The Need for a Geriatric Approach in Medicine and the Role of an Empathetic Clinician

By – Arnaz Dalal
(Equitable Healthcare Access Consortium)

Over the last month I have been hearing a lot about “Doctors and the lack of Empathy” , about how our health system needs to create a separate space for the elderly patients.

Well I am no expert on this matter but can share my experience as a daughter who lost her father a few months ago due to sudden complications that eventually led to his passing. He was 77 years old . The aging process for my father had been rather rapid in the last 2 years.

My father was admitted to the hospital in a small town of Orissa where the only saving grace was this one big hospital built by one of the benevolent steel companies there. It is a modern and well equipped hospital which was  inaugurated a couple of years ago.

He was admitted for a urinary infection and was being treated for that when he was diagnosed with a pneumonia patch in his lung. His sodium levels had gone down and every other day some parameter was not right.

He was in the hospital for around 2.5 weeks but not one day in that time did the family ever  feel that he was lacking for care or attention and we should shift him to bigger hospitals in Bhubaneshwar or Cuttack where specialists would be available and maybe better facilities.

This Doctor who my dad was being treated by was a young man, very busy attending to different types of patients..he was everywhere at once… as they were understaffed. But every time we needed to speak to him, would always be there to hear our concerns, give us options, patiently hear our ranting and spend a good 15 minutes on every round he made with my father. He would talk to him so compassionately and sweetly and urge him to eat his food or do his physiotherapy and sometimes even wait there to ensure the nurses were doing their job properly. My father’s face would light up when  the Doctor would come every day on his rounds.  His attitude was one of humility and empathy and you could almost feel that he felt the pain we were going through seeing our dad’s condition worsen.

As it so happened my dad’s condition worsened with complications one could not have imagined and very soon he was shifted to the ICU due to difficulty in breathing and fall in oxygen levels in his body. There was a lot of strain on his heart and fluid accumulation in his lungs. He was being fed nasally as he had barely eaten in the last 2.5 weeks. He was a pitiful site in his bed with all the tubes and wires attached to him.

Very soon we were told that my dad might not live long and we had to take the decision of putting him on ventilator support – which another doctor in the ICU was pushing for vehemently and almost screamed at us for opting for “Palliative care” . But the same sweet Doctor who was attending to my dad, had sat us down and explained the pros and cons of both these options clearly.  His opinion was that we should opt for Palliative care and not Ventilator support . It would ease my dad’s pain and at the same time  be aware of people and surroundings  instead of an artificial support system doing the breathing for him where he wasn’t even conscious and from the support of which he might not come out of.  In both the scenarios it was just a matter of time till his body completely gave up. The doctor also told us to take a second opinion from a senior specialist from another hospital in the city to see if his suggestion of treatment was in line with the norm.   Ultimately we decided to opt for Palliative Care  because we wanted the last days of my dad to be spent in a state where he knew he was surrounded by his loved ones and not on some ventilator- knocked out cold with the sedatives.

There was just one other patient in the ICU . He was in the last stages of mouth cancer and hailed from a small town. His old father was not very educated and went blindly with what the doctors suggested. And it was rather ironic that this patient was put on  ventilator support by the same Doctor who was very upset with us for not putting our dad on the ventilator.

ICU is a place where you are not allowed to be by the side of your loved one except for a fleeting 5 mins . But to our good luck our Doctor had informed the nurses to allow us to be with my dad in turns. We were able to spend a considerable amount of time through the day with him.  Yes, I am sure some would call it a blatant flouting of rules….but this was not that at all. The Doctor knew my dad would be gone in a matter of hours/days. They could not move him to a room either as he was on the critical list and needed the constant medical attention. The compassionate professional that he was, he intrinsically understood the need of the family to be by Dad’s side, and so taking the necessary precautions that one does in an ICU he let us be.

I will remain eternally thankful to this Doctor because of whom I was able to be around my dad. He used to be doped much of the time to relieve his pain..but he had his moments of absolute clarity too. I would stand next to him, hold his swollen hands and pray, talk to him about how I would take him back to his hometown, talk about memories – with his kids, his dog, his house and his parents…..he would just look at me …sometimes a tear trickling down his cheek…unable to speak …even when he tried his speech wasn’t coherent….we spent 12 days in that ICU ….watching the life ebb out of him slowly and steadily …preparing for the inevitable….but grateful for the chance we got to spend with him…of him knowing he was surrounded by his loved ones …each and every one of us who mattered was there….!

He departed for his heavenly abode peacefully…after more than a month of having been in the hospital for something as routine as a simple urinary infection that eventually led to many complications due to his age and fast deterioration of health.

We ..his family felt at peace – because we did all we could to make his last days as peaceful as we could and be there by his side in the ICU- which had we been in a bigger city would have been next to impossible…..!

His doctor…who was filled with remorse that he could not do more to ensure that my dad had lived….. He was there to help us through the last formalities at the hospital all the way.

The nursing staff in the ICU -who were so compassionate and gentle not just to my dad but to all of us . They would always encourage me to come and pray to him..they said my dad responded the most to me – his eyes would come alive when I was around!! The smiling faces and the kind words they spoke to my dad as they attended to him was like a balm to us.

Today six months hence I would not have wanted any of the above to be any different….Not the hospital..Not the doctor…Not the treatment!

There is a need for healthcare professionals of various disciplines to be trained in geriatric care in India. It would be a step in the right direction for hospitals to come up with care rooms for the elderly as their needs are very different from the normal patient.  Just like we have special neonatal care units and wards for babies and kids, the geriatrics need special facilities too. Particularly, when the inevitable is around the corner and there is not much that can be done medically, keeping the patient in the ICU and isolating them from their family just does not make sense. Lying alone in a cold ICU bed, with morbid thoughts is not the end we want our loved one to have, so why not make the structure more inclusive for the patient and their family. And this can be achieved only when healthcare professionals start thinking of such ideas not as ‘Doctors in Business’ but as ‘Individuals with families’.

As the Golden rule says “Do unto others as you would have them do unto you” !