From EMS, “This is a 93-year-old female with dementia who is coming in for agitation.” The ED provider described her as “combative.” At interdisciplinary rounds, she was presented as a “classic geriatric case… so sad.” I, a palliative medicine fellow on a geriatric emergency medicine rotation, was consulted to see this patient and make recommendations regarding her difficult behavior.
I gently knocked and walked in, saw her sitting up in bed and immediately thought, “how many layers of shirts are under that jacket?!” I introduced myself and inquired about her hospitalization. She shared that she had raised her voice at “some people,” so her family worried and brought her in. She told me about her desire to return home, and the frustration with being trapped in this hospital bed with a “guard” at the door staring at her. Unexpectedly, she turned the questioning on me, pointing to the emergency medicine providers in the hallway and asking “well, what have they told you about me?” I opted for honesty and summarized what I heard: that she had eloped several times from her apartment and been found wandering the streets and grocery stores. That her anger could be so fierce, it scared her family. That she needed a safe place to go when she left the hospital.
Later, when discussing her case with my team, I described her as “frustrated,” “confused,” and “disheveled.” Her family consisted of a daughter and granddaughter, who were on their way. As we waited, my team visited again with the patient, hearing more of her perspective. We all agreed that she was “quite paranoid.” When her family arrived, they shared their concerns about the patient’s inability to remain safe, even with constant oversight. Then there was talk of locked memory units, and for someone to adopt her dog.
Feeling satisfied with a plan, we were disbanding when her granddaughter sighed and mentioned that she hoped the facility would have music. We all softly agreed that music was good for the soul. She stood up straighter and said that music was especially important to her grandmother, a world-renowned piano player who had performed internationally and taught countless students. We also learned that she had an advanced degree in Psychology, and with her expertise in music, had healed many. There were collective smiles and a chorus of “mm” as they shared stories of her life. A sense of knowing her that significantly shifted her narrative and allowed us to see her as a beloved mother and grandmother. A story that had begun as a “classic geriatric case… so sad,” was concluding as that of a teacher whose world had become so incredibly small, yet too large for her to safely navigate. A patient for whom the medical team had been satisfied with a “safe dispo,” was now a beloved dog owner about to be stripped of many things she held dear. A medical plan that had felt like a win mere moments before, now resembled helpless sadness for this accomplished musician.
Humanizing patients is what we aim to do in healthcare, especially in Palliative Medicine. In moments like these, I am reminded that the human connection is powerful. Yet, it often makes our jobs harder, forcing us to absorb unshakeable pieces of our patients, frequently pushing us to want to give more, and more, and more. And to remember these individual cases, to add them to the collected stories of hope and heartache that represent the difficult paths life can take. It is these connections and collections that fill our cups at the same time that they deplete what was already there. It is walking a tightrope of objectivity vs vulnerability when we say “93-year-old female with dementia” rather than “a matriarch whose story is being erased by a changed brain.” I continue to work on building my shield, one that is transparent enough to allow connection, yet keeps me from absorbing too many blows.
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