My work in geriatrics and palliative care has allowed me to walk alongside many brave and magnificent people doing their best as they cope with illness and the frailties of life and who often shared with me what really mattered to them.  Over the years, working across the south, the midwest, and the east coast, also offered me opportunities to experience a variety of ethnicities, religions, and unique local cultures.  I never knew who I might meet and what they would teach me. 

Some changed my perspectives on life and others were the catalyst for pointing me in the direction of geriatrics and end of life care.  They have shared stories of wisdom, strength, gratitude, disappointment and sorrow and left behind treasured memories.  This is barely a glimpse.  Reading this may feel a bit disjointed, but so are the accumulated memories I have from my patients in New Orleans, Boston, Detroit, Richmond, Chattanooga, New York and Rhode Island.  Welcome to my world.

Glass Half-Full or Half-Empty

Early on, the first patient who inspired me to put pen to paper and share her story was Mary who lived in the back of a boarding house in Richmond Virginia.  It was so dark in the hallway that I had to feel around for the numbers on the doors.  When I knocked, she answered and said “it isn’t much, but I ain’t sayin’ you can’t come in.”  She was a widow who never had children and she relied on neighbors for help.    There was an old wringer washer in the kitchen and her rooms were infested with a variety of bugs ….. which she was mostly unaware of due to poor vision.   She’d make one pot of stew to last the week and kept her extra water in vodka bottles that her neighbor would carry in for her.  She chuckled when she saw me looking at the bottles and clarified that they were full of only water and not alcohol.  I mention Mary because I would find myself looking around and thinking she shouldn’t stay in this place.  Meanwhile, she was proud of and grateful for what she had and how she was managing.  It was one of many lessons I needed to learn about walking in someone else’s shoes and leaving my preconceptions behind.  She saw the glass half-full.

In contrast, living in a mansion with views from every window, a Chihuly glass collection, and eating only fruit and eclairs, lived a woman cared for by hired staff.  There was minimal contact with family and friends.  She presented as mistrustful and bitterly angry to the very end of her life with a that glass she saw as…….(yup) half-empty.

Nature

One Native American woman who was over 100 years old, would usually end our visits with reflections on her childhood and connections with nature.  Her father knew the healing properties of herbs and plants and what to gather to make a  tonic for the family every spring.   When her cousin was born, a country doctor told her aunt and uncle that their child would not live through the night. However, her father kept the child wrapped in warm onions and the baby girl survived….and thrived.  Her stories were beautiful descriptions of her deep love and respect for Mother Nature.

Happy Living

I have held onto a piece of paper given to me in Detroit by one of my patients and it is time to share it.  Erma was obviously a very thoughtful and faith-filled woman and she wanted me to have a copy of her words on living a happy life.  Well done Erma!

Erma’s “Seven Precepts for Happy Living”

1). As a matter of faith: I will start out each day with a prayer of Thanksgiving for the hope of experience it extends to enjoy the beauty of God’s miracles and gifts.

2). As a matter of policy: Unless the remarks could be construed as a compliment, I will refrain from talking about people who are not present to defend themselves.

3). As a matter of principle: I will make a conscientious effort not to deliberately gain an advantage by undermining the other fellow’s efforts, belittling his achievements or exaggerating his deficiencies.

4). As a matter of creed: I will believe God is my strength and my inspiration, the bible my comfort, my marriage my most cherished possession, and my family and my good friends my pride and joy.

5). As a matter of expedience: In all pursuits of enterprise or activity, I will be guided by the motto “Trust in God in all you do, Have the faith He has in you.”

6). As a matter of charity: I will endeavor to apply the Golden Rule in all my personal dealings with others.  I will try to put myself in the other fellow’s place and always let thought and plan be the precursor of word and deed so I will not purposely say or do anything to injure the other fellow’s feelings.

7). Last, but the most important.  As a matter of religious ritual: I will daily petition God for guidance with the following supplication: “When I am weak make me strong and show me the right when I am wrong” and then I will remind myself that wholehearted devotion to God and unselfish service to others form the keystone of nobler living.

Grace

I witnessed grace from a truly lovely woman in upstate New York who told her story without bitterness or anger.  She had been institutionalized in a psychiatric hospital after the birth of her son and subjected to insulin shock therapy and cold water hydrotherapy, among other things that were used during the 1940’s.  She eventually recovered only to be re-institutionalized when her second son was born!   The concept of post-partum depression was, as yet unknown.  She was able to focus, however, on gratitude for eventually being able to raise her sons. She had the strength of character to focus on the good bits and to bravely carry on with with warmth and kindness.

History

Some stories offered a bit of history.  I was told by Lucy that she witnessed Margaret Sanger handing out leaflets on birth control in a NYC subway in the 1920’s.  She had grown up in New York City along the East River and described being able to swim and play along the banks.  Back in the day, her Turtle Bay neighborhood had a brewery where the United Nations now stands.

Another man who had immigrated from Mexico met Pancho Villa on the road when his carriage overturned. 

In Detroit, many of my patients had relocated from the south to work in the auto industry.  Sadly, one shared that he had witnessed a lynching as a young child, and another brought his folk remedies along with him.  He used burnt flour for nausea and mothballs soaked in kerosene for aches and pains and a myriad of other symptoms.  That kerosene solution probably helped him to avoid colds and the flu because the odor permeated our exam room and surely kept most people at a distance.  His daughter begged me to convince him to stop using it, but he felt it had contributed to his long life.   He then added that his friends who never used it….were all dead.  Not a lot to argue about there!

An African American veteran from World War I shared his story in a shockingly matter of fact manner.  He was attacked by mustard gas on the battlefield and, believed to be dead, was loaded onto a cart.  Thankfully, someone saw him move and took him off and he was able to tell me this story when he was well into his 9th decade.

Pants

At the beginning of one home visit, Joe was angry and convinced that I had stolen and was wearing his black pants.  As the driver for a Mafia boss back in the day, this was a bit intimidating.  Keeping him focused on our conversation was a challenge and there were way too many stories that he was sharing, including his opinion that guys who ended up on drugs could not be trusted and “you had to do what you had to do.”  When I left, he was still looking suspiciously at my pants.  

Just….Wow

How many can say that they worked not one, but two full time jobs for over 25 years?  There can’t be many, but I met one of them.   Mr A was African American and had 10 children and he said simply, “a man does what he needs to take care of his family.”  He worked one job in construction from 6 am – 2 pm and then a second security job from 4 pm to midnight.  Really?  He was also a deacon and would be asked to say grace whenever he attended lunch at the senior day center.  Meeting him for his first history and physical, I felt an almost mystical aura around this very wise and special man.

I have cared for those who had numbers tattooed on their arms applied in  Auschwitz during WW II.   After finishing a consultation with a woman in a Jewish nursing home just outside NYC, the residents were gathering in a large meeting hall to mark the occasion of Yom HaShoah or Holocaust Remembrance Day.  I stood in the back as the rabbi asked for any survivors to stand and over a third of the attendees got up.  I gasped.  Then a frail appearing man took the microphone and began to describe the day that he and his family were loaded onto a cattle train for transport.  They were told not to look out the windows, but his older sister did and was immediately shot.  He seemed to be in a trance as he continued with his story and the rabbi had to put his arms around him to pull him back from the abyss. Tragedy was being re-lived by many that day.  

When I arrived to see Rosetta at her home, she was not in her usual spot on the front room couch.  Her wheelchair bound partner said she was “up in the attic”!? She had declined quickly, was barely able to ambulate at this point, and was dying of cancer.  I found her lying on blankets in a poorly ventilated and hot attic with some bread and water that she had brought with her when she crawled up the stairs.  She explained that she knew she was dying and needed privacy away from her partner’s friends.  After a long discussion of options with Rosetta and her partner, it was agreed that if he kept his friends out of the house then Rosetta would come back downstairs.  However, she was going to need to be carried down the stairs.  Across the street was a park with a group of men having some beers.  Looking back this may not have been the best choice, but I asked if they would help Rosetta and they did with gentleness and compassion.  We got her settled, increased her support and services and worked with her partner so that she could stay in her home as she wished.  To think that she saw the only solution to her need for privacy (and dignity) at the end of her life was to die alone in her attic.   

A Little Humor

There are also many memories that bring a smile or laugh.  Trying to catch a mouse in the hospital room of a patient with an upside down, pink wash basin while the patient who was bedbound was rolling side to side to help in the effort!  The mouse got away. 

After pumping up the blood pressure cuff of a newly admitted patient in the middle of the night, the exhausted resident fell asleep on the patient’s pillow.  She put on her call light and then whispered, “please release the cuff, but don’t wake him up poor thing.” 

Sisters who were admitted to the same dementia unit of a nursing home had both been nurses.  Ever the task-oriented caregivers that they were trained to be, they often got up early in the morning and could be found setting up to give another fellow patient a bed bath.  A lovely and ingrained gesture, albeit inappropriate.       

Thank You

People often wanted to offer a way to say thank you.  I have found turnips in the back seat of my car, been offered puppies, chocolate chip cookies, cooking tips, personal sketches and even some of Mary’s stew of the week.  A line from a thank you note written by the husband of one of my patients read, “Many people have given of themselves to help me, some that I know about and surely many that I do not.  You I know about, and will forever be grateful.”  One note like this can explain and be the motivation for a whole career.  My thanks though have always been through the intense and intimate connections made when life starts to meet up with death and what really matters tends to take center stage.   

My stories could go on and on as I piece together this collage of the amazing bravery and magnificent strength of everyday people that I have had a free ticket and a front row seat to witness.  Not just these patients, but all their dedicated caregivers, my mentors and colleagues are also part of this collage.