Geriatrics: Why Do We Do It?

FROM THE EDITOR

Dr. Barbara Resnick

Geriatrics: Why Do We Do It?

Why do we work in geriatrics? Not for money,but for love is my answer! Numerous times overthe past fewmonths I have been keenly remindedof the challenges our physician and nurse practi-tioner colleagues running geriatric practices areenduring and the painful career decisions someacademic physicians have had to make. Unfortu-nately, to survive in faculty positions, they havehad to work in clinical areas not exclusivelyfocused on geriatrics. In our current health caresystem, geriatrics just doesn’t pay.

I believe that those of us who choose geriatricshave a passion that may only be understood byour colleagues who have done likewise. In a re-cent Medscape posting of February 25, 2011,Eric Widera, MD, published an article titled,“Want Job Satisfaction? Choose Geriatrics.”1

In that article, he articulated some of his reasonsfor why he works in geriatrics. Specifically, hestates:

The heart of geriatrics revolves around listeningto the stories that our patients tell, and buildingmeaningful and deep relationships. Not onlyare these stories and relationships integral toproviding care for the elderly, they also arewhat keep me going as a physician by con-stantly inspiring me.

Isn’t it often that story, told in themidst of a hec-tic and stressful day, that makes us smile andgives us that tap on the shoulder and gentle re-minder of why we do what we do? Just the otherday, finishing up an exam with a patient, I experi-enced one such story. The gentleman had quitehigh blood pressure likely due to excessive alco-hol use. I quickly learned that his use of alcoholwas to cope with the intense loss he experiencedin no longer having the wife he once knew, givenher advanced dementia. At the end of the exam,he shared with me some tidbits about his wifethat made me sit down and listen, despite havinga full waiting room.Hiswife ofmore than 60 yearswas a physician who studied genetics. Today

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studying genetics is relatively common, but50 years ago, itwas innovative and required a levelof knowledge that I would imagine not many had.Listening to his stories, I was in awe of what shehad done, and it helped me appreciate his devas-tation, as well as to see his wife in a new way.

Listening is at the core of geriatrics. Yet, givenour current resources in clinical sites and theshortage of providers who want to listen, it maybe becoming all the more challenging. I am hop-ing this brief blurb of an editorial will serve asthat gentle reminder never to forget to stopand listen to those for whom we provide care.Corinne Rieder, EdD, Executive Director of theJohn A. Hartford Foundation, posted a blog2 onthe Hartford webpage that can serve as such a re-minder. Her blog also reminds us that, as we carefor a mother or father with dementia, we mustcare as well for their children and family whoremember what was and must deal with whatis. Dr. Rieder has graciously allowed me to sharethiswith all of you so that you, too,may take amo-ment and listen and learn from your residents,outpatients, inpatients, or community healthencounters.

Dr. Rieder, unfortunately, has the lived experi-ence of dealing with a mother with dementia. Shehas a 92-year-old mother with Alzheimer’s dis-ease, and, following a recent holiday visit to hermother, she shared what she learned:

I can’t deny itdI miss the mother I once had.Even at age 80, she was vibrant, loving, and in-dependent. And she was strong. For nearly20 years she provided care to my father, whobefore his death struggled with normal-pressure hydrocephalus and macular degenera-tion. What an incredible woman!Unfortunately, time and illness are no re-

specters of persons. The past 12 years havenot been kind to my mother. At 92, she has be-come frail and suffers with advanced dementia.Each challenging new declinedlosing her

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memory; needing help to shop, bathe, and man-age money; and now requiring assistance justto dress and eatdhas left her feeling dimin-ished, depressed, fearful, and incompetent. Re-cently, the appearance of other typicalAlzheimer’s symptomsdchanges in personal-ity, behavior, sleep patterns, and in recentmonths, a growing disorientation to placesand peopledhave deepened her feelings of in-adequacy and frustration. It’s heartbreaking.

As difficult as her situation has been for fam-ily and caregivers, it has been far more so forher. Dr. Rieder further reminds us that, “Often,it’s tempting to let such an overwhelming ill-ness [dementia] obscure the person behindthe symptoms. After all, can someone witha sick brain really have anything worthwhileto say?”

During her holiday visit with her mother,Dr. Reider learned the answer to that questionand shares it with us as she relates the followingwords of her mother:

“Corinne,I appreciate all of the help you give me.I know nothing about nothing.Don’t ask me anything about anything.I feel so desperate. My mind is zero.You will have to tell me what to do and what

not to do.I feel like I have lived 1,000 years.You have to keep me on the right track and tell

me what to do.You may have to tell me how to get to the

bathroom.I am desperate to learn things.Is this the bed I sleep on?So this is my bed. I have lots to learn.Do we have one or two bathrooms?Two? Yippee!I forget sometimes, and you may have to tell

me more than once.Don’t forget I’m here.What are the charges here?When are we going home? I need my purse.

You say that this is my home? How do youknow? Your father and I bought it? I don’tremember.I’m not that bright of a person. I don’t know

everything.I don’t want to make mistakes. You will have

to help me as we go along.If I do anything wrong you have to tell me.

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I don’t want to cause any trouble.What is allowable and what isn’t?You didn’t ask how old I amd92, that’s right.I was brought up in a farm in Missouri. We

had 120 acres. I milked cows. I cooked. I gotthe eggs.”That afternoon, I learned a great deal about

the importance of intently listening to someonestruggling with Alzheimer’s. My mother neededto know that I was genuinely interested in herquestions and fears and that I understood herconfusion and sadness. And likewise, it was im-portant for me to show my caring and support.I may miss the mother I once knew, but I havealso become deeply aware of how much I loveand appreciate the one I have now.I wonder how many other caregivers and

family members have made the same discov-ery. With most of the media’s attention focusedon caregiving, medical research, and mostoften, how much the growing number of olderpeople with dementia are going to cost oursociety in scarce resourcesdboth human andfinancialdwe may not always listen to whatthe patients themselves have to say. Perhapswe are afraid and don’t want to acknowledgewhat dementia could do to us or our lovedones. We may feel that patients with dementiahave nothing to tell us that we don’t alreadyknow. Or maybe we’re just too busy or impa-tient to take the time. But what my motherhas taught me is that all of usdincluding peo-ple with dementiadneed to be heard andunderstood, to realize we’re not alone, andto know someone loves and supports us forwho we arednot just who we once were.

On the webpage there is a beautiful picture ofDr. Rieder’s mother as a young woman, andunderneath that picture are words I will think ofoften on my busy clinical days: “Don’t forgetI am here.”

Thanks to Dr. Rieder for sharing her story andallowing us to use it as a way to remember to lis-ten and to learn. Listening and learning can be in-corporated into care activities, such as whenwalking someone to the dining room, and caneven happen during unpleasant care interactionssuch as wound care, suture removal, or othertypes of interactions. I challenge you all to listenfor a precious life story or insight this week andthen to share that experience with nursing andstudents, or students in other health care fields,

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to encourage them to assure themselves job satis-faction by choosing geriatrics!

References

1. Widera E. Want job satisfaction? Choose geriatrics.

Medscape. Available at www.medscape.com/viewarticle/

737617. Cited March 21, 2011.

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2. Rieder C. The John A. Hartford Foundation Blog. Listening

to my mother. Available at www.jhartfound.org/blog/?

p52883. Cited March 20, 2011.

0197-4572/$ - see front matter

� 2011 Published by Mosby, Inc.

doi:10.1016/j.gerinurse.2011.04.001

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