For me, it was always Geriatric Medicine. Therefore, it came as no surprise when I discovered only many years later that my childhood friend in Glasgow turned out to be the son of the late Bernard Isaacs, one of the true giants of modern day Geriatric Medicine. It was Bernard Isaacs who coined the phrase the Geriatric Giants (incontinence, immobility, instability (falls) and intellectual impairment) to characterize the symptoms of varying medical and social causes amongst his patients in the East End of Glasgow. My friend left Glasgow for Birmingham in 1975 where his father took up the Chair in Geriatric Medicine and unfortunately I never saw him again. When I think back to that time now, I’m in awe that I used to play in the back yard of one of the geriatric giants – what a privilege!
On the subject of coincidences, I also discovered that the Geriatric Medicine Unit at The Ottawa Hospital, where I now practice, was actually based on the blue print of another famous Glaswegian Geriatrician, John Dall, who spent a year in Ottawa in the mid-1980’s setting up the geriatrics department at the Ottawa Civic Hospital. I knew him as a trainee in Geriatric Medicine and I have spoken to him since on several occasions. It is certainly a privilege to be able to say I work in the same unit that he was instrumental in setting up over 30 years ago.
Whilst training as a Registrar in Geriatric Medicine at Glasgow Royal Infirmary some 20 years ago – coincidentally the same hospital where Bernard Isaacs had practiced – I recall being asked a question by a Consultant Geriatrician on morning rounds, ‘what would I want to be done if the patient was my mother or grandmother?’ At the time I remember feeling rather uncomfortable with this line of questioning; after all, this had nothing to do with me or any member of my family. This was about a patient, a total stranger to me, and my role as a physician was to do my best by doing the right thing for my patient, always showing concern, whilst remaining objective at all times. I always believed that I was trained to be empathetic but at the same time reminded to remain detached emotionally. I knew it was a privilege to be involved in someone else’s care but did I have the right to become, in some way, emotionally involved as well, was that fair on my patient, was that fair on me and most importantly was that expected of my role as a physician? From time to time, similar situations would arise and I would begin to ask myself this question more, always reflecting on my role as the physician but it was not until many years later when I arrived in Ottawa did I really start to think much more about this.
I have had the privilege of meeting a number of people in their later years whom I can only describe as ‘living legends’. One such legend was world renowned Glaswegian Geriatrician, Sir William Ferguson Anderson. It was once written about him that “he had enormous empathy towards neglected old people, brought academia into the specialty, lectured across continents bringing the achievements of UK geriatric medicine to worldwide audiences, was a prolific author, championed teaching medical students about the diseases of old age, promoted community and preventive care and by his ambassadorial abilities raised the whole status of geriatric medicine”. He provided me with a tremendous amount of inspiration, as he had for so many others.
Geriatric Medicine focuses on seniors in their twilight years but the lives they previously led never cease to fascinate me. I often ask my patients and their families to share a little bit about what they were like in the past to help me begin to understand how they must be feeling now and to start to build that connection which allows for the delivery of such compassionate care. It is a privilege to hear their personal experience.
Privilege is synonymous with being a physician. It is not a right but an honour. Not for one minute over the course of the past 27 years of practicing medicine have I felt that it gets any easier. It does become more rewarding however and it’s this feeling as much as anything that I hope will contribute to protecting me from my own burnout.
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