Monday, 3 March 2014

Please don't call my father "darling"


This post is a bit of a departure from previous themes and reflects a very current and ongoing preoccupation of mine – eldercare. My 90 year old father (we’ll call him Tom Walker here but that’s not his real name) was until a month ago, living at home on his own. My mother died nearly 5 years ago and none of us could have predicted Dad’s adaptability in the face of the loss of his partner of nearly 60 years. Whoever said you can’t teach an old dog new tricks hadn’t met my Dad. Whether it was learning to use the microwave (yes, really...) or making new friends in a community he had only moved to three years earlier, Dad has consistently demonstrated that aging and adaptability can live comfortably together, and indeed can complement each other well.

In recent months, however, his physical health and capacities have declined, in the face of robust cognitive skills, an observant wit and a remarkably intact sense of humour. His physical mobility is limited, he has severe macular degeneration and a range of medical problems. About a month ago, he became acutely unwell and needed to be hospitalised, always a reminder to me of how fortunate we are in Australia, in spite of the many legitimate criticisms that can be levelled against our health system. At 90, he was taken by ambulance to the Emergency Department of our local hospital, where he received first class attention and responded well to the care he received there. He was subsequently transferred to another facility, (a happy “perk” of his veteran status) and remains there now awaiting longterm placement, as he has exercised his good judgement that going home is not a wise move. So far so good, and I reiterate that we are very fortunate in many respects – we live in a first-world country and his medical care has been of a very high standard (bear in mind this is a man who has survived several heart attacks, two lots of quadruple bypass surgery 20 years apart, and is on his 7th pace-maker). 

There is one aspect, though, of his care that has consistently jarred with me (and, it has to be said, with him) and that is the condescending manner in which many nursing staff speak to him. I am sorry to single out nurses here, but after a month’s observation, at different times and on different days, this is not a behaviour I have observed in medical or allied health staff. That’s not to say those staff are not sometimes also “guilty” and nor is it to say that all nurses interact in this way.

However, my father’s name is not “darling”. And it’s not “sweetheart” either. 

His name is Tom – or failing that, “Mr. Walker”. It’s written on a whiteboard next to his bed, so even a busy or distracted clinician needs only to glance at this on the way in.

At what age do patients lose the right to be referred to by their name in hospital?

It’s perhaps a small thing, but the use of people’s names (seems to me at least) to signal respect, and is a small nod to the idea that the person in the bed or the chair is indeed an adult person, not just another elderly, grey haired patient whose birth date is suggestive of a pre-historic era. And nor is this person a young child.

And while I’m on the topic of respectful communication, why do (some) nurses address their questions to Tom via me? For example,  the other day when he was lying in bed and I was sitting nearby, a nurse entered his room, turned to me and asked “Does he use his footstool”? I was both irritated and bemused by this – irritated because Dad is more than capable of answering the question and bemused because I was the least qualified person in the room to answer it – I spend about an hour a day there, but have no idea what goes on for the other 15 or so hours that he is awake. The nurse in question was visibly surprised when I politely suggested that she should ask Tom. 

I’ve also noticed that there’s a default assumption with elderly patients that they must be hard-of-hearing, so staff come up very close to Tom and shout. The only problem here of course is that he isn’t hard of hearing at all. I’ve lost count of the number of times I have interjected and politely pointed out that he is not deaf – often to be met with a blank look and something along the lines of “Oh, most of the oldies here are deaf, so we just assume we need to raise our voices”.  Or “I’m 32 and I’ve had a loud voice all my life, so I’ll always have a loud voice” Really?!

Most of the little communication touches that patients of all ages appreciate probably come back to something as simple as respect, and the capacity to consider an interaction from the perspective of another person – in this case, a physically frail, but mentally able older person.  I could recount several other examples of missed opportunities to communicate respectfully, but I don’t want to labour the point. Dad and I both notice not only the ones whose manner is condescending, but also those who are genuinely warm and show a personal interest in him. Happily there are many in the latter category

I do find it ironic though, that because of his poor eye-sight, Dad can’t read nurses’ name badges, but he always asks them their name, and goes to great lengths to mentally rehearse, and then to use their names, e.g. when he is thanking them for assistance. 

I guess we can only hope that his light-touch role modeling will rub off on some. I need to believe that things will be better for the aging baby boomers. 

© Pamela Snow 2014

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