medical student,” I said.

“God bless you,” the surgeon said. He paused. “My son is a third-year resident. I tell him to remember that you’re not supposed to enjoy residency.” The surgeon paused again. “But I still say I would never have wanted to do anything else.”

This surgeon had started working as a surgeon at this hospital when I was 8 years old. Assuming he’d done about 8 years of training to become a cardiothoracic surgeon and that he’d spent his entire career at this one hospital, he’d been operating about as long as I’d been alive.

I reflected on his sense of fulfilment in being a surgeon. I wondered if I’d end up liking my path in medicine as much as he liked his. I wondered if it was possible to enjoy one’s path in medicine as much these days as it was when he started.

~

Medicine has changed a lot in the 30+ years I’ve been alive. We’ve made lots of amazing advancements, but health disparities remain staggering. Work conditions are variable hospital to hospital and clinic to clinic. I love medicine, but I can’t ignore how strained our healthcare system was before the COVID pandemic and how much worse it has become even after the COVID vaccine reached the US public. I also know that my path in medicine will be quite different than that of a surgeon.

I am pursuing a medical career that does not involve surgery or procedures and, therefore, is not a hospital money-maker in our current healthcare system. Money gives power even in healthcare, as such, I’ll neither have the high pay nor inherent influence on hospital administration that surgeons do. All physician roles have amazing components and are important for patient care however to say each physician’s place in the system is the same is not simplification, it’s erroneous. I’ve come to feel the differences between physician types more thoroughly as each new step of my doctorhood quest unfolds.

As I wrap up my time as a medical student, I’ve been reflecting on what I’ve learned and seen in healthcare so far and where I want to end up as a physician. As a student, I’ve seen more parts of the patient care system than I will in any other capacity during the doctorhood quest. I’ve participated in countless conversations throughout the inpatient and outpatient healthcare settings. I’ve been a fly on the wall for even more conversations than I’ve participated in. From insurance navigation nightmares to cool medical cases, from nurse-to-patient ratios to supply chain issues I’ve come to understand that healthcare is a complex group sport where the field and rules change based on geographic location (because of geography itself, demographic composition, and regional laws), insurance status, medical society guidelines, government funding, hospital and/or clinic revenue generation, supply chains, ability to hire healthcare professionals, and many other factors.

I start residency in about 6 months. At that point, I’ll continue to learn what I need to know to be an independent physician. After 3 years, I could graduate residency to work as a hospitalist or primary care physician or I could continue my training to further specialize. I’m excited and hopeful about these rapidly approaching adventures. I wonder what I’ll tell a medical student about my journey 30 years from now. I dream that my message will be as positive as this surgeon’s message was to me.

Welcoming 2023

Fog

by Carl Sandburg

The fog comes

on little cat feet.

It sits looking

over harbor and city

on silent haunches

and then moves on.

2022 was a year of achievement. I finished my last exam and clinical rotation of medical school. I applied for residency and got cool interviews. I went to my first medical conference. I got married. I re-combined houses with my husband after he graduated from nursing school and started his first nursing job. I did some of my longest hikes. I feasted frequently.

2023 will be marked by change including finishing medical school and starting residency in a place yet-to-be-determined. I started with Carl Sandburg’s “Fog” because quietness, absorption, and forward movement are the 3 themes I think will get me through the whirlwind of transitions that will unfold in the coming months.

Quietness

Life is loud whether visiting with friends and family, undertaking adventures, or working. In all pursuits, inner quietness can act as a grounding point. This year my primary goal is to cultivate my inner quietness.

Absorption

Residency is a huge leap of responsibility from medical school. It’s the first time I’ll get paid to be a physician, but with more responsibility comes a ton more to learn. In this context, I’m planning to tap my inner sponge and absorb as much knowledge as I can.

Forward Movement

Whether the days are long or short each one is a step forward. This can be difficult to remember in the moment. As I work through the joyful and unpleasant times of 2023, I hope to remember that my efforts are moving me along life’s adventure even if it’s not readily apparent how each piece fits together.

Battle at the Kitchen Sink

Disclaimer

This is a throwback story from my Peace Corps days. I’ve been thinking a lot about Paraguay lately and decided it was time to share some of the stories I didn’t share when I lived there. I always find myself thinking about Paraguay when the weather gets cold in New England (my current home), because I miss the sun and the mango trees Paraguay reliably had year-round.

Setting

The last quarter of my 27 months in Paraguay as a Peace Corps volunteer. Which is to say, I was very comfortable. At that point, Paraguay was my home.

Battle at the Kitchen Sink

It was grapefruit season. I remember this because we had gone foraging for grapefruits. In Paraguay there’s a citrus season (there’s also a season for every fruit you love… passion fruit, avocadoes, mangos, pineapples…). The Peace Corps volunteers who came before me had shown me how to hunt for grapefruits, so it was one of the first things I showed the new Peace Corps volunteer visiting me that weekend. It was her first time traveling beyond the training community in Paraguay where all Paraguay Peace Corps volunteers in my era spent their first three months learning language, culture, and other skills they might need once they arrived in their sites (where’d they work for 2 years). She was visiting me to learn about what it was like to transition from training to working in Paraguay.

After our lesson on foraging grapefruit, I showed the visiting volunteer (just as the Paraguayans had shown me) how to peel the grapefruit properly. This involved using a knife to carefully cut the peel off in a spiral, leaving a thick layer of that bitter white stuff that hides under the colorful part of the peel. I showed her how to cut a little cone-shaped hole in the top of the grapefruit. Then, how to squeeze the whole thing and suck the juice out until the grapefruit was dry. This is how Paraguayans most frequently eat grapefruit and oranges. It is my preferred method above all methods I’ve tried.

We then had lunch. I took the dishes out to my kitchen sink, which was located outside my apartment in the back under a mango tree. I had running water (which was nice) but my kitchen sink was outside – an unfortunate location on rainy days, but perfectly fine on this day. I set the dishes in the sink and then looked around for my soap and sponge. As with all full sinks, the sponge was hard to find. I went to dig under the dishes to see if it was there. Sitting among the dishes exactly where my hand had just been when I put the dishes in the sink, was a tarantula about the size of my palm.

I don’t know your position on spiders. But, living in Paraguay I developed a set of rules for all home invaders. Spiders were included in that list and my rules for them were as follows: they received the death penalty if they were too big and in my home territory (which included my sink), if they were too close to my bed, and if they were too close to the toilet. If they did not violate any of these rules, I was willing to live peacefully together. The tarantula in my sink resoundingly violated the size rule permissible within my territory.

My heart thumbed. I didn’t know much about tarantulas, but it was the largest spider I’d seen outside of a zoo exhibit. I yelped (sound effects are always part of my life) and then promptly went to find my bottle for fighting invaders (obviously I developed rules for invaders because there were many including ants and roaches). My invader-fighting bottle was a rather short (maybe 10 inches in length) plastic bottle that was square and originally contained my favorite yogurt in Paraguay.

I banged at the tarantula as hard as I could. Of course, having never fought one before, I was jittery.

I missed.

The tarantula climbed out of the sink, plopped on the ground, and started marching toward me.

I didn’t miss the second, third, and fourth time I tried to hit it.

Luckily, the new volunteer was at the front of the house and did not witness this battle, though I told her about it promptly thereafter. All in good time. She would likely battle her own home invaders during her years in Paraguay.

Reflection

These years since I’ve returned to the US have been challenging as I plodded through pre-med classes and several jobs and now, medical school. I’ve encountered many challenging situations with people who act tough and aren’t particularly nice. Most, if not all, of these tough-acting people have never battled a tarantula. Knowing that they lack tarantula experience has put my interactions with them into perspective. Afterall, toughness is relative, like all attributes.

There are many times in medical school where I’ve thought of my Peace Corps days as reminder that the current challenge is not harder than ones I’ve encountered before. Resilience comes from knowing where you’ve been even if others don’t. It comes from applying skills you learned in the past to new scenarios in the present. Most challenges can’t be overcome with a plastic bottle weapon. But, having a plan and being ready to implement it even when surprised can be applied to almost anything.

Did the Jones Cheat?

I strode along one of my most frequented paths which combines my town’s main street and a side street that parallels it. I like the route because it represents two separate worlds despite their proximity. The main street is scattered with restaurants reflecting the many Central and South American cultures that comprise a large portion of my town’s heritage, hair salons, family-owned gift shops and clothing boutiques with their signs as much in Portuguese and Spanish as English, churches, places to learn English and send money orders, and empty store fronts. The side street is lined with one-family homes so large that if I lived in them, I’d need a map to navigate them and an intercom to find my family members in the far reaches of rooms and floors away from me.

As I crossed a four-way intersection, navigating the streetlights (including their left turn arrows) as I always do because I don’t think the walk signal ever turns on, I came upon the first house in the row of mansions. I slowed my pace. There was a landscaping crew. This was a common sight on this street and in many places in Connecticut – people spend lots of money on their lawns here. You always know a landscaping crew because they have big beaten-up trucks with letters painted on the side and a big trailer behind. What made this crew different was that they didn’t have mowing equipment, pruners, or leaf blowers from what I could tell. They weren’t even looking at the plants in the yard. THE LANDSCAPE CREW WAS HANGING CHRISTMAS LIGHTS AND CHRISTMAS WREATHS FOR A PRIVATE HOME.

I thought of that scene in The Grinch where one neighbor is using the Christmas light gun to decorate her house and the other neighbor is blowing electrical fuses to try to get her Christmas light display to just turn on. It never occurred to me that people might pay someone to hang their Christmas decorations at their home. Businesses obviously do that, but a private home having someone else decorate for Christmas?

On a later night, I passed the house of the family who had paid a crew to decorate for Christmas. Their house looked fantastic but in my heart of hearts the decorations were empty. I found myself wondering:

  • Is decorating for Christmas more about the quality of the decorations or is it more about the combination of annoyance and joy of putting them up and then criticizing and loving your own work until you must go through the added chore of taking the decorations down again?
  • Is decorating for Christmas about the quality of your house decorations or the conversations that go into convincing various family members or friends to help you hang decorations or the determination required to hang them all by yourself?

I found myself leaning toward the belief that decorating for Christmas was a lot about the journey and less about the end. Having decorated many a Christmas tree I cut down in the middle of my dad’s woods as a child, which is to say that we had untrimmed trees in all their asymmetrical glory, I find myself solidly believing that what makes home Christmas decorations special is that they were done by amateurs in the spirit of holiday cheer, family fun, and acceptance of an imperfect final product. It’s not that I faulted this family who paid to have their house decorated for Christmas, it’s just that their approached seemed business-like. Much like the Christmas displays on 5th Avenue in NYC, the house with decorations hung by a hired crew was beautiful.

I found myself chuckling about the concept of “keeping up with the Jones.” I found myself glad I grew up in a space and time where lawns were sometimes mowed by teenagers, often not mowed recently, and sometimes mowed by livestock. I’m not sure why the imperfection of unprofessionally maintained homes warms my soul, but it does. And as the holiday season unfolds, I find myself thinking about what exactly is most important in creating holiday spirit.

Heartbroken

Tears fell down their cheeks. There was a long pause. “My heart broke and I’m just having trouble processing that,” the patient said. They’d been hospitalized for a heart attack several months earlier. I was seeing them at a primary care visit long after discharge. On paper they were recovering well, but they didn’t feel that way. They felt broken.

This interaction resurfaces in my mind periodically because it shows a side of illness that isn’t often seen in the hospital (where I’ve spent most of my time training). This patient had experienced an acute illness (heart injury). They had recovered their functionality. By medical definitions, they were a success story. Yet, they were miserable. How could that be?

In medicine we organize diseases into buckets with specific treatments and endpoints related to the organs affected by each disease. For example, this patient had a disease of the heart which might include endpoints like their ability to tolerate exercise or their heart rhythm. These endpoints are a simplicity required to synthesize something as complex as the human organism. However, as this story shows, looking at only specific endpoints can lead to missing things related to the illness that aren’t listed as clear endpoints to track. In the case of this patient, the heart is connected to the brain which is an organ of personality, mood, and feelings (among other things). While the functionality of this patient’s heart met all medical endpoints, their mood/feelings were severely affected by the experience of surviving a heart injury.

This patient’s experience reminds me that the diagnoses we make and interventions we do have lasting impacts on patients. Remembering this motivates me to provide information and support that I think will empower patients in their processing of what happened to them while they were hospitalized. I often wonder what conversations this heartbroken patient had with their care team while they were in the hospital recovering from their heart attack. Was there anything that their care team could have done differently to lessen the patient’s distress after discharge or was the patient’s feeling of heartbrokenness inevitable? I’ll never know the answer.

With this patient’s experience in mind, I try to ask myself if there is anything missing or left unclear before I discharge a patient. Healthcare is far from perfect (it’s quite broken actually) yet, even in a broken system, we can choose to communicate and help as best we can.

Pike Place Market

I sat and ate a biscuit with a high cheese-to-dough ratio and a heavy pad of butter soaking into flaky perfection. It was my first true meal of the day. I was hungry and still having trouble believing I was on the US West Coast, having started my day on the US East Coast. The time change was confusing – the journey across the country was space and time travel. This biscuit shop was on the ocean edge of Pike Place Market in Seattle. Before arriving, I hadn’t known biscuits were popular in Seattle, but I was glad to find several biscuit shops as I wandered about the city.

The last time I’d been to Pike Place Market was in high school on a family trip. But, as all the places of family lore are, the market was familiar because my mother had told me about it many times. My parents met in Seattle. I’d lived there for several years before our family moved East, back to the coast of my grandparents. Pike Place Market is a place of fish stands and cute cafes. It’s full of people.

As I experienced the market for the first time on my own and as an adult, I was most struck by the maze that was the market and the perfect, stunning flower bouquets wrapped in parchment paper. I also liked the mosaic mural of North American birds. The mosaic bird mural reminded me of the bird murals in Harlem (where my sister lives). Per my sister, the bird murals in Harlem depict all the birds that will go extinct sometime sooner than I’d like. I wondered about the mosaic mural birds, would a day come when those birds (too) would only be found in murals?

I liked that Pike Place Market unfolded as a maze. It reminded me of Mercado Cuatro in Asunción, Paraguay. The markets share a maze layout, haphazard vendor stands, a huge range of goods, and people-filled walkways. Pike Place Market lacked the feral kittens that Mercado Cuatro had, but it had its own large bronze pigs with bronze pig hoofprints throughout the market. I followed the hoofprints for a bit. I decided the pigs were a good addition to the market.

I would later learn that the Starbucks in Pike Place Market was so busy because it was the founding Starbucks and people visited it for that reason. I was familiar with Starbucks because I’d worked there when I lived in Washington, DC. The Starbucks in Pike Place Market was much fancier than the one where I’d worked. However, I wasn’t inspired to stop at the first, ever, Starbucks. There were too many other places to choose from for me to pick a place I already knew.  I found a tea shop that sold crumpets (which I didn’t know existed outside of fairytales) and got an earl gray tea.

I was mildly disconcerted by the neon lights in Pike Place Market; they seemed a little aggressive for an enclosed space with so little wiggle room. I did like the nooks with tables and chairs and the scattered sculptures I stumbled upon when I rounded sharp hallway corners. I followed the hallways, stairwells, and odd steps until I thought I’d explored the whole market. I found the public bathrooms on both sides of the street. They were not striking, except that their stall doors were very short. A tall person could easily see over them.

I spent time looking out over the construction next to the market at the ocean. It was drizzling and cold, so I was glad I had worn my puffy coat. The waterfront was in flux. I’d later learn from a family friend that there used to be a highway between the market and the ocean. But, for many years now, they’d been slowly working toward reclaiming the waterfront. It’s funny how we call progress building roads and buildings, only to realize years later that beautiful park spaces are more important. I was glad that someday I’d be able to walk from the market to the ocean, but not today. This visit, there was no direct way because of the construction.

Once I felt that I had a good mental map of the market and had seen enough, I turned back to the city to explore its streets. Seattle was a home to me, but not a familiar one. It was a home of my distant past and the setting of early family stories. I wouldn’t have time to return to the market in the morning to watch them throw fish during this Seattle visit, but I knew I’d be back again. And I was grateful to have my own memory of the market. Lore-made memory to re-lived experience.

Sometimes People Step Up to Be Heroes

The patient sat with a blanket over their head. They were a little goofy and fairly expressed their distaste of their bed and various lines (IVs, urinary catheter, etc.). I didn’t blame them for not liking the hospital; nobody wants to get sick. The patient answered many questions correctly – they knew their name and their spouse’s name – but they couldn’t tell me where they were, why they were there, or what month it was. Yet, to see them sitting there alert and able to talk with me was a miracle that I was humbled to see.

The patient’s spouse and child had saved them. The patient had a cardiac arrest (their heart stopped) after going to bed one night. Their spouse noticed, pulled them to the floor, and started chest compressions. Sometime in that whirlwind, 9-1-1 was called and their teenaged child helped the spouse do compressions. The spouse and child did compressions for 45 minutes, just the two of them, until an ambulance showed up. Once the ambulance crew arrived, the patient received a couple of shocks and then, the patient’s pulse returned.

When I started as an EMT, my first medical experience, my crew chief told me cardiac arrest is death. All we can do is try to give the person’s whose heart stopped a chance at a cat life by doing CPR to pump blood while the heart isn’t pumping, delivering shocks (if indicated) to jumpstart the heart, and giving medications that sometimes help the heart restart. 

It’s important to realize that getting a pulse back isn’t the end of cardiac arrest. After getting a pulse back the main question is whether the heart stopped so long that the brain was irreversibly damaged by lack of blood flow. The likelihood of brain damage from lack of blood increases the longer the patient remains without a pulse. 45 minutes of CPR, especially CPR by non-medical people who don’t have access to a device that can deliver a shock, is a REALLY long time.

Most people won’t wake up after 45 minutes of CPR. But this patient did. They woke up and their brain was well enough to talk and move their body. It was too early to know if they’d fully recover to the mental state they’d had before their heart stopped. However, what was obvious when they woke up was that they were mostly there. Their brain had survived 45 minutes without a pumping heart thanks to their spouse and child.

When we successfully get a pulse back after CPR and the patient doesn’t immediately wake up, usually they are sedated and put on a ventilator (breathing machine) for 72 hours. This gives their brain time to rest after not receiving good blood flow. Usually after those 72 hours of rest, we decrease their sedation (medications used to put people to sleep while on a ventilator) and see how their brain is working. This patient underwent this process of sedation and then wakening after 72 hours.

It’s impossible to know exactly what the patient’s spouse and child felt as they waited those 72 hours to see if their loved one would wake up. What I can say from seeing them sitting at the patient’s bedside and sleeping in the hospital waiting room, is that the experience changed them. Once the patient woke up, the stress floating away from their family members was almost tangible. The spouse and child had saved the patient’s life; they had stepped up when the powers that be asked them to step up. They had given the patient a second chance at life. They were, by all definitions I know, heroes.

Finding Purpose and Meaning

The patient was nicely dressed and collected. They sat with elegance as I chatted with them during their checkup. By most accounts they were doing well. They didn’t have many aching joints or the other common issues of people their age. But, as we finished going through all the normal appointment questions and checklist items for a primary care visit, the conversation turned to the main issue at hand: meaningful existence. 

The patient had recently moved from the south to the north to be close to their adult children. In moving, they had left behind the hair salon where they’d worked for many years and where they continued to work until moving. Nobody in their new, northern community would hire them as a hairdresser because of their age. This disappointed them. They were very energetic. They were involved in many clubs and had many social engagements weekly, yet, they found themselves depressed, tired, and empty. Nothing they were doing gave them the sense of purpose that working had.

We brainstormed together. If not work, could the patient volunteer? Where might they like to volunteer? Our town had many opportunities for volunteering. The patient jotted down a few nonprofit ideas and smiled. They said they’d consider it; it seemed better that sitting around doing pointless things.

Depression is common in the elderly. Among other things, it’s postulated that feelings of isolation and loss of purpose can contribute to depression. On an anecdotal level, I’ve heard many elderly patients describe feeling alone, especially when they’ve moved to be close to adult children and left behind an existing community their age or that they had been part of for a long time. Even children who visit frequently aren’t the same as having a whole community – especially a community that has also lived through the same decades and seen the same changes in the world. What’s more, many elderly people are retired or decrease their activity in work and volunteering. It’s easy to say that retirement and less work is good and that these wise people have worked their whole lives and deserve a rest. This is true; however, what I’ve also noticed anecdotally among the hundreds of patients I’ve met as a medical student, is that the happiest people are the people who have meaningful projects regardless of age.

This elderly patient is an example of someone who was driven to work well after they reached retirement age. Their case showed me that perhaps encouraging and supporting our elders to be active participants in their community would be helpful for their wellbeing. This seems especially important in a place like the US where many families are scattered all over the country and generations tend to live separately. There are many elderly folks who find meaning in caring for grandchildren as I’ve seen in other places like when I lived in Paraguay. However, we must remember that there are many elderly people who didn’t have children or who don’t wish to spend their days caring for their kids’ kids and that their need for meaningful activities is also valid. As we forge forward as a society, it seems prudent to keep this in mind and continue to support and develop programs that help an aging population remain active in their communities’ productivity and progress if they would like to be. Be it work, volunteering, or other projects in and out of the home.