They were miserable. It was obvious from the silence they kept as their spouse explained everything that had happened since our previous appointment. It was obvious from the frown on their face and the apathy in their voice. It was obvious because no matter how many things I mentioned that I knew they liked, they didn’t smile or brighten once.

They weren’t excited about their new hearing aids which enabled them to hear birds again. In fact, they often didn’t bother turning the hearing aids on, per their spouse’s report. They were afraid to go outside for fear of falling. They couldn’t change a lightbulb because they felt weak and dizzy.

They had once been the person everyone in the family relied on to fix things. They had once been the advice giver. They had once been able to keep up with even the most social of butterflies. They had once been independent – free to run errands and tend their lawn without supervision. And now, they were none of those things.

The patient had tried therapy. We were always optimizing their medical conditions to keep them as healthy and functional as possible. The thought of starting another medication to help with depression was suffocating for both the patient and I because they were already on many medications. What was left?

Everyone who lives a long time eventually slows down. Some slow down and then die before developing medical problems that cause them to visit doctors and hospitals often. Others find that their social calendars fill with doctors’ appointments. Either way, or somewhere in-between, the transition from independent and fast to reliant and slow is hard. It’s an identity shift and a lifestyle change. The bitterness of slow declines is that they don’t ask permission. The body marches along, making changes that upend everything that came before, without giving time for the person undergoing the changes to accept or adjust to them.

I knew the patient was suffering and, yet, I didn’t have much to offer. I wanted to see the patient through this phase. Was it the last phase of their life? Probably. How long would this phase last? It could last days, or it could last years. It was impossible to tell. Almost the only thing I could do was acknowledge their misery. Call it what it was. I referred them to doctors who specialize in caring for the elderly. Perhaps those doctors had a secret for helping this patient. I hoped they did. Perhaps it was a secret I, too, would uncover.

At the very least, I stood witness. I knew who the patient was and who they had been. I acknowledged their struggle. At that appointment and the previous and the next, I listened to my patient for no other reason than to ensure that they felt heard. Listening wouldn’t change their situation, but sometimes the only thing I can offer as a doctor is a listening ear. And sometimes, that’s enough to help my patients make it through until our next appointment. Occasionally, it’s enough to make my patients feel better. Such situations remind me that medicine isn’t always about medicine, sometimes it’s about being human.