Life Lessons: laments on ageing

What non-clinical lessons have you learned while on clinical placement? Blog editor at the BSDJ, Malaikah Khan, kicks off our new series with her experiences on her geriatrics placement and how she came to terms with her fears.

As if being thrust into a clinical environment at the tender age of 20 wasn’t scary enough, being forced to face my most unexplainable fear was exactly the psychological turmoil I had expected of medical school. Beyond the unfamiliarity of new places, people, and expectations, I found myself face to face dealing with the concept of ageing. Although the clinical aspect of geriatrics was familiar to me – general medicine with a hint of polypharmacy sprinkled in – it was the mental block I had, my fear of growing old, that would hinder me on this placement.

This hadn’t come on suddenly. Throughout clinical placements, it manifested insidiously and transcended specialties. We would see lovely patients on the ward round and move on from them, only for the registrar to shake their head solemnly and point out that this patient wouldn’t live beyond three months. Patients I would wrap my arm around and guide into consultation rooms with the ophthalmologist, them going blind from age-related macular degeneration, yet extending endless gratitude and joy to everyone they met.

At the time, I couldn’t imagine a bleaker future. Being reliant on others and wracked with a medication list the size of a weekly shop receipt? Yeah, no thanks. I couldn’t see a world outside of being young and fit and able to conquer anything. Somehow, I refused to accept that that was the future destined for those of us who are lucky after all.

These views made me dread my geriatrics placement during fourth year. At its core, my visceral reaction to not wanting to grow old was a direct result of watching so many people, both loved ones and strangers, struggle with their health and eventually pass away. So, I retreated far back. I thought I could get through my placement just as well if I kept my conversations superficial and concise.

I’m not sure what, when, or how things changed, but very soon, things were different. I was looking forward to seeing patients because I could speak to them about all sorts of things. Their past experiences, professions, and skills never ceased to impress me, and it became increasingly clear that a wealth of experience can only come with time. They spoke matter-of-factly about time passing, about how inevitable it was for them to be where they are. They told me it felt like they’d blinked and suddenly, they were seventy-odd with carers coming to help them twice a day, but that there were no regrets after living the exciting lives they’d lived.

I realised that my fear for the future detracted from the present moment. I asked myself if I wanted to be young and silly forever, and if that was a more exciting prospect to me than to become older and wiser.

Above all, it struck me how almost every wish that someone had expressed for their death had been afforded for them. I thought it was easier to die than to live in difficulty, requiring so much attention from those looking after them, but the thought and care that went into looking after every patient was beyond what I could imagine. The lengths to which patients’ wishes were honoured astounded me every day. The compassion in the hands of every member of the team reminded me there is little to be afraid of.

It was on this placement that I learned how much medicine is an art as much as it is a science. It was a privilege to help with caring for people in their last moments of life. Fears do not disappear overnight, but four weeks of befriending the only people who could help me grow out of this fear certainly helped.