Lessons Learned From the "Very Old" Patients

Lessons Learned From the "Very Old" Patients

Anne Katz, PhD, RN, FAAN

Aug 01, 2018

I have never seen myself as someone who cares for older patients. Most of my clinical career has focused on caring for young gay men in the early days of the HIV/AIDS crisis or high-risk pregnant women. Then I moved into a position in oncology and the fact that most of my patients are "older" somehow passed me by. Recently I have started seeing patients with prostate cancer at the end of their course of radiation therapy for their survivorship transition appointment and it hit me—I see older patients by the score, and some of them are really old!

The men are instructed to bring their partner/spouse or a family member or friend with them and so I have the pleasure of interacting with not one, but two older/elderly people. They range in age from 69 to 95—and I have learned so much from them! The discussion about their care during survivorship does not take that long and I have the luxury of spending as much time as I need with them. So we talk about where they go for the winter (Florida or Texas are leading the list now, with Palm Springs and Arizona bringing up the rear) and what they have been doing in their retirement years to keep busy. I have learned more about golf than I am really interested in knowing. Taking care of the myriad repairs to the cottage seems to take a lot of time and energy not to mention cause all sorts of minor injuries. I have heard about the many volunteer opportunities that exist where I live and many of the men have translated their employed skills into worthy ways of helping others. There are grandchildren to take care of and as I have learned, with two grandsons of my own, being a grandparent is way more fun than parenting.

One of the couple usually discloses the number of years they have been together and I then ask what the secret(s) is/are to 50+ years of living with one person. This usually results in laughter but also lessons about compromise, letting go of anger, investment of time and energy, and love. Most of all about love. I have met couples who have found each other later in life, often after the loss of a first spouse, and I marvel at the capacity of people to move on, not letting go of memories while creating new ones with someone else.

There are men who are single too, due to death or divorce or never finding the right partner. They often want to talk for a long time and I can see how loneliness may make an appointment at the cancer center something to fill space in the day. They often appear a little untidy looking, with creased clothes and the odd stain on their shirt front. But of course this is not the case with everyone. Some of the single men appear dressed "just so" and they talk with pride about their cooking skills and their social obligations and I feel like I am using up their valuable time!

But the men that I learn the most from are the "very old," those who are in their 80s and beyond who have seen so much and have so much to teach me. Many are veterans and their smudged tattoos from their days in the war bear testament to not only their service, but to their bravery and what they have seen of humanity at its worst. When I look beyond the bald pates, age spots, and deep wrinkles I can sometimes imagine the faces of the young men they once were who went off to war because it was an adventure, a way to leave the farm, or because they wanted to make a difference in the only way they knew how. They may not remember the name of their current doctor or how many radiation treatments they had, but they remember the name of the ship that took them away and, of course, the one that brought them home again.

I take my time with them and do not hurry them to finish their stories. I wait patiently as they ease themselves out of the chair, waving away my offer of a helping hand to get upright. They thank me for seeing them, for offering information, for the care that the cancer center has provided. There is always a twinkle in their eyes as I wave them goodbye with a cheerful “Congratulations! You’ve graduated from our care and now you go back to your primary care provider!” And then I sit for a few minutes and reflect on lives lived and lessons learned.


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