Me: Good afternoon, Ms. Jones, Mr. Jones. What can I do for you?
Son (Mr. Jones): I’m worried about my mother. I know we’re here for her regular blood-pressure checkup, but I think she’s depressed and want to know if she can just get a little medication for it today.
It was late afternoon, the time of day when most clinicians struggle to gather their last bit of steam to make it to the day’s end. It was my first time meeting Ms. Jones (not her real name) and her son—a visit I now say was sheer serendipity. The story was pretty straightforward.
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Ms. Jones was 79 years old, widowed, and slightly forgetful, but not so much as to be a threat to anyone else’s safety or her own. She and her husband, an electrician, had raised three successful children, the eldest of whom lived nearby and had come with her for her checkup. She had a short list of basic medications: a daily aspirin, a pill for blood pressure, and a calcium-with-Vitamin-D tablet for her bones. While I could have easily stuck to the script of the scheduled visit and given into what Mr. Jones asked for, the body language and distance between mother and son demanded something more.
Me: OK. Well, how about we talk about what’s going on?
Mr. Jones: She’s depressed. She just doesn’t want to go anywhere anymore. She doesn’t want to do anything anymore, and it’s just not like her. I know she needs medication. I think most people do at this age.
There’s an old saying that, between two people, there are always three sides to every story: his side, her side, and the right side. His side was that, when it came to family functions that she had, for years, enjoyed and even helped plan, his mother’s answer lately was a resounding and resolute “No!” When it came to exercise, such as taking Zumba classes at the local senior center, her answer was “No.” And when it came to get-togethers with neighbors in the community, her answer again, quite predictably, was “No.” All in all, her days were starting to add up to nothing; and nothing, in Mr. Jones’ estimation, meant depression. He and the rest of the family were sure of it.
Her side was quite the opposite. Her days did add up to something. Every morning she got up and made breakfast, the same way she had done for all 36 years of her marriage, even though, now, she was only cooking for one. After breakfast and maybe a Sudoku puzzle or two, she crossed the street and headed to the nearby park. If she remembered her container of day-old bread, she would feed the birds, and if not, she’d simply sit, quietly reminiscing through one or another memory of her husband, the children, and their old friends. From time to time, she might bring along her crocheting, if the weather was nice.
By 2, before school let out, she’d start making her way back to her apartment to catch her favorite afternoon game shows on cable TV. Sometimes, depending on how good the reception was in her apartment, she’d pull out her “transistor” radio and tune into the AM station, where she’d find a treasure trove of nonstop, swing-style jazz. In her mind, and in that soft afternoon space, she remembered every skirt that had swung too high when they danced, every kiss that had lasted far too long. It was true she had no interest in get-togethers, no desire to go to the senior center for exercise classes, and surely no interest in community goings-on. No matter what it looked like to the rest of the family, and whether they believed it or not, it didn’t add up to depression, and there was nothing more that she wanted to hear or say about it.
Despite popular opinion, clinical care of elderly people is not much different from that of any other population. There are signs and symptoms to listen for, specific tests to order, and treatment options to consider. There are medications to prescribe, and adverse reactions and side effects to monitor. What makes older members of society unique, however, is their vulnerability.
In a world dictated by 15-minute slots, addressing vulnerability as a clinician is no easy task. Helping relatives understand the very natural changes associated with aging takes time and skill. What was missing in this equation was the third side. Mother and son were in the midst of trading places, and they needed help in finding balance. Ms. Jones needed to acknowledge the validity of her son’s concerns. Mr. Jones needed to understand differences between true depression and natural developmental changes. And, to pull this off successfully, I needed to carefully set the stage.
Me: Ms. Jones, so what is it that you don’t like anymore about the family get-togethers, and why don’t you want to go?
Ms. Jones: I just don’t want to. All they do is gossip and talk about stuff I don’t care anything about.
Me: Who are “they"? And what do they talk about?
As Ms. Jones explained it, “they” were a series of husbands, wives, grandchildren, and great-grandchildren whose lives centered around Facebook announcements, Instagram photos, and round-the-clock text messages, transmitted via a bunch of gadgets they never seemed able to put down. They danced to music that was nothing more than noise, as far as she was concerned. And what little conversation they did have always centered on speculation about celebrities, politicians, and issues that had nothing to do with their day-to-day lives. While Ms. Jones had always been in reasonably good health—with the exception of the blood pressure—many of her lifelong friends had not been so lucky and had long since passed away. The people at the senior center weren’t people that she knew, had any relationship with, or even cared about. In a word: Every moment spent with any of them was a moment disconnected from the life she once knew.
As with most clinical visits with adult children and their senior parents, the remainder of our time was centered around helping Mr. Jones remember the passage of his own developmental stages so that he could better understand his mother’s—stages marked by his pulling away from family, outgrowing certain interests, losing friends, and making new ones. And, of course, there was the inevitable post-college experience of starting a family, with a life full of new interests, passions, and opportunities to make memories of his own.
We talked about the sadness associated with outliving friends and finding oneself alone in a world entirely different than one has known. Rather than concluding all that his mother needed was another medication, we talked about activities and outings that might help her remain connected to fond memories she seemed determined to hold onto. Surely trips to museums and libraries, where time stands still, would be far more therapeutic than any pill could ever be.
Slowing down long enough to trade places with our seniors is not only good clinical care; it’s a much-needed act of compassion. Our task as nurse practitioners is to remember that our work is far more than pumping out prescriptions on demand. It’s holding space for discussion and clarification. It’s ensuring that the care we give, particularly for older adults, is safe and sensible. And more than anything, whether we understand it or not, it’s about protecting the health of those who are most vulnerable and honoring their right to hold onto a personal meaning of life.
For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those the promote products or services will not be posted.
