Sarah Hanafi is a Psychiatry Resident (R1) at McGill University
I started my Geriatrics rotation on the Restorative Care unit. Having trained mostly in acute care, I found myself perplexed by this care model. On the surface, many patients seemed to suffer from maladaptive personality traits that hindered their graduation to primary care. It felt like a bizarre blend between an internal medicine ward and a long-term care facility; this mirrored the disorientation I felt in managing patients who had few medical problems, per se, but lacked the means — whether intrinsic or extrinsic — to cope.
One patient in particular made her pain management the battleground for negotiating her independence. She refused to participate in physiotherapy, attend breakfast, endure a physical exam, or even accept her medication lest she make an unrelated concession in the process of heeding the instructions given to her. The members of our team were visibly frustrated to the point of minimizing their interactions with her.
I was curious and, as a medical student, had the luxury of time. As I perched on her windowsill, I listened. I did not push my agenda — my physiotherapy or medications or neurological examination — but simply listened. The initial gulf of frustration was soon filled by Loss: loss of independence, love, control, and identity. Though she may not have recognized these losses by name, it became evident to me that they were central to the discord that had become a hallmark of her embattled admission to the unit. She left clues along the trail of our interaction: in references to being shepherded like a child, in the characterization of her disposition plan as being “dumped into some facility,” in her complaints that “that nurse” was all-business, and in the lack of pain after an hour of my listening. In that first week, I reflected on her words and the words of many other similarly hurting patients. Sadly, I don’t know what became of their hurts and fears. Nor can I say that I expected any drastic change in their care, as our institutions cannot replace meaningful connections with family and community. But I left this experience reflecting on words that sounded oddly familiar.
In her words, I heard my own mother’s vulnerabilities. As I argued with Maman over her lifestyle hygiene and my micromanaging, she asserted her independence by ending the conversation, fought with me when all she wanted to say was “I’m lonely,” and struggled to carve out a new identity that was not overshadowed by the label “Traumatic Brain Injury.” I realized I was struggling to reconcile with this new reality, for in my mind my mother was still the fiercely strong woman who loved race cars and social justice rallies, and was the centre of any social function — the same social functions that now precipitated debilitating tinnitus and migraine headaches.
That weekend, as we sipped on mint tea, I tried to see my mother without my own agenda. As I recounted my experience on the Restorative Care Unit and my reflections on our relationship, I saw tears of gratitude. The tears of someone who finally felt heard. And there wasn’t anything more to say beyond the affection and mercy of an embrace to bridge a longstanding gulf of misunderstanding.
In this journey called medical school, it’s been experiences like these that have challenged me to grow as they snuck their way past the wall separating the personal from the professional, calling me to confront my fears and delve deeper into the relationships I cherish most.
The practice of medicine is inherently social, but this facet rises to the foreground at the extremes of age when patients are more vulnerable or less independent. While we can employ complex management algorithms to optimize someone’s pain, sometimes all our patients need is to be heard; surprisingly, it’s often the simplest solutions that are the most effective. Rather than labeling someone as “difficult” on the wards or at home, I hope I’ll first seek to understand before I seek to be understood.
Note: The patient depicted in this story is fictional; the mother's story is true and she has given her consent for it to be told.