How to Approach the Elderly in Despair
A story about Mrs.W and her frustrating experiences with aging
Her Story
Mrs.W, 85 years young, has 3 melanoma skin cancer spots on her face. One on her left temple, one on the bridge of her nose, and one under her right ear. She had already undergone surgery last week to remove the spot on her temple.
“I’m just a mess. Why is this happening to me?”
The bruising from the surgery had spread so much that a quarter of her face was bright red. To make matters worse, she had fallen getting up from the toilet seat. The support rails failed. She had smashed her face into the wall which gave her deep cuts and bruises all over.
“Oh, don’t look. I’m so embarrassed!”
She was clearly upset at her situation and exclaimed multiple times how embarrassed and broken she was. Completely understandable considering all the damage her face has taken in the last week.
Despair, the complete loss or absence of hope, was what I saw in her teary eyes. This was reinforced by her asking me why all of this was happening as if there was something she could’ve done to prevent it all.
I had no answers. The age-adjusted incidence of frailty and cancer is ~60% and ~2%, respectively. The odds were never in her favor.
Her story is not unique. Patients who make it past 80 are often riddled with complicated health issues that devastate them. Many of these conditions have little to do with how they lived their previous eight decades of life.
Acceptance
I don’t believe in positive thinking or whatever nonsense The Secret tries to sell. The book states that negative thoughts cause negative outcomes, hence the importance of positive imagery. Byrne, the author, does not believe in accidents or bad luck. She writes, “Your life right now is a reflection of your past thoughts.”
The great philosopher, Dave Chappelle, shares his thoughts on The Secret.
Positive imagery, bitch fly to Africa and tell one of them starving children that shit. What’s wrong with you[children]? I[child] have not eaten in 5 days. What you need to do is visualize some roast beef, mash potatoes with some gravy. Oh, please bitch, your killing me, stop talking about that! No, no, no! The problem is that you have a bad attitude about starving to death.
I do believe in acceptance.
Although grief is most often associated with the loss of a loved one, any loss can cause it. The loss of good health, for example, can also be devastating. Following this logic, Mrs.W is going through The Five Stages of Grief — denial, anger, bargaining, depression, and acceptance.
Her despair occurs in the depression stage. Fortunately, this is not the end of her journey. The next step is acceptance — the action of consenting to receive something offered.
“Everything will be okay in the end. If it’s not okay, it’s not the end. “ — John Lennon
Acceptance cannot be forced. Similar to those who are grieving, patients can better reach acceptance by having strong pillars of support. That’s where we come in.
If desolate and despairing patients are actually grieving, we can find a plethora of resources that teach us how to support them. A simple Google search has given me many insights that can be applied to sickly patients struggling to cope.
I especially enjoyed How to Offer Support to a Grieving Colleague by Sabina Nawaz. There’s one tip I found particularly applicable.
Don’t track their progress. While we know that the acuteness of grief will dull over time, many people in the throes of grieving aren’t ready to hear that, or to think about letting go of the grieving process. During brief pauses in their pain, they might feel guilty when they’ve managed to set aside sadness for a short time. Instead of saying, “Are you doing any better?” or “I’m glad you came to the party. It must mean you’re doing better,” simply try, “It’s good to see you” or “I’m glad you came.”
As a healthcare professional, tracking progress is part of the job. That being said, a machine can more easily and accurately do the same thing. What can’t be automated is meaningful human interactions. Once what is part of the job is done, put down the clipboard and forget about the numbers for a moment. Saying “I’m glad you came[to the appointment]” sincerely could be the highlight of Mrs.W’s day.
Mrs.W is scheduled to have another skin cancer spot removed next week. I’m looking forward to having another opportunity to support her.
