What is missing

Quite a number of the patients who come to us are the in the geriatric age group. The lady about whom I wrote earlier, her issue on further reflection and questioning was, one of comfort than cure. The family was quite keen to explore options for cure, but what she was asking was for comfort and care. The health care systems they have been to, including ours is not built for comfort or care, but for cure. Comfort for an elderly is, the family around, people to care for her and basic amenities taken care of. She was not sure, once she goes home if she will get the comfort she was experiencing to some extend, in the palliative care ward where she was. But even what was being provided was not enough. Institutions do not allow family to be around to provide care and comfort in a hospital context. We want less disturbance to do the curing. We want all the relatives (other than may be one) out during rounds and nursing care. This is best provided at home, but will Medical care be possible in a village context where the nearest health facility is a few kilometers away, and even if available has no systems to provide support? So the next best was to remain in the hospital!

But care and comfort is not enough. Just before seeing this lady today in the ward, I had a call with a close relative in the geriatric age group. He was telling me, everything is fine, I am cared for, and I have all the comfort I require, there is nothing I lack. But one thing is missing. I asked what it is, he said purpose. He said, I still want to contribute to the big picture of what God is doing (not these words, I am paraphrasing) but I do not know how I can. I cannot write, my thoughts are not clear, mind is not clear to pray for others, and so I get disturbed. Contribution to the world and purpose is yet another issue which seems to be missing in all our health care systems to the elderly. These discussions were with person who was being well cared for at home, but somehow in setting up systems of care and comfort, we had no idea how to address this key issue, the issue of contribution.

There is another lady in the ward, of geriatric age group again, who had consumed poison. We see daily two to three attempted suicides, but all in the younger age group. This was the first elderly patient I had seen, who tried to commit suicide. The attending doctor told me, that the children had taken control of her property and divided it between themselves. Though she was living with one of the children, she felt lost. Her control was gone. There was a feeling of losing control, though she was still contributing in whatever way she could to the family and grandchildren.

Another lady was brought to OPD by her son. She was agitated, restless and was not sleeping at night. Her son complained, we have a 52 member house hold – joint family, and she wants to know everything what is happening. She wanted things done the way she thinks. Things have changed from her days, but somehow she is not recognizing this, what can we do. She has her room and things to do but this is not enough for her, we are lost how to help her. Give her some drug to sleep. She was agitated and restless because she was confused. She was cared for, she had her area of contribution, but area of control had been limited. And the way her sons and daughters were managing, was not acceptable to her. 

How can one, give comfort, help to contribute at the same time, address the issue of independence and freedom by providing avenues for elderly to be in charge of some things which they can?

And all these are possible, if there is a larger community one is part of. The caring, the comfort, the contribution, the control, and clarity in midst of confusion, but where is this community in today’s context?

To live well in one thing, to age gracefully in yet another matter, but to pass on in comfort and with the assurance that the life, till end was one of meaning and significance, is a greater thing. What would it take to create such communities of caring and living together….?