Of Medicine and Nonagenarians...

Today I saw two of my nonagenarians. I love when they come to see me. You want to know why? It's because I have discovered a very intriguing lesson with these jewels of humanity. The more I do to them (ie treat them), the worse they become. That's right. I try to do as much nothing with these patients as I can. I figure that they have reached this far without me, who am I to step in and ruin their day? Case and point: Mr. L came today and complained of being tired. His wife says that he spends "20 out of 24 hours of the day in bed. I think he is depressed..." No. He is just 92 years old. I decide I will placate his wife by saying that I will try to adjust a few of his medicines to give him some more "oomph". After 10 minutes of screaming at him (he is hard of hearing of course), trying desperately to explain to him that no, the 20 mg pill will no longer be used but instead 2 and a half 10 mg pills will be substituted, I give up. I say, "Mr. L, there is more of a chance of you hurting yourself by taking the wrong dosages thereby obviating the benefit I was trying to provide. Stick with the red pill in the morning and the green pill at night." He was perfectly happy with this. You see, he didn't want me to change anything...he LIKED it just the way it was, even though his wife didn't. Some physicians would say that this isn't the way to practice medicine, but I beg to differ. After age 90, folks are on borrowed time so it all becomes more social during our quarterly visits. "Oh, what a beautiful walker you have, Mrs. J and might I add that your great grandchildren sure are getting big...." It is this artful dance we do, enjoying the conversation, knowing that as long as we don't stray too far from the current treatment plan, they may just make it another year closer to being featured on the 100 year old birthday Person of the Week by Willard Scott (if he hasn't already died himself). This way of slowly rearranging the deck chairs on the Titanic is what I call the Art of Medicine. Knowing what to do is elementary, it can be learned from any medical school. But knowing what NOT to do, now that is something all together different. That my friends, is truly the Holy Grail of medical knowledge...