by Joan Rachlin, JD, MPH, Executive Director
I spent several days recently at the Jewish General Hospital (JGH) in Montreal, Canada, where my 95-year-old father-in-love (he started out as my father-in-law, but that status quickly changed), Sam, had been admitted for a host of medical problems.
Sam began his life in a Polish shtetl where he learned about caring, community, and devotion to friends and family in ways that have both benefited and inspired everyone who knows him. He worked as a peddler in the French Canadian community for nearly 50 years, and befriended all his customers. Sam was known for extending credit where none might have been due, and for his unending gentleness and kindness. He had many stories to tell, but after decades of heart problems, successive pneumonias, and a stroke, he has now been robbed of both speech and mobility. Nothing, though, can take away his incredible goodness, and that's what makes our family's vigil by his bedside a labor of great love.
I remember reading an article by Atul Gawande, MD, MPH, in The New Yorker several years ago titled “The Way We Age Now” that spoke about caring for the elderly. Dr. Gawande (who, by the way, will be one of the keynote speakers at PRIM&R’s upcoming Advancing Ethical Research Conference on November 7-9) wrote about how so few caregivers want to care for aging patients because they're often hard of hearing, poorly groomed, low-income, and generally afflicted with a host of chronic medical issues that, at best, can only be marginally improved. He talked about the manner in which a health care professional can tell a lot about an elderly patient's overall status by looking at their feet, since many of them can no longer continue the previously simple act of clipping and cleaning toenails or removing calluses once arthritis, spinal stenosis, or other orthopedic travails set in.
During Sam’s most recent hospitalization at the JGH, my admiration for the care he received was taken to new heights. The first thing that impressed, scratch that—stunned me—involved Dr. Luc Trudeau, the director of the hypertension clinic and an internist who has been at the JGH for more than 30 years. I had previously met Dr. Trudeau almost a year ago when Sam was hospitalized following a stroke.
During that time, Dr. Trudeau and I had a few conversations that I considered to be as good as it gets when dealing with physicians. Not only was he competent and attentive, but he was also consistently respectful, patient, vigilant, responsive, empathic, and determined to help Sam regain as much post-stroke strength and mobility as possible. When I saw him again recently, I reminded him of our earlier interactions and he said, without missing a beat, "Oh yes, I remember. Your father-in-law was in room 622, in the bed next to the window." His instant recall reinforced my observations of this uncommon man from our earlier encounters, and I immediately decided that if Dr. Trudeau could be cloned, I'd willingly surrender my opposition to human cloning.
Then there is David K. Williams, one of the nurses who took care of Sam. David is responsible for a large number of patients, but each time he comes to see Sam, it's as though he has no one else in the world to worry about. And when David is caring for Sam, he sees just a man, rather than a man who is very old and very sick; the removal of those “old and sick” modifiers makes all the difference. Like Dr. Trudeau, David is gentle and kind, and they both follow the well-known medical corollary of the golden rule: Treat every patient the way you’d want your parents to be treated. David told me that his mantra is, "take care of one patient at a time,” and I know that he means that in the both the literal and figurative senses. He is an intentional, mindful, and present man, who is both competent and caring.
There are so many caregivers like David and Dr. Trudeau at the JGH, including one nurse who came in to insert an IV, and found that Sam's veins were very thin and mostly collapsed. Instead of repeated poking, which would have caused Sam pain, she went to get warm compresses, which she then gently applied, reheated, and reapplied until she found a vein that could accept her needle. Or the nurse's aide who spent what seemed like an hour comforting a scared and crying patient. All of this tender, loving care reminded me of a well-known Boston Globe Magazine piece entitled “A Patient’s Story,” written by Ken Schwartz, a Boston lawyer who died of lung cancer almost 20 years ago at age 42. He wrote a deeply personal and professionally piercing account of his illness in which he described the power of the human connection between patients and their caregivers. Ken Schwartz reminded caregivers to stay in the moment with patients and how “acts of kindness —the simple human touch [of ] caregivers—made the unbearable bearable.” Thanks for your small, medium, and large acts of kindness and compassion, Dr. Trudeau, Dr. Hockstein, Dr. Henault, Dr. Edwards, Dr. Lachleban, Dr. Langlois, Dr. Goldstein, David, Theresa, Valerie, Linda, and the many other wonderful members of the JGH staff.
Although this is not a research ethics post, it is about the truism that treating people with respect, kindness, and justice is a universal need, no matter the setting or circumstance. It's so easy to dismiss the elderly when we pass them on the street, see them in a store, or encounter them in a healthcare setting, but I am increasingly reminded that someday, all of us "boomers" will be at risk for playing out stories like Sam's in hospitals and nursing homes across this country. I know that other cultures and countries have different attitudes toward caring for the elderly, but the United States has a long way to go.
This is thus a gentle plea to remember that each elder is a unique individual with a back story, a family that loves them, and with the universal hope that their dignity will be maintained and protected by others once they lose the ability to preserve it for themselves.
Modeling kindness and respect in patient careTags:
by Joan Rachlin, JD, MPH, Executive Director