The Monday Memo
April 1, 2019 PITT DPT STUDENTS
Have you ever looked at the hands of someone over the age of 75? They tell a story. You may notice spots left by days spent in the sun, callouses left by years of hard work, or scars from an old sports injury. Those hands have clapped for performances and held the hands of others. They have allowed their person to engage and interact with the world, but these hands tell another story. They tell the story of the future. You may also notice atrophy where plump muscles were once prominent, thinning skin prone to bruising, and swollen joints struck daily with the pain of arthritis. And we can see all that in the hands. What about the rest of the person? We have a whole body, and save tragedies, we are all destined to age. How do we approach these aging bodies and the souls inside them? How do we offer the respect deserved by years of life experience on earth? Atul Gawande offers a unique and moving take on the subject of aging in his novel, Being Mortal: Medicine and What Matters in the End.
Throughout the novel, Gawande, a physician, explores the obstacles many elderly people face as they begin to require more assistance with everyday life and, ultimately, the trials and tribulations of end of life planning and the emotions that go with it. Dr. Gawande acknowledges times he failed to have the ‘hard conversations’ and is open about the learning process he had to go through to better serve his patients, even in a well-established career. His take on assisted living homes and hospice care as avenues to facilitate life, rather than usher in death, is particularly powerful. The purpose of these institutions should be to allow people to decide how they want to LIVE their final days to the fullest, not how they want to die.
I believe physical therapists can gain a lot from this novel in dealing with the geriatric population. We are taught to push and encourage our patients to better themselves and improve, but what about the octogenarian who is simply, not into it or just done? I think we have a unique opportunity there to effect change, and this is where patient-centered treatment and goal setting comes into play. Of course, as Dr. Gawande learns in his book, it is important to be honest and realistic, but that does not mean you cannot improve the quality of life in terminally ill patients. He notes, “Our ultimate goal, after all, is not a good death but a good life to the very end.” Every patient should have the opportunity to share their goals with their therapist. We cannot simply assume that all older adults are content living out their lives playing Bingo. We as a society need to respect and appreciate that every older adult has had a long life to decide what they do and do not like to do. As a physical therapist, take note of those activities and find ways to incorporate them into treatment in interventions that provide an appropriate challenge, while being enjoyable and specific to the patient.
The next time an older patient sits down in front of you, take a look at their hands, ask them their story, and listen to their goals for life.
“In the end, people don’t view their life as merely the average of all its moments—which, after all, is mostly nothing much plus some sleep. For human beings, life is meaningful because it is a story.” -Atul Gawande
-Katie Schuetz, SPT
Gawande, A. (2014) Being Mortal: Medicine and What Matters in the End. New York, NY: Metropolitan Books.