Monthly Archives: October 2022

Finding Purpose and Meaning

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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.

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Listening in Medicine

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This patient was always cheerful. Despite approaching a month in the hospital. Despite extensive injuries for which they required multiple procedures, surgeries, and a long course of antibiotics. Every time I checked in, they had a visitor, were listening to mass, or were simply doing life things.

One day when I stopped in, the patient was different. Still as pleasant as ever, but their cheer was guarded. I noticed that their voice was heavier. That their eyes were drooping at the edges. Their smile seemed more effortful. “Is everything okay? Are you okay?” I asked. In the minutes I was with the patient, I asked these questions periodically. Interleaving with the normal questions about signs and symptoms and physical exams I needed to do. I’ve learned that if you create space for things that haven’t been said to be said, sometimes patients share what’s bothering them and you can do something about it.

I paused as I was preparing to leave and asked one more time if the patient was okay. They started crying. I waited. “It’s just I haven’t seen my children. I miss my children,” the patient said. I’d come to learn that they had two young children who they hadn’t seen since their admission. They video called them but, obviously, that wasn’t the same as seeing their children and giving them hugs.

Since COVID, hospital visitation policies have become more restrictive. There are reasons for these restrictions, however the unintended consequence is patient social isolation which is bad for patient mental health to put it simply. At the time when I was seeing this patient, the hospital I was in was not allowing children to enter the hospital as visitors. Rules, though, usually have exceptions. I spoke with the nursing staff, as they steward hospital floors, and they were able to arrange for the patient to see their children.

This patient interaction reminded me how listening is critical in medicine. The hospital is a difficult place to have a good conversation as patient. The hospital is confusing and foreign to most people; there are unintentional power differences that exist as medical knowledge and understanding are uncommon among those who didn’t study medicine; there are many faces with different roles in the hospital so it’s impossible to keep track of who is the right person to ask for what; and the hospital is busy and short-staffed, so healthcare workers are doing their best but they are always running behind. Given these barriers to communication, the burden falls not on the patient but on their care team to ensure that time to hear patients’ needs is made. To do this doesn’t necessitate longer patient interactions, necessarily, but it does necessitate listening for more than reports of a fever or bowel changes.

It can be hard to listen for things that don’t directly relate to changing a patient’s care plan. Yet, patients are more than carriers of disease and, therefore, to best support them in their journey to better health we in healthcare must listen to all ailments. Sometimes we can lessen a burden and sometimes we can’t. Arranging for a parent to see their children after weeks in the hospital is something we can solve easily. I was glad I was able to help this patient see their children, but I wondered how long the patient had suffered from missing their children. Perhaps, if one of us from their care team had listened more carefully earlier, the patient wouldn’t have had to wait almost a month before seeing their children. To me, it seemed unreasonable to add the burden of missing loved ones to this patient’s burden of healing from an accident that had almost killed them and injuries that would likely change their life. Being sick is hard enough; let us in healthcare not forget the human things, like social supports, that can help make healing less daunting.