November 2013

The Medicine

A visit to the nursing home

By Karen Hitchcock
How we look after the elderly

The first time I see Irena, we are two doctors down and have a full waiting room. I call her name, four times. Finally she stands up: 94 years old, 125 centimetres tall.

The clinic is for elderly patients with multiple chronic problems: failing heart, kidneys and lungs, dissolving bones and aching joints, bone marrow that’s drying up. In the name of efficiency, these patients cannot ask to see the same doctor at each appointment; they have to make do with whoever picks them up from the pile. They are old and complex and getting expensive – we wouldn’t want to spoil them. There is a desk between us, and I am supposed to type notes directly into the computer as they talk, as if I am a travel agent. Of course, most patients are deaf, so we spend the consultation shouting at each other. Apparently, a doctor who knows you and in whom you might trust is less important than that god Efficiency. I have the highest respect for rules I agree with, so I make an unofficial arrangement with the nurse coordinators and start to see regularly my own cohort of patients. Irena becomes one of mine.

Though deaf, Irena whispers. I look at her: cataract, arthritis, stains on her cardigan, false teeth that are too big for her gums so they move up and down independently of her lips when she speaks. I get inefficient: I leave the desk and sit next to her so I can hear. Her English is halting, slow as calligraphy. I ask her if next time she wants me to arrange a Russian interpreter. She looks at me and raises an eyebrow: “You don’t like my English?” I ask her how she has been since she last came to the clinic. She says what she says every time thereafter: “I am 94, doctor. I am old.” She always pauses here and raises a finger before her punchline: “But I am not dead yet.” Then she laughs.

I sit beside her to feel her pulse or listen to her lungs, and she tells me snippets that over months become grand narratives. In Stalin’s Russia, her husband was taken to a labour camp for running his own business as a tailor. They wouldn’t let him take his violin. For a year, this tiny woman travelled to the camp every week and demanded they give it to him. She wrote letters. To Stalin. They relented. Her husband played so beautifully he was granted an unofficial reward: though it was against the rules, Irena could stay in the camp for a week.

Once patients enter a nursing home, they are no longer eligible to attend this clinic. It’s another world, and all the rules change. I know Irena is on her way there when I sit next to her doing something clinical and she whispers in her ancient staccato: “Doctor. This week. I dirtied myself. Two times.”

The black heart of a health system based solely on utilitarian economics is the unspoken truth that once a citizen ceases to be productive their care ceases to be cost-effective. If you are old and sick and reliant on the state, you are a dead woman. As a Russian Jew born in 1919, Irena had been a dead woman many times before – in 1941, for instance, until her father, whom she never saw again, intervened in her fate, saying “You must be far away by morning.”

When Irena doesn’t turn up to two appointments in a row, I realise she’s been moved to a home. I am sad and increasingly troubled by questions about the camp that only she can answer. Did her husband have his own room? What was in it? Was there a window? Was the bed comfortable? What did they eat? Was she happy? I start to feel panicked when I think of her. What was it like in there?

I call the nursing home and ask them to ask Irena if I might visit. She says to come tomorrow. The next day, I step into one of the taxis lined up in front of the hospital and ask the driver to take me to the nursing home. The taxi driver looks from my face to my hospital ID and back to my face; then he drives me 300 metres around the corner.

Irena’s room has a narrow bed, a wardrobe, a bar fridge and a single armchair. I sit on her walking frame and ask how she is. She is old, but not dead yet. We laugh at this. She tells me she fell and thought she was being taken to hospital but instead found herself in this room. Someone brings one cup of tea and a dark brown biscuit and smiles at me over Irena’s head. Irena dips her finger into the plastic cup, says “cold” and pushes it away. When I stand up to leave, she opens her fridge. It is full of brown biscuits, piled into the door shelves and drawers. She insists that I take some and wraps a handful in a napkin. She puts the parcel in my hands: “Will you come again?”

I push out into the sun and stride back to the hospital. The young rule the world; we stomp around doling out mean rations to the old, the machinery of our secure, able bodies purring to us the myth that we will live forever. And one by one my patients retreat to these small rooms and then slip away. Soon they will all be gone. And then it will be your turn and mine to sit in cells and drink the weak tea they hand out at eleven and two, hoarding biscuits in our fridges. Not dead, yet.


Karen Hitchcock

Karen Hitchcock is a doctor and writer. She is the author of a collection of short fiction, Little White Slips, and the Quarterly Essay Dear Life: On Caring for the Elderly.

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