‘Who are you,’ he said, ‘to tell me what I need?’ He was 93 years old. He wore tired striped pyjamas and lay in a bed at the far end of a hospital bay. Voicing these words to me took so much courage that from where I stood I could see his hands shake slightly and the line of his jaw do its very best to be firm and resolute.
I was not 93 years old. I was not wearing tired striped pyjamas. I was a junior doctor with a shiny stethoscope and a very important pager that bleeped out its importance to the whole ward every few minutes. I also had a long list of jobs that morning and one of those jobs was to visit the bedside of this 93-year-old man and explain to him what care package would be put in place once he was discharged: the people who would wash and dress him, make sure he ate and drew his curtains, and who would switch on the television for him before they left. Although I have always thought ‘care package’ was a strange term, as though caring should be limited to something you could wrap in brown paper and tie up with string. I thought it would be an easy job to relay all this, something that would only take a few minutes. I was wrong.
Joanna Cannon has written a new novel based on her experiences as a doctor caring for elderly patients
‘Pardon?’ I said.
‘Who are you,’ he repeated, but with a little more certainty this time, ‘to tell me what I need?’
I explained to him it would be the same for any patient, that we wanted to make sure he stayed safe and well, that we just wanted the best for him. I hid my shame behind a change in personal pronoun. I had grown very fond of this elderly gentleman. Doctors are not supposed to have favourite patients, but sometimes it’s impossible to avoid. From the time we had already spent together, I knew this was a man who had lied about his age in order to fight for his country, who had a little boy who went to school one morning, was involved in an accident and never came home. A man who used to have a caravan in Cromer and a job at the Gas Board, and a wife he missed so desperately he would kiss her photograph each night before he went to bed. I knew all of these things, and yet I had stood by his bedside and failed to acknowledge any of them. I had seen him, as society sees most elderly people, as a problem to solve, a date of birth, nothing more than a name on a list.
The first job for any junior doctor each morning is to print out a list of their patients. It’s a simple record: name, hospital number and date of birth. As you scan the list, your gaze is always drawn to anyone under the age of 65 because (with the exception of obvious specialities) the vast majority of your patients will consist of the elderly. People who were perhaps admitted due to a fall or an infection, but – despite having recovered – are now unable to return home because they have no family to take care of them and can’t continue living alone. Or because they’re waiting for funding for a care home. People who are there because they simply have nowhere else to go. They have turned a chapter and the life they once had is no longer appropriate, so they linger in wards while the world decides what to do with them. As the ward round moves through the hospital each day and entries are made in case notes, the only thing written for these patients is ‘no change – awaiting social care’ (which is often abbreviated to ‘N/C awaiting SC’, seemingly in order to take up as little ink, effort and space on the page as possible). These are the people society often calls ‘bed blockers’ – a vile, thoughtless term that somehow implies a kind of deliberate stubbornness on behalf of the patient, when, in reality, it’s the system that ‘blocks a bed’, not the person. I have even heard this term used by visitors or other patients, and sometimes, sadly, by hospital staff within earshot of elderly people. Elderly people whose sole concern in life is that they don’t become a nuisance to anybody.
Alongside those awaiting social care, there are, of course, elderly patients who are unwell. When I first started working as a junior doctor, I was warned that I would find paediatrics upsetting. ‘It’s so traumatic to see children who are poorly,’ I was told. Of course it is, but in paediatrics there is (usually) a tribe of family by that poorly child’s beside. An army of people. It was care of the elderly I found truly distressing, because there are patients – like the 93-year-old man in tired striped pyjamas – who have no one. At visiting time, the plastic chair by the side of their bed remains empty. There is no family to reassure them. No relative to stand their corner. No one to explain things to them. On a ward round, where a consultant is often just as pressed for time as the junior doctors are, there isn’t always the opportunity to go through anything in slow detail, and so we say, ‘I’ll come back later and explain that medication’, or those blood results, or that chest x-ray. The problem with this is that at the end of your shift you find yourself with a list of 20 people you have said you will return to. But you still do it. Because keeping your promise to a patient should always remain very high on your list of things to do.
However, the hospital only reflects the wider world, where elderly people merge into the landscape and seem only to provide a backdrop as we go about our hurried and very important lives. It seems that there comes a point where the only significant fact left is your age and everything else is forgotten as you are placed in a faceless, generic pool of people called ‘the elderly’. It’s a little like ‘babies and children’ – except no one rushes over to an elderly person to tell them how wonderful they are. When you become old, people don’t always bother to ask your name. You become ‘dearie’ or ‘sweetheart’. The same people are also strangely blessed with a sudden ability to know, far more than anyone else, what is best for you. Your age becomes an explanation for everything else in your life – every thought, every quirk of behaviour is placed firmly at the feet of your date of birth.
When I worked on a ward for people with dementia, there was an elderly gentleman whose behaviour caused all sorts of problems. Each time he was given a cup of tea, he would take a sip and then lean over and pour the rest on to the carpet. Nothing we did could stop him and it got to the point where all we could do was place a washing-up bowl by his bed in anticipation. It seemed to be a random symptom of his age, of his illness, until we spoke to his daughter. She said her father used to be a lorry driver. Whenever he pulled up in a layby to drink tea from his flask, he would take the final dregs, lean over and tip them out through the window. In the same way, a female patient on the ward would, at the start of each day, raise her skirt and walk around the room, showing off her underwear to everyone in sight. We couldn’t understand why, until we found out that she used to be a farmer’s wife, and she would collect hen’s eggs in the gathered material of her apron every morning. It all made complete sense, but only because we had taken the time to listen to their stories.
The world rarely stops to listen to stories. We live in an age where time and experience are airbrushed from faces, where becoming old is seen as a flaw, a lapse in concentration, almost an illness in its own right. Instead of celebrating our age, we do our level best to hide it, and multimillion-pound industries feed purely on our fear of growing old. On the way to a meeting about this article, I found myself on a pavement, behind an elderly woman with walking sticks and a shopping trolley and a joyful determination to continue living her life the way she always had. I was running late. I was frustrated. I was tutting internally. I tried to edge my way past to overtake this woman (a woman who, in not that many years into the future, might very well be me). We forget, I think, that life can be so very much richer if we stop trying to overtake everyone and walk alongside them for a while instead.
When I worked in the hospital, I saw the wisdom and humour in growing old, but I also saw much of the distress. The woman in her 80s who never had a visitor, but whose daughter walked on to the ward after her mother had died, demanding the wedding ring. The 102-year-old woman who had buried her husband, her best friend and her children, and who couldn’t understand why people still told her she was ‘doing so well’. The elderly man whose wife died suddenly when he was admitted for a routine procedure, and who passed away the next morning of what I will always, very unmedically, consider to be a broken heart. You try, as a doctor, to listen and to speak out about how it must feel to grow old, but like thousands of people working in the NHS, you wonder sometimes if your voice is heard at all.
When I became an author, through a series of strange and fortunate twists of fate, I realised that my voice might now carry a little further. While I would never write about my patients, I could write about the things they taught me. I knew that with my second novel, I wanted to write about growing old. Three Things About Elsie opens with 84-year-old Florence, who has fallen in her flat at a home for the elderly and is waiting for someone to rescue her. In the story, I wanted to explore how we are all valuable, no matter what our age, and how the world will forever be slightly different, just because we once existed. I wanted to write about the lesson taught to me by a 93-year-old man in tired striped pyjamas.
Joanna at work as an NHS doctor. Joanna supports Arts for Health, a charity that arranges social events for people living with dementia and their carers
Sadly, he will never know any of this. He never received his care package, because he died without ever being discharged. I like to think that he is now reunited with the wife he missed so desperately. I had moved on to my next job when it happened, but knowing how fond of him I had grown, one of the nurses managed to get a message to me (because nurses not only care for their patients, they care for their colleagues as well). Wherever he is, I hope he knows just how much his words affected me and how I listened as he helped me to understand what it feels like to grow old. I hope he knows I stitched that listening into the pages of a story and found a way to send it out into the world, in the hope that other people might listen to him, too.
Three Things About Elsie by Joanna Cannon is published by HarperCollins, price £14.99. To order a copy for £11.99 (a 20 per cent discount) until 28 January, visit you-bookshop.co.uk or call 0844 571 0640; p&p is free on orders over £15. Joanna supports Arts for Health, a charity that arranges social events for people living with dementia and their carers. For more information, visit artsforhealth.sssft.nhs.uk