Vermont Medicine Magazine

It wasn’t that Hodgkin’s lymphoma was a familiar condition to any of us or wasn’t interesting medically. Rather, I think what put us off was the patient’s age: the same as ours. It was way too scary to contemplate that someone our age could be facing serious illness and possible death. It was much easier to keep mortality at bay if we were taking care of people our grandparents’ age.

Forty-plus years later, I still work on the medical wards, now as an occasional evening-shift hospitalist, admitting patients from the emergency department. On a recent shift, three patients I admitted consecutively reminded me of my reaction to the young patient in 1979.

The first was a man wearing a turquoise choker and a gray ponytail. He wouldn’t have looked out of place at an Eagles reunion concert. He had newly diagnosed diabetes and pancreatitis, and his birth year was 1955. He was uncomfortable and vomiting and gave terse replies to questions.

The next was a man with high blood pressure and new stroke, which left him aphasic. He was born in 1956.

The last was a man with a history of prostate cancer surgery, now with leg cellulitis. He was born in 1954, the same year as I was. We chatted about which high school he had attended and the bakery truck he now drove. I asked if he got free samples. When I questioned him about alcohol use, he said he had four to six drinks a night. I asked if he thought that was too much, and he said he reckoned so and was thinking about cutting back. I asked about depression, and he said the hormone treatment for his prostate cancer had taken away his sex drive and that made him sad. We talked briefly about the various treatments available to him.

At the end of the visit, I asked the usual “Any other questions?” and he said, “Well, actually I was wondering—is this your normal job?” I wasn’t sure what he meant, but I explained that I was mostly an administrator now and just helped in the hospital occasionally. He said, “Because you seem different than the rest.” I laughed and replied, “Yeah, I’m a lot older than they are.” He said, “Well, yes, that—but talking to you was more like a conversation.” I wasn’t sure at first if he thought I had been too casual, and therefore not professional, but he seemed to mean it in a positive way, so I thanked him and went on to do more admissions.

Later, driving home at 2 a.m., I thought more about our interaction. Was he more open with me about his drinking and sexual issues because I looked like him? We would have the same cultural frame of reference—growing up watching The Man from U.N.C.L.E. and The Monkees while LBJ was president. Would the 25-year-old me in 1979 have had the same rapport with a patient born in 1914? I think not.

There was a lot I didn’t know in my early years. Watching my father die from cancer in hospice in his 80s and my mother’s slow decline from Alzheimer’s until her death at 95 taught me more than any continuing medical education lecture I can now recall.
But that evening shift brought home to me the ever-narrowing gap between my age and those of my patients. All the folks I admitted that night could easily be on the guest list of my rapidly approaching 50th high school reunion.

Even as, one by one, my peers, neighbors, and cousins begin to manifest the frailties and ailments of advancing age, I have endeavored to keep my blinders firmly on, forging ahead, not allowing myself to hear the approaching drumbeat of mortality. My instinct to push away thoughts of my vulnerability hasn’t changed much since 1979—it’s still hard to see myself as old enough for Medicare Part A, and I can’t really imagine being seriously ill or dependent.

Now I am increasingly aware of my precarious position as I sit by the hospital bed, taking a history. I am outside the bedrails—for now. I’m healthy, but the odds of tumors or Parkinson’s disease or a catastrophic stroke relentlessly increase with age. I am not exempt.

Deep down, I know that sooner than I want, I will be lying in a hospital bed being interviewed by someone much younger than I. I just hope it’s a conversation.

---

Sean Stitham, M.D.’80 practices in the Seattle, Wash. area. This essay was originally published in the June 3, 2021 issue of the New England Journal of Medicine. Reprinted by permission.