The Secret To Longevity
My oldest patient is 103 years old. She is a long-term resident in a nursing home, and has been there for as long as I've known her. I took over her care 6 years ago, when she was a spry 97. When we first met she nearly knocked me over with her abrasive crankiness. She was never malevolent (at least to me, she does occasionally try to hit the nurses) but she is as sour and unpleasant a character as any I've met, except for those who are actually hostile. She has no immediate family and never married. Her closest family is two nieces who support her financially (like pay for the nursing home) and make any important decisions for her and I suspect otherwise try to minimize contact. When I first met her, I thought "She's been through a lot. She's 97. She's entitled to be grumpy." Then I found out from the nieces that her personality has been the same as long as they've known her.

I’m a very idealistic kind of doctor, and I take my work seriously, so when I first assumed her care, I tried very hard to fix whatever problems of hers I could find. I was sure she was depressed, and tried several antidepressants that made absolutely no difference. She steadfastly refused to talk to the psychologists that I asked to see her. Most of the time I order lab tests she refuses, so I only order them rarely now, and I check with her first. I don’t mind people who want no medical care, but she never said that. She would tell me myriad things that bothered her, but wouldn’t accept any attempts to treat them. Finally, I came to accept that I couldn’t improve on her status quo, and that she had reached a stable equilibrium that I was not strong enough to disturb.

Compounding my difficulty in helping her was that her nieces don’t feel close enough to her (and I suspect dislike her too much) to help me make important decisions that family frequently have to make when their loved-one loses the capacity to make them for herself. About two years ago she developed a serious urinary infection for which I hospitalized her. She spent the two or three days in the hospital pulling out every IV that was inserted, trying to hide under the bed sheets, and trying to hit every nurse that came close to her. She never had the mental wherewithal to simply and rationally tell me that she was refusing further care or that she understood the consequences of forgoing antibiotics, so I had to keep her in soft restraints those few days and do things to her that she resisted at every step. I finally got the nieces to agree that if her heart or breathing ever stop (an event too happy to expect soon) we should do nothing to intervene. In medical jargon that order is called Do Not Resuscitate. At least I will spare her a week in an ICU in her last days.

Oh, and she’s pretty deaf. She called me Dr. Peen when we first met. Back then I showed her my card, to try to correct her and show her how my name was spelled, and I screamed “NO, IT’S BEAN” in her ear, but she never got it. She still calls me Dr. Peen and I’ve long ago stopped correcting her.

I see her about every two months, and do very little during those visits. She frequently only pays attention briefly, and when she’s done with me, goes back to watching TV. I last saw her about two weeks ago.

Me: Hi. How are you?
Her: [in bed, turning away from the TV toward me] Dr. Peen?
Me: Yeah. How are you doing?
Her: [with increasing volume] Bad. BAD. I WISH I WAS DEAD.
Me: I’m sorry to hear that. Is there anything I can do for you?
Her: [screaming] GIVE ME POISON!
Me: I really can’t do that. Is there anything else I can do?
Her: [Ignores me and goes back to watching TV.] - served up by Doctor Bean @ 9:03 AM