Anonymous Doctor

The elderly get a raw deal in the hospital. You could be the most high-functioning 95-year-old on the planet, living on your own, no signs of dementia, coming into the ER for an entirely treatable and non-serious reason-- a broken toe, let's say-- and as soon as anyone looks at your chart and sees that you're 95, you are going to be basically disregarded and assumed to be 24 hours from death. It becomes almost like a game of telephone, from the resident who takes the history, to the next doctor who sees you, to the next, to the next, each time making you out to be less like a functioning person and more like a corpse.

"So, we have a 95-year-old, broken toe. Came in on her own, lives independently, I don't think we need to admit her."

"I'll just write down failure to thrive," said the attending. "And we'll keep her overnight for observation."

"She's thriving fine. I don't think we need to admit her-- she's probably in better shape outside than in here, she can pick up who knows what."

"Yeah, but just in case."

"Just in case what?"

"She's 95."

***

Two hours later, the attending gives his report:

"95 year old, failure to thrive. Came in unable to walk--"

"She has a broken toe."

"Sure, yeah. Incontinent--"

"She spilled water on herself."

"Okay, fine, then we'll say hand tremors, unsteady--"

"No..."

"We admitted her with syncope--"

"She said she was dizzy. It was because she spilled her water and the nurses wouldn't get her any more--"

"Yeah, syncope, agitation--"

"You'd be agitated too if you had to wait 6 hours in the ER with a broken toe."

"We think it's a broken toe. Maybe it's a broken hip."

"It's not a broken hip."

"We're keeping her for observation, we'll get social work involved to help with placement--"

"She lives at home."

"Yeah, well, we should let social work decide if that's okay--"

"She's high-functioning, she's fine--"

"And the plan going forward is, uh... hospice."

"She has a broken toe."

"Yeah, I don't really think we should be bothering to treat it. Let's just say hospice. She signed a DNR, right?"

"She's a functioning woman."

"Let's prep an OR and we can just remove the whole foot so it doesn't give her any more problems."

"What?"

"Yeah, and let's get psych involved to deal with her depression."

"What depression?"

"She reacted very poorly when I said we were going to remove her foot."