The Grapevine Art & Soul Salon

Carolyn Cook: An Open Letter to a First-Year Medical Student

Dear Friend,

Thank you for choosing to be a doctor.

You have an arduous journey ahead, of study and internship and residency and specialization and long hours and grueling schedules. I don't envy you one bit. I hope you help lots of people and make lots of money and one day have a lovely home and a cabin on a lake so you can finally relax.

In the meantime, I have a favor to ask.

Please, if you can find it in your heart, go into geriatric medicine. And change it.

The elderly population of this country is going to explode in the next twenty years, and the chances of anyone over 85 getting dementia are about fifty-fifty. Pretty soon there will be millions of people out there with dementia, and millions more middle-aged people trying to help them, not to mention the millions of rational octogenarians trying to help their demented spouses. We need doctors, and we need them to understand.

Take my mom and me, for instance.

If you do become a geriatrician, please understand that when I come to your office with my mom, I've had to convince her to go to the doctor, which she doesn't want to do because she's from the greatest generation (whatever that is) and she is not supposed to get sick. It took work to get her to you. So you have two people in your office who need your help.

Please understand that she can't tell you exactly what's going on, even though she sounds utterly articulate, because she can't access information in her brain the way she used to. She says what she believes is true, what she thinks you want to hear, or what makes sense to her in that moment. If her knee is bothering her, she might tell you she remembers falling, and you might diagnose a bruised knee and send her on her way. But she believes with all her heart that she fell because someone tripped her, and she can name this person, and she can tell you that this person cursed her out for getting in her way and left her lying there in pain.

And that may be true. But it's probably not, because (a) no-one would do that, and (b) it's the same story she uses to explain the arthritis in her finger and the pain in her hip. She will tell you with a straight face about the time she was knocked down and left on the ground with a broken hip. But she has never had a broken hip. Really. I think I would know. So that bruised knee diagnosis might not be accurate.

You're right to take her seriously, look her in the eye, and treat her as an adult. She is your elder. Please, do be kind to her. She's been on this earth many years. She has had a career and a marriage and three children, and has excelled at everything she has done. (I'm not exaggerating. Even her hobbies have been brilliant: just look at the framed needlework on her walls.) She nursed her own father through heart disease and was with him when he died. She nursed her mother through dementia and was with her when she died. She nursed my father through cancer, and you guessed it, was with him when he died. She is my HERO. Respect her.

But respect me too. If I'm looking over her shoulder and mouthing the word “dementia,” find a reason to step out in the hall and talk to me. Set up your office or your examining room for that. I don't know how. Let's figure it out. Let's reinvent this thing.

Work with me. I'm with her a lot, and I can help you decipher her meandering stories. I can tell you what drugs she's on, and when she eats, and how to notify the assisted living staff about a change in medication. I can be your partner. I have a keen eye and a level head (most of the time), and I'll help you if you'll listen to me. One more thing you should know, though. Just a little perspective:

I am watching my mom slowly die, slowly disappear, slowly become a person I barely recognize. She's scared, and I'm scared. She's my mommy, the first warmth I ever felt, the first body to embrace me, the first drop of milk in my mouth, the first to stand me on my feet and say, “you can do it.” And she is disappearing. When she's scared, or angry, or hurt (which she often is, because she's losing impulse control and executive function so it's hard for her to calm herself), I want to make things right. I want to move mountains to make my mommy happy again. It's not just that I admire her and care about her well-being. I do, but it goes deeper. At some gut level, I am still that tiny child she cared for, and if her world is not safe for her, then my world is not safe for me. If Momma ain't happy, ain't nobody happy. I know I'm a grown-up now and have all kinds of agency, and I know I'm safe and secure and have money in the bank. But the three-year-old who lives in my body and chatters away in my brain is terrified, because Mommy is not okay.

So, dear friend, dear sojourner on the path of healing, I need you. I need you to understand. I need you to reassure me that you get it. I need you to return my calls, to listen to my worries, to trust my instincts. If you will be my partner in Mom's care, I will calm my inner three-year-old and work with you to find the best path forward through the threadless labyrinth of dementia.

Geriatric medicine. The care and keeping of old people.

It's not glamorous work; it won't get you a Nobel Prize or a prestigious job at a research hospital. But it will help my mom, and millions of people like her, live decent, dignified lives. And it will help middle-aged children like me breathe easier, knowing that their loved ones are getting the care they need. It's a high calling. Think about it.

Good luck with medical school, my dear. Get some sleep; eat healthy meals; laugh. I wish you happy times, true friends, and much success. And about that cabin on the lake: be sure to put some rocking chairs on the front porch.

Because God willing, someday you too will be old.

The post is reprinted with permission from Carolyn Cook, whose blog Lifelong Metamorphoses is located at http://lifelongmetamorphoses.wordpress.com/.