90 is the new 30

Lipari, Steven

The case seemed straightforward: a man broke his right ankle after a skydiving jump. He had surgery to repair the fracture and was returning home for rehabilitation. I was to handle the transfer. It seemed like one of the many necessary, but largely clerical tasks that consume our time in practice.

As I read through the patient’s chart a piece of biographical data jumped out at me. It made this a case of recreational trauma unlike any other.

The patient was 95 years old.

Mr. Smith was on his fourth, but highest jump, at 14,000 feet. He leapt from a Cessna with his grandson.

“I guess I just hit the ground a little hard,” he explained sheepishly.

“Have you broken any bones in the past?” I queried.

“Yeah, I broke the other ankle last year.”

I asked him how it happened.

“I fell off my motorcycle,” he responded with a sly smile.

Mr. Smith was most concerned about a new onset of difficulty voiding. He explained that he needs to have both feet flat on the ground before he can urinate. With his leg cast, he can’t plant his right foot.

“Is this the first time you noticed that you have trouble urinating?” I asked.

“Well, I discovered this problem when I was scuba diving below the ice up north a couple of years ago. Most people pee in their wet suit while diving. But I couldn’t, so I had to propel myself to the ocean floor, sweeping my arms upward, so I could stand upright before I could go!” he said with a self-deprecating chuckle.

Mr. Smith has atrial fibrillation. He took his warfarin before the jump.

“Mr. Smith, do you understand that you have a high risk of bleeding when taking this medicine before jumping out of an airplane?”

“Oh, yeah. But I forgot. Anyway, if I die skydiving, what a way to go,” he answered shrugging his shoulders.

It seems even Mr. Smith wasn’t immune from a “senior moment” that prevented him from taking anticoagulation meds before willingly plummeting from the equivalent height of the tallest Rocky Mountain peak.

All too often in medicine we are confronted with the saddest stories. Recently, I looked after a 43-year-old man who died due to advanced MS that prevented him from swallowing. His power of attorney declined a feeding tube. The patient, who had no family of his own and suffered from major depressive disorder, died unable to move, with no one at this bedside.

Another man was admitted with metastatic disease after he was failing to cope at home. He suffered from severe bone pain, anorexia and weakness. His wife had advanced Alzheimer’s disease and his primary caretaker was his daughter. She was undertreating his pain and absconding with his opioid medication. His daughter was using the opiates herself while trading sex for drugs. Suspicious men were visiting the home at all hours of the day and night, making my patient feel unsafe. He fled to the hospital out of desperation.

It’s hard to share our patients’ narratives with people outside of medicine, not only because of confidentiality, but also because the devastating nature of these tales doesn’t making for pleasant mealtime conversation. While I feel privileged to help people in a direct and intimate way when they are most vulnerable, their apparent unjust suffering weighs heavily on my heart. It is an all-too-familiar experience with elderly patients in particular, who rarely present with stories of inspiration, lightness and good cheer.

Then came my encounter with Mr. Smith.

It was so uplifting to meet this gentleman who does more - and with more joie de vivre - than most 30-year-olds. All too often I find myself dismissing elderly patients, conspiring in conventional thinking that seniors aren’t candidates for certain procedures. I just instinctively assume, without really pondering it, that they’ll be too fatigued or too weak, or just too “old.”

That has changed thanks to Mr. Smith.

I’m just a fraction of his age, but I have never even tried skydiving, riding a motorcycle or diving below sea ice. Nor do I intend to.

So I have to ask myself: Which one of us really is “older?”

As I reflect on that, Mr. Smith - now fully recovered - is planning his next jump.

Theme: Health Care Delivery | Prestation des soins de santé
Theme: Patients

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.


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