My encounters with 100-year-old patients

Taureef Mohammed

The first question that came to my mind was, why? Why was she here, in a hospital? What could a centenarian possibly want from a doctor? More years? Surely, staying at home would have been better than spending time in this sterile dystopia.

Like all centenarians, she was remarkably healthy. In fact, on paper, having a history of only hypertension, and age-related kidney disease (everybody’s kidney function decreases with age), she might have been the healthiest on the adult medicine ward. She also seemed like the happiest. Her smile and age made her stand out.

But despite how healthy she had appeared on paper, her paper-thin, wrinkly, white skin draped over her thin frame – the plump of muscle and collagen had long disappeared – her knobby fingers, soft, raspy voice, and slow speech told a different story.

The big, blue blotches, which had blotted out almost all of the white skin on her forearms, sent a clear message: fragile, handle with care, limit the prodding and poking. First do no harm was the first maxim we learnt in medicine. For her, it was best to do nothing.

Plus, what could I possibly offer a 100-year-old patient? I had come up with my assessment and plan: do nothing. This would be a quick consultation. I was wrong. It was the kind of lazy thinking that a junior doctor struggling to keep up with the constantly moving assembly line of patients in a hospital was susceptible to.

I have now learnt that nothing with old people is quick. If you’re doing it quickly, you are doing it wrong.

The son and daughter wanted answers, and I, a junior doctor in my second year of internal medicine training, was taken by surprise at how adamant they were to get these answers.

I had thought, “Your mother is 100 years old, do you really need to quiz me like this on every single detail, especially in the middle of the night?” I could hear their reply: “Yes. Is something wrong with that?”

“No, it’s perfectly fine. But again, she is 100-years-old.”

“Yes. we know.”

We were on completely different pages. They treasured their mother. And I, as I now realise, was in a situation that I had never anticipated.

Never in my training had I imagined a scenario like this, that I would be assessing a 100-year-old patient, accompanied by her two children, both in their seventies, possibly even close to 80, on the adult medicine ward of a hospital.

Unlike the young adult with a sexually-transmitted disease, the middle-aged woman with a new breast cancer diagnosis, the traveller with some kind of rare infectious disease, the centenarian with shortness of breath accompanied by her family was not a scenario I had prepared for.

And so, I went to this family with all the wrong assumptions, and, faced with unexpected questions that I had no answers for, inevitably looked like a fool, the usual outcome when one goes into an unfamiliar situation with misplaced self-confidence.

But I learned my lesson.

A few weeks ago, in the outpatient clinic, five years after meeting this family who seemed to have emerged from a completely different world – so unfamiliar and strange the episode had felt – I met another centenarian. She – all the centenarians I have met so far have been females – was 101.

She was accompanied by her son, who wheeled her into the clinic room. Everything seemed identical to the patient from five years ago: the voice, the fingers, the skin, the smile, the keenness of the son, who walked with a folder containing all of his mother’s medical records, the few that she had collected over the last century.

She was on two prescription medications, and did not have any major medical issue. Everybody was identical except, I suppose, me.

This time, I had told myself, I would shut up and not assume anything. The day before, I looked over the chart, checked the results of the tests she had done, and came up with a plan.

At the end of the appointment, I told her the diagnosis, and outlined the treatment options. “No,” she said, adding, “I don’t want any of that. I drink a lot of milk and eat well, and that seems to be doing the trick.”

She burst out in a scandalous laughter, her son joined in, I soon followed. A comedy show. We were all on the same page.

Taureef Mohammed is a physician from TT working in Canada.

E-mail: taureef_im@hotmail.com