Remembering the care in healthcare

In light of what is being planned for Medicare coverage and with comparative effectiveness analysis increasingly determining health care coverage and access, mention of an old essay for nurses and medical professionals on medical ethics felt like an especially important reminder. I first read it when it was published in the Journal of the American Medical Association nearly a dozen years ago.

As Anthony Ughetti wrote, caring selflessly for someone in the final weeks and months of their lives is a rewarding part of being a healthcare professional, as is caring for those most in need of our care. Elderly, sick and the most vulnerable among us deserve love, support and care from a compassionate society, not to be seen as useless eaters and less deserving of healthcare.

The JAMA article “Aging and Caring” described a lecture given to a class of graduate nursing students by Dr. Paul E. Ruskin, M.D., Director of the Geriatric Psychiatry Fellowship at the University of Maryland and Veterans Administration Maryland Health Care System in Baltimore. As Dr. Ruskin wrote:

I started my lecture with the following case presentation: The patient is a white female who appears her reported age. She neither speaks nor comprehends the spoken word. Sometimes she babbles incoherently for hours on end. She is disoriented about person, place, and time. She does, however, seem to recognize her own name. I have worked with her for the past 6 months, but she still does not recognize me.

She shows complete disregard for her physical appearance and makes no effort whatsoever to assist in her own care. She must be fed, bathed, and clothed by others. Because she is edentulous, her food must be puréed, and because she is incontinent of both urine and stool, she must be changed and bathed often. Her shirt is generally soiled from almost incessant drooling. She does not work. Her sleep pattern is erratic. Often she awakens in the middle of the night and her screaming awakens others. Most of the time she is very friendly and happy. However, several times a day she gets quite agitated without apparent cause. She screams loudly until someone comes to comfort her.

After the case presentation, I asked the nurses how they would feel about taking care of a patient such as the one described. They used words such as “frustrated,” “hopeless,” “annoyed,” and “depressed” to describe how they would feel. When I stated that I enjoyed taking care of her and I thought they would too, the class looked at me in disbelief. I then passed around a picture of the patient– my six month old daughter.

Why do we recoil at providing care for adults when they most need help? The reasons for why it’s harder to care for a 90-year old than a 6-month old with identical symptoms goes deeper than the physical work of a 100-pound versus 15-pound patient, he said. “We need to change our perspective,” he wrote, “The aged patient is just as lovable as the child. Those who are ending their live in the helplessness of old age deserve the same care and attention of those who are beginning their lives in the helplessness of infancy.”