My patient presented to a private hospital, haemorrhaging, and was assessed as too unstable to be managed there.
She was transferred to the ED of a public hospital and taken straight into resuscitation.
She was asked if she wanted to be resuscitated.
“It depends on what I have,” she said.
At that point no-one knew.
She was asked if she had an advance care directive.
“Yes,” she told them.
Did she bring it with her?
No, she came in as an emergency.
I later saw that the notes from ED indicated that she was not for CPR or intubation, but for ICU if she had a reversible condition.
I asked my patient if she had said that.
“Probably,” she said to me. “They kept on pressuring me.”
She had no family with her, she was haemorrhaging, and she was even more frightened by her condition after the conversation about resuscitation.
She was a fit and active 77-year-old, but there was an assumption being made based on her age (and possibly her sex?).
I can’t see how the psychological message she was receiving in her most vulnerable state would help her physical recovery.
I always thought that in such a situation, one would reassure the patient that they were now in the right place to get the medical help they needed, rather than imply that they were of questionable worthiness to be treated at all.
Another patient of mine had a myocardial infarct at the beach.
She was transported to hospital by ambulance in her bathing suit.
When she arrived, the focus of conversation was directed to where her Medicare card was, and her private healthcare details.
That information was with her husband, who had her wallet and was following in his car behind the ambulance.
Her interrogation continued until her husband arrived to clear up the administrative details.
She reported to me how unpleasant it was to be arguing with clerical workers in a potentially life-threatening emergency.
Priorities in the ED certainly seem to have changed from what I remember in my day as a student and intern.
Having an older cohort of patients, I also see them succumbing to the stereotypes of their age.
They present to me saying, “Here I am again, your worst nightmare.”
Or, “I have old lady-itis.”
Or, “I’m ready for the knackery yard.”
One of my patients who recently had a fall and was admitted to hospital with fractures was re-traumatised to hear that they had assigned a gerontologist as her consultant.
They reassured her that everyone over 65 was assigned a gerontologist…
I must say I cringed at hearing that myself.
I certainly don’t see myself in that category at all.
When my dentist complained about his age, and how he was now older than all of the parents of his hygienists, I commented how I only very recently felt like I needed to move on from my paediatrician.
After telling my daughter that anecdote, she said, “That’s great, Mum. I read that if you see yourself subjectively as younger than you are chronologically, you age better and live longer.”
But ageism starts young.
I recently had a birthday and my five-year-old grandson asked me when I would be 1000.
I told him in 929 years … and that he would have to help me blow out all the candles.
So, my colleagues, it’s time to resist the ageing messages and stereotypes we constantly receive.
Anyone free to go rollerskating with me this afternoon?
Dr Pam Rachootin is a GP in Adelaide, SA.
