Scanning through endless records prior to seeing my new patient I came across one of my favorite phrases: “patient is a pleasant 92 year old man.”  When patients are described as “pleasant,” it usually means they enjoy your company and have a lot to say. Admittedly, I also have a soft spot for elderly patients. I suppose this stems from my belief that we as a society need to do a better job of respecting our elders. It also stems from the enjoyment of hearing an elderly person say exactly what is on their mind; witnessing someone unapologetically express their truest self becomes the purest form of comedy, and incites the deepest form of envy. Needless to say, I am consistently very eager to talk elderly patients.

I entered this particular nonagenarian’s room quietly as it was evident he was curled up in his bed asleep. I gently patted his shoulder and spoke his name, first softly and then progressively louder. Once I had reached a substantial volume he finally woke up and yelled “wwhaaaa?” I pulled up a chair next to him and asked if we could talk. I won’t tell you about his medical history, firstly for the purpose of protecting his privacy, and secondly because we didn’t discuss it much. His dementia rendered him a poor historian regarding his medical conditions, but what he chose to focus on was his diagnosis in relation to when his wife had passed away four months prior. He recounted how they had met fifty years ago, tripping on his words as they caught in his throat in between spells of openly weeping. Initially I was uncomfortable, not because of his swift outpouring of emotions, but rather the juxtaposition of his despair and the comedy of the content of his stories. “My wife, she didn’t want any children. So, instead we had two pet pigs! But one winter we had to eat them” he recalled, barely able to articulate this tale without his dentures becoming completely displaced. “Oh!” I responded, repressing a laugh and trying my best to be respectful. We chatted for twenty more minutes as he wrestled with the painful sentiment that his mortality was directly coupled with his wife’s death. “I just want to be with her,” he repeated over and over.

On the surface the concept of an individual’s longevity being connected to an independent (or arguably interdependent) entity is nothing new. So many of us have heard stories of one person passing away shortly after his or her significant other does. The idea that our patient’s longevity might be directly influenced by forces external to the immediate medical treatments is a consideration that I feel is often overlooked. What can we, the medical team, do to address these additional influencing factors? Do we forget, when breaching the uncomfortable topic of mortality, to ask patients not only if they would want to be resuscitated, but also about the factors that keep them fighting to live each day? My patient was 92 years old and the conversation of his code status was, for him, not centered around his age or diagnosis, but rather the fact that he didn’t see a point in fighting for a life without his wife. The presumption that an individual’s longevity is linked to a separate person (or ability) is something my family deals with regularly. My grandmother is 93 years old and suffers from Alzheimer’s Disease. Each time we visit she constantly reminds us how thankful she is that her little Schnauzer is there to keep her company. This dog, unfortunately, has diabetes and related complications which has rendered her rather ill. My grandmother has the resources to provide care for her beloved little companion and my father, as her POA, respects that she chooses to make her dog’s healthy a priority. It is the opinion of many family members that my grandmother’s longevity is directly linked with her little buddy. While superficially this may appear simple, the reality is far more complicated. How do we make sure to address factors that are important to our patients and their longevity? What happens if they don’t have the resources available to help them nurture and experience the things in life that are most important to them? Do we often, as providers, overlook these personal aspects of our patient’s will to thrive? When having this difficult discussions in my future career I aim delve beyond inquiring whether a patient would want a machine to help them breathe, and always remember to ask further questions about their support system, their goals, and if there is anything we can do to help (even if I am in a rush). Sometimes a Schnauzer’s special diabetes-friendly kibble is much more important than we realize.    

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