Karen Hitchcock’s essay Dear Life: On Caring for the Elderly is compassionate, respectful and beautifully written. As a study of ageism in our society, it is also seriously scary.
The author is a physician who works in a major Melbourne hospital. Her patients are mostly elderly. She has a Doctor of Philosophy Degree in Writing and is the author of award-winning fiction.
In this important essay, Karen Hitchcock conveys the sense that exists in our society of the hopelessness of old age. She suggests that this may be because younger people do not want to confront their own mortality. Perhaps they see their future selves in the elderly.
‘My chief aim is to strike a note of caution and to make explicit something that often remains unsaid and yet can be heard quite clearly: that the elderly are burdensome, bankrupting, non-productive. That old age is not worth living.’
Karen Hitchcock writes realistically about the problems of ageing. She writes also about the difficulties faced by health professionals who are confronted with sick old people. Ageing people who present at a hospital for treatment often have more than one physical problem. Often, too, they have complex social needs.
Ever increasing specialisation within the medical profession means that doctors focus on their own micro area of expertise. Patients presenting with ‘multi-morbid’ conditions can set off what Karen Hitchcock calls ‘turf wars’. Many specialist doctors do not want to take responsibility for these old men and women and their multiple problems.
‘What if you come with two or three or four organs failing, and can no longer negotiate your stairs to go and buy food? What if your disease won’t fit into a fragment? Who will be your doctor?’ she asks.
There is another perceived problem that results when aged care facilities send ill patients to an acute hospital. Karen Hitchcock quotes one surgeon, who said: ‘It’s ridiculous: none of these patients should be treated. None of them.’
I once worked as a registered nurse in an aged care facility. I remember cringing at a barrage of abuse from a hospital registrar. I had dared to send an old woman who had experienced a heart attack by ambulance to ‘his’ hospital.
Some hospitals do manage to care very well, for elderly patients. Others are ‘overstretched, underfunded and caring for far too many patients’. Always there are ethical, fiscal and humanitarian problems about treating the elderly.
The essay discusses aged life that is worth living. It touches on euthanasia. It discusses advanced care planning. This involves the health care system’s plans for an elderly individual with chronic disease. Hitchcock also writes about Advanced Care Directives. These include a person’s instructions for their own end-of-life care.
There are major structural problems in the health care system when it comes to caring for older people.
But Karen Hitchcock offers a glimmer of hope. She manages to show another, dignified side of ageing, illness and death. Anecdotes about her much-loved grandmother, as well as those about some of her patients, are full of warmth and understanding.
As an avid reader of Karen Hitchcock’s regular essays in The Monthly, I expected Dear Life would be engrossing. It did not disappoint. This is a learned essay. It is also easily accessible to the lay-person.
Quarterly Essay No 57, Dear Life: On Caring for the Elderly, by Karen Hitchcock, rrp. $22.99.