Quarterly Essay 57 Dear Life: On Caring for the Elderly
4/5
()
About this ebook
Ours is a society in which ageism, often disguised, threatens to turn the elderly into a “burden” – difficult, hopeless, expensive and homogenous. While we rightly seek to curb treatment when it is futile, harmful or against a patient’s wishes, this can sometimes lead to limits on care that suit the system rather than the person. Doctors may declare a situation hopeless when it may not be so.
We must plan for a future when more of us will be old, Hitchcock argues, with the aim of making that time better, not shorter. And we must change our institutions and society to meet the needs of an ageing population. Dear Life is a landmark essay by one of Australia’s most powerful writers.
“The elderly, the frail are our society. They are our parents and grandparents, our carers and neighbours, and they are every one of us in the not-too-distant future . . . They are not a growing cost to be managed or a burden to be shifted or a horror to be hidden away, but people whose needs require us to change.” —Karen Hitchcock, Dear Life
Karen Hitchcock
Karen Hitchcock is the author of the award-winning story collection Little White Slips and a regular contributor to the Monthly. She is also a staff physician in acute and general medicine at the Alfred Hospital, Melbourne.
Read more from Karen Hitchcock
The Medicine: A Doctor's Notes Rating: 0 out of 5 stars0 ratingsDear Life: On Caring for the Elderly Rating: 4 out of 5 stars4/5
Related to Quarterly Essay 57 Dear Life
Titles in the series (93)
Quarterly Essay 1 In Denial: The Stolen Generations and the Right Rating: 4 out of 5 stars4/5Quarterly Essay 5 Girt By Sea: Australia, the Refugees and the Politics of Fear Rating: 0 out of 5 stars0 ratingsQuarterly Essay 26 His Master's Voice: The Corruption of Public Debate Under Howard Rating: 0 out of 5 stars0 ratingsQuarterly Essay 15 Latham's World: The New Politics of the Outsiders Rating: 0 out of 5 stars0 ratingsQuarterly Essay 21 What's Left?: The Death of Social Democracy Rating: 0 out of 5 stars0 ratingsQuarterly Essay 9 Beautiful Lies: Population and Environment in Australia Rating: 0 out of 5 stars0 ratingsQuarterly Essay 2 Appeasing Jakarta: Australia's Complicity in the East Timor Tragedy Rating: 0 out of 5 stars0 ratingsQuarterly Essay 10 Bad Company: The Cult of the CEO Rating: 0 out of 5 stars0 ratingsQuarterly Essay 3 The Opportunist: John Howard and the Triumph of Reaction Rating: 0 out of 5 stars0 ratingsQuarterly Essay 4 Rabbit Syndrome: Australia and America Rating: 0 out of 5 stars0 ratingsSending Them Home: Refugees and the New Politics of Indifference; Quarterly Essay 13 Rating: 5 out of 5 stars5/5Quarterly Essay 19 Relaxed and Comfortable: The Liberal Party's Australia Rating: 0 out of 5 stars0 ratingsQuarterly Essay 12 Made in England: Australia's British Inheritance Rating: 0 out of 5 stars0 ratingsQuarterly Essay 14 Mission Impossible: The Sheikhs, the U.S. and the Future of Iraq Rating: 0 out of 5 stars0 ratingsQuarterly Essay 11 Whitefella Jump Up: The Shortest Way to Nationhood Rating: 0 out of 5 stars0 ratingsQuarterly Essay 7 Paradise Betrayed: West Papua's Struggle for Independence Rating: 0 out of 5 stars0 ratingsQuarterly Essay 18 Worried Well: The Depression Epidemic and the Medicalisation of Our Sorrows Rating: 0 out of 5 stars0 ratingsQuarterly Essay 20 A Time for War: Australia as a Military Power Rating: 0 out of 5 stars0 ratings"Kangaroo Court": Family Law Court in Australia; Quarterly Essay 17 Rating: 0 out of 5 stars0 ratingsQuarterly Essay 23 The History Question: Who Owns The Past? Rating: 0 out of 5 stars0 ratingsQuarterly Essay 6 Beyond Belief: What Future for Labor? Rating: 0 out of 5 stars0 ratingsQuarterly Essay 8 Groundswell: The Rise of the Greens Rating: 0 out of 5 stars0 ratingsQuarterly Essay 29 Love and Money: The Family and the Free Market Rating: 0 out of 5 stars0 ratingsQuarterly Essay 24 No Fixed Address: Nomads and the Fate of the Planet Rating: 0 out of 5 stars0 ratingsQuarterly Essay 27 Reaction Time: Climate Change and the Nuclear Option Rating: 0 out of 5 stars0 ratingsQuarterly Essay 22 Voting for Jesus: Christianity and Politics in Australia Rating: 4 out of 5 stars4/5Quarterly Essay 36 Australian Story: Kevin Rudd and the Lucky Country Rating: 0 out of 5 stars0 ratingsQuarterly Essay 25 Bipolar Nation: How to Win the 2007 Election Rating: 0 out of 5 stars0 ratingsQuarterly Essay 41 The Happy Life: The Search for Contentment in the Modern World Rating: 3 out of 5 stars3/5Quarterly Essay 32 American Revolution: The Fall of Wall Street and the Rise of Barack Obama Rating: 0 out of 5 stars0 ratings
Related ebooks
Quarterly Essay 51 The Prince: Faith, Abuse and George Pell Rating: 5 out of 5 stars5/5Quarterly Essay 27 Reaction Time: Climate Change and the Nuclear Option Rating: 0 out of 5 stars0 ratingsQuarterly Essay 54 Dragon's Tail: The Lucky Country After the China Boom Rating: 0 out of 5 stars0 ratingsQuarterly Essay 35 Radical Hope: Education and Equality for Australia Rating: 0 out of 5 stars0 ratingsQuarterly Essay 45 Us and Them: On the Importance of Animals Rating: 4 out of 5 stars4/5Quarterly Essay 56 Clivosaurus: The Politics of Clive Palmer Rating: 0 out of 5 stars0 ratingsQuarterly Essay 41 The Happy Life: The Search for Contentment in the Modern World Rating: 3 out of 5 stars3/5Quarterly Essay 43 Bad News: Murdoch's Australian and the Shaping of the Nation Rating: 0 out of 5 stars0 ratingsQuarterly Essay 46 Great Expectations: Government, Entitlement and an Angry Nation Rating: 0 out of 5 stars0 ratingsSending Them Home: Refugees and the New Politics of Indifference; Quarterly Essay 13 Rating: 5 out of 5 stars5/5Quarterly Essay 49 Not Dead Yet: Labor's Post-Left Future Rating: 0 out of 5 stars0 ratingsQuarterly Essay 12 Made in England: Australia's British Inheritance Rating: 0 out of 5 stars0 ratingsQuarterly Essay 55 A Rightful Place: Race, Recognition and a More Complete Commonwealth Rating: 0 out of 5 stars0 ratingsQuarterly Essay 63 Enemy Within: American Politics in the Time of Trump Rating: 0 out of 5 stars0 ratingsTriple Helix: My donor-conceived story Rating: 3 out of 5 stars3/5Quarterly Essay 3 The Opportunist: John Howard and the Triumph of Reaction Rating: 0 out of 5 stars0 ratingsQuarterly Essay 61 Balancing Act: Australia Between Recession and Renewal Rating: 0 out of 5 stars0 ratingsBad Cop: Peter Dutton's Strongman Politics; Quarterly Essay 93 Rating: 0 out of 5 stars0 ratingsQuarterly Essay 73 Australia Fair: Listening to the Nation Rating: 0 out of 5 stars0 ratingsMazin Grace Rating: 3 out of 5 stars3/5Quarterly Essay 78 The Coal Curse: Resources, Climate and Australia’s Future Rating: 0 out of 5 stars0 ratingsQuarterly Essay 44 Man-Made World: Choosing Between Progress and Planet Rating: 0 out of 5 stars0 ratingsQuarterly Essay 75 Men at Work: Australia's Parenthood Trap Rating: 0 out of 5 stars0 ratingsQuarterly Essay 36 Australian Story: Kevin Rudd and the Lucky Country Rating: 0 out of 5 stars0 ratingsQuarterly Essay 6 Beyond Belief: What Future for Labor? Rating: 0 out of 5 stars0 ratingsTrivial Pursuit: Leadership and the End of the Reform Era; Quarterly Essay 40 Rating: 0 out of 5 stars0 ratingsQuarterly Essay 37 What's Right?: The Future of Conservatism in Australia Rating: 0 out of 5 stars0 ratingsGrowing Up in Country Australia Rating: 5 out of 5 stars5/5Quarterly Essay 30 Last Drinks: The Impact of the Northern Territory Intervention Rating: 0 out of 5 stars0 ratingsThe Reckoning: Quarterly Essay 84 Rating: 0 out of 5 stars0 ratings
Social Science For You
Questions for Couples: 469 Thought-Provoking Conversation Starters for Connecting, Building Trust, and Rekindling Intimacy Rating: 0 out of 5 stars0 ratingsThe Human Condition Rating: 4 out of 5 stars4/5Fervent: A Woman's Battle Plan to Serious, Specific, and Strategic Prayer Rating: 5 out of 5 stars5/5All About Love: New Visions Rating: 4 out of 5 stars4/5The Art of Witty Banter: Be Clever, Quick, & Magnetic Rating: 4 out of 5 stars4/5My Secret Garden: Women's Sexual Fantasies Rating: 4 out of 5 stars4/5A People's History of the United States Rating: 4 out of 5 stars4/5Just Mercy: a story of justice and redemption Rating: 5 out of 5 stars5/5Verbal Judo, Second Edition: The Gentle Art of Persuasion Rating: 4 out of 5 stars4/5The Like Switch: An Ex-FBI Agent's Guide to Influencing, Attracting, and Winning People Over Rating: 4 out of 5 stars4/5The Song of the Cell: An Exploration of Medicine and the New Human Rating: 4 out of 5 stars4/5I Don't Want to Talk About It: Overcoming the Secret Legacy of Male Depression Rating: 4 out of 5 stars4/5Come As You Are: Revised and Updated: The Surprising New Science That Will Transform Your Sex Life Rating: 4 out of 5 stars4/5Prisoners of Geography: Ten Maps That Explain Everything About the World Rating: 4 out of 5 stars4/5Dreamland: The True Tale of America's Opiate Epidemic Rating: 4 out of 5 stars4/5The Denial of Death Rating: 4 out of 5 stars4/5Homicide: A Year on the Killing Streets Rating: 4 out of 5 stars4/5The Sun Does Shine: How I Found Life and Freedom on Death Row (Oprah's Book Club Selection) Rating: 4 out of 5 stars4/5Freedom Is a Constant Struggle: Ferguson, Palestine, and the Foundations of a Movement Rating: 4 out of 5 stars4/5Women Don't Owe You Pretty Rating: 4 out of 5 stars4/5Dumbing Us Down - 25th Anniversary Edition: The Hidden Curriculum of Compulsory Schooling Rating: 4 out of 5 stars4/5King, Warrior, Magician, Lover: Rediscovering the Archetypes of the Mature Masculine Rating: 4 out of 5 stars4/5
Reviews for Quarterly Essay 57 Dear Life
4 ratings0 reviews
Book preview
Quarterly Essay 57 Dear Life - Karen Hitchcock
DEAR LIFE
On Caring for the Elderly
Karen Hitchcock
CONTENTS
Dear Life: On Caring for the Elderly
Old and Sick
Fragments
Hospital Is No Place for the Elderly
Best-Laid Plans
Separate and Solitary
Death
We, The Living
Sources
CORRESPONDENCE
Richard Denniss
Tad Tietze
Paul Cleary
Geoff Robinson
Mark Bahnisch
Dennis Atkins
Malcolm Mackerras
Grant Agnew
Guy Rundle
Contributors
Copyright
Subscribe
DEAR LIFE
On Caring for the Elderly
Karen Hitchcock
We elders have learned a thing or two, including invisibility … When I mention the phenomenon to anyone around my age, I get back nods and smiles. Yes, we’re invisible. Honored, respected, even loved, but not quite worth listening to anymore. You’ve had your turn, Pops; now it’s ours.
– Roger Angell, 93
There are many ways to get sick, many ways to crumble and crash. I work as a physician in a big inner-city hospital overflowing with the sick. The orthopaedic ward is full of people who got up for a glass of water and snapped their hip. The psychiatry ward’s full of near suicides and phantom voices drilling holes in people’s heads. The cardiac cath lab’s overflowing with heart attacks. The burns unit usually has one or two people who tipped a bucket of petrol over their head and struck a match. We house the frail and the elderly, the drunken and overdosed. Hearts and lungs are plucked from the brain-dead and sewn into the diseased; people crowd the emergency department, suffering because their organs are slowly failing the body that shelters them. What made them sick? What is health? What is it that we do to people in a hospital?
Fundamentally, it would seem, a doctor’s job is to treat and protect diseased and threatened organs – those beautiful and intricate and faithful structures that pump and squeeze and metabolise away, mostly quietly, keeping us alive. Just treat them, doc, and go home. How difficult can it be? But when doctors sit in consulting rooms or walk the wards, we don’t confront kidneys and hearts. We encounter complex, imperfect, suffering people with specific histories, cultures and understandings of sickness and health. And we do this, for the most part, within institutions with vast management structures whose role is to maintain economic viability and safety. We do it within government-dictated fiscal constraints. The business of health care is something much more than a delivery of goods and services.
The medical system is constructed from tacked-together fragments – GP, specialists, the hospital, mental health services, community services – all of which have little contact with each other. We treat social and medical needs separately, although they are intricately entwined. Hospitals themselves are designed around a body fragmented into discrete organs. Often, our institutions serve clinicians, bureaucrats and cutting-edge science better than those they are supposed to be serving.
Most of my patients are old. This new longevity of ours is a triumph. I have had patients who are over 100 years of age and still live at home. I see them and feel wonder and hope. But the health system – and society – is struggling to adapt to our ageing population. At times it seems we are struggling against it.
In 1976 Robert Neil Butler, an American geriatrician, won a Pulitzer Prize for his book Why Survive? Being old in America, in which he coined the term ageism.
In Why Survive? Butler outlines many ways the elderly are neglected in society and shut out of the medical system. Five years earlier, in France, Simone de Beauvoir published The Coming of Age, in which she too describes a society where the elderly are forgotten, discarded or despised. Both books are rigorously researched and statistic-heavy. The points the writers make are as relevant today as they were forty years ago.
It is difficult to improve the care we offer our elders – in and out of hospital – when, as Linda Marsa writes, we are fearful of the swelling ranks of ‘greedy geezers’, the oncoming grey tsunami of the sick and frail elderly who will be an emotional and financial burden on their families and friends, and whose infirmities could bankrupt the healthcare system.
We hear a continual cry that our healthcare system is unsustainable
; that the healthcare needs of ageing baby-boomers may bankrupt the country. Age discrimination in medicine is widespread, although often hidden behind many benevolent aims: the promotion of patient autonomy, the wise allocation of health resources, the avoidance of what is futile, the primacy of quality of life. Our response to age-related memory loss and dementia is to institutionalise, isolate, sedate. Supporting independence and wellbeing in old age remains a low priority.
One of the most-read articles in the Atlantic in 2014 was Why I Hope to Die at 75
by a professor of bioethics, Ezekiel Emanuel. In it, he jauntily promotes the idea that it is a horror to grow old; that growing old necessarily involves the accumulation of disability, the transformation of a human subject into a wreck and a burden on family and society. Emanuel’s answer to his dire evaluation of elderly life is to die early. There’s a picture of him, a man in his late fifties, radiating vitality, sitting with his feet up on his desk, long legs crossed, drinking from a cup that says The Boss.
Another picture shows him with his arms slung around two of his nephews at a base camp of Mount Kilimanjaro, which the three climbed. Accompanying the article is a bright yellow graph that depicts the decline in one’s productivity with increasing age. Emanuel knows his place – as the boss, at the top of the mountain, at the peak of a very particular kind of productivity – and he would rather die than give it up.
There are many ways to show that we devalue our elderly, are repulsed by them, terrified of becoming them. They have been and remain the last priority in our medical system and the ones we target first with our austerity measures. This essay does not offer simple solutions to the structural inadequacies it diagnoses. The solutions are not simple. My chief aim is to strike a note of caution and to make explicit something that often remains unsaid and yet can be heard quite clearly: that the elderly are burdensome, bankrupting, non-productive. That old age is not worth living.
OLD AND SICK
Before I started studying medicine, my grandmother was diagnosed with idiopathic pulmonary fibrosis. I had no idea what that was.
Scarring of the lungs,
she said.
She was put on little white tablets called prednisolone. I had no idea what they were.
She was thrilled when I announced my plan to become a doctor. She was ecstatic with pride. She’d tell anyone who listened – the person scanning our groceries at the supermarket, for example. She’d look at him, then at me, then at him and I’d know it was coming: This is my granddaughter.
The guy would look up from the tin of baked beans in his hand, his face all, "And?"
She’d put her hand on my forearm, lean in towards him and say, She’s studying to be a doctor.
I’d roll my eyes and go, Nan, jeez …
When I visited her at home, the first thing she’d say to me as I walked in the door was, Stop. Stand over there. Now turn around.
I’d roll my eyes and say, Nan, jeez.
I just want to look at you,
she’d say. Now, come here, and bring that comb.
She’d been a hairdresser. My hair often didn’t live up to her standards.
In my second year of med school, I bought my first stethoscope. When Nan said, Stand over there,
I said, Wait!
Pulled the stethoscope out of my backpack, looped it around my neck and turned around. You should have seen her face.
By the time I was in third year, she was eighty-one and permanently attached by the nostrils to a long tube connected to an oxygen concentrator. The concentrator sat in the lounge room, humming like an air-conditioner, and the tube was long enough for her to move all around the house.
She said, My lungs are ‘diseased’, what a terrible word … Listen to them if you wish.
I pressed my stethoscope against her soft pink skin, and caught my breath. By then I knew what those fine crackling sounds meant.
She always had an afternoon nap, and I’d get into bed next to her with my textbook, and she’d quietly watch me from her side of the twenty or so pillows.
Just before my fourth-year clinical exams, she fell in the bathroom at night and lay on the cold tiles until morning. At the hospital they said she’d had a heart attack and things looked bad. She was too weak to drink. She gripped my hand, hard as steel, and whispered to me, I don’t want to die yet.
The consultant physician said, We could consider palliation …
I begged him, Please keep going.
In hospital she told me halting, dreamy stories, about planting the orchard of almond trees on the bare land her husband inherited in Deer Park. How the neighbouring farmers laughed at her and said, Almonds won’t grow here, love. It’s futile.
She watered them by hand, with buckets when there was no rain, watched them grow. I’d spent my childhood gathering sacks of nuts from those gigantic trees.
One evening Nan’s IV cannula blocked and the cover resident came to site a new one, a trainee nurse in tow. I don’t know what the IV line was for – fluid or diuretics or antibiotics – something necessary for her treatment. The resident said to me authoritatively, You realise this is futile.
I tried to explain – that, for Nan, being in hospital and the pain of a thin needle in her forearm was worth it for a little more life – but it came out as a stutter. I just stood there under his accusatory stare, gripped by deep shame.
He told me to wait in the corridor. I heard him croon to my Nan, as she winced with each of his failed attempts: I’m sorry, you poor thing. This is cruel. We know it’s unfair.
There was silence for a moment. Let’s try the cubital fossa,
he said to the nurse, and then started chatting with her about his plans for surgical training. When they were done, they walked out and past me without a word. I went back in, pressed my cheek against my grandmother’s cool forehead and said I was sorry.
Don’t worry …
she said, stroking my hair. Everything’s okay.
*
Some doctors seem to view old patients as a different species of human, unrelated in any way to their young selves.
At every morning handover in every hospital in Australia, a registrar will report admitting an elderly patient – perhaps a 92-year-old who fell taking out the garbage – and say, He’s so cute
or She’s so adorable.
As if the patient were a baby or a kitten. This doesn’t seem so terrible. It is not meant to be cruel or disparaging. But what does it tell us about the way we view the elderly?
If you are old and in hospital, you can be one of three things: cute, difficult or mute. If you want people to be nice to you, I’d recommend cute. It’s easy to be cute: just say something any normal human might say. Because you are ancient, it will be seen as cute. If you want the best treatment and don’t give a damn whom you piss off, be difficult. It’s not hard to be difficult: simply respond as one should when a 25-year-old speaks to you as if you are three. Alternatively, request that you get your bedpan within