Rage, Rage Against the Dying of the Light (Dylan Thomas)



They come into the ED after they have fallen down and can’t get up. They don’t eat or drink for a few days, a week, then get dehydrated and can’t take care of themselves.

They forget to turn off the stove. They leave the keys in the lock to to the outside door. It becomes too hard for them to bathe, so they simply stop bathing. They run out of food, but they don’t remember that one must go to the grocery store to buy more.

Email, their lifeline to the outside world and the family members that live in it, suddenly becomes stange and difficult to understand. Hitting the keyboard and yelling at the beige box become the only way they know how to express their frustration.

One glass of wine becomes two mixed drinks a night becomes half a bottle of wine becomes a fifth of liquor. The overt withdrawal symptoms seen in the emergency department are unexpected in a woman in her late seventies whose substance abuse history is “Not Applicable”.

The elderly account for a large number of visits to the emergency department each year. They come for falls, trips, slips, bruises, congestive heart failure, accidental poisonings, depression, confusion, and urinary tract infections. They have heart attacks, strokes, trouble breathing, headaches, visual hallucinations and chronic constipation.

They can be delightful people who bring a smile to the faces of their caregivers in the ED, or they can be someone’s worst nightmare (family or staff). They can command instant mobilization of resources, by virtue of the frightening acuity of their presenting symptoms. On the other hand, they can easily get lost in the shuffle and be pushed, literally, into a corner while squeakier wheels get the grease. 

Seeing elderly patients in the ED brings forth many emotions in me. I have pictures in my mind of family members, friends and patients from the past who inform my responses to the person in front of me. I won’t belabor the fine points of evaluating an elderly person with changes in mental status here, but I will share some insights with you that I have gleaned over the years. 

Old people have a lot to share. Youngsters, and even us middle-agers, sometimes tend to treat our elders as if they have given their best years and brightest ideas up and are just coasting through the rest of their lives. Not so. They are often very bright, very attentive to their surroundings and have much to say about the world around them. 

Old people tell great stories. No, they don’t do it in 140 characters or less. No, they don’t do it by embedding YouTube video clips in the conversation. They do it the old fashioned way. They paint delightful word pictures filled with satin and lace and fragrant hay fields and fishing ponds on a summer afternoon and tales of “the one that got away”. Be prepared to stay awhile. You can’t tweet a masterpiece. 

Old people remind us of where we’ve been. My own relatives, as they aged and faded out of my life, would often let me know that I shouldn’t forget where I came from. It was good advice then, and it’s especially good advice now, as many of us struggle for meaning in a cacophonous world.

Old people remind us of where we’re going. We will all age. None of us will get out of this alive. We can choose to ignore the wisdom that our elders have to impart, but at our peril. One day, we will be the one in the wheelchair or softly restrained to the gurney, trying to get someone’s attention. 

You are one day older today then when you read my post from yesterday. How will you age gracefully today? What will you learn? What will you give back?


“It`s not how old you are, it`s how you are old.” 

Jules Renard