On old man tears

He moved to the assisted living facility about a month ago, settling into the community nicely. He sits with some other fellows and the staff have given them the nickname of “the bad boys”. He had some sharp abdominal pains around his appendectomy surgical site and was worried about cancer. My preceptor assured him that we’ll look at it.

We asked the 85 year old veteran widower questions about safety: do any of the staff hurt you? Does anyone threaten you? He gave a spirited, “No, I’d sock ’em if they tried anything!” and we proceeded through the interview.

My preceptor works with the VA, or Department of Veterans Affairs, and performs home-care visits for geriatric and palliative care. In the past month, we’ve seen mainly veterans from the Korean War era, and they always like to tell me how much they enjoy kimchi. They are overwhelmingly male and most have outlived their spouses; uncommon for the elderly, usually assisted living facilities have a 10 to 1 female to male ratio.

Granted, I’ve only seen four patients through this VA home-based primary care program, but I wonder how much of their decline in health can be attributed to the loss of their spouse and partner. This program targets the oldest and highest needs population of veterans: those that cannot make clinic visits or that need a broader spectrum of care that includes dietiticians, psychologists, social workers, and skilled nursing visits. When an elderly veteran loses their spouse, is that when they need these services the most?

His wife of 57 years passed in February, nine months ago. When my preceptor asked him if he gets sad, I was warmed and surprised to hear how openly he said, “Yes. I cry sometimes, too.” No shame, no hiding behind guarded language. When we walked deeper into the subject, he told us how he feels sad especially when he’s alone in the small apartment.

They were hospitalized together, her for pneumonia and him for a urinary tract infection. The staff set them up in beds next to each other. He could barely recall how she turned to him and said a few words he couldn’t hear, and then died. Due to his own illness, he couldn’t remember the funeral and he couldn’t remember speaking at her wake.

He spoke with a reporter’s careful matter-of-factness. The lack of closure must have hurt. We asked if he had any interest in the women around him, to which he said “No, I can’t disrespect my wife like that.” They give him compliments and invite him to bingo, but his health issues like urinary incontinence and the memory of his wife stop him from pursuing any intimacy.

Before the physical exam, we asked him about his goals for the rest of his life: how long does he want to live, does he have an advance directive? He said he’s ready to go. His kids have kids, and those kids have kids, and those kids are starting to have kids. Without any hesitation, he told us that he’s done all he needs to do, and his wife is waiting for him.

Then, we listened to his heart, tested his limb strength, palpated his abdomen and surgical site, and asked him if he had any questions for us. He gave us a cheerful “No,” and we left him to the small apartment.

Perhaps I’m projecting, but I doubt that he imagined he would live this long. I doubt that he thought he’d outlive his partner.

Life is a long, winding trip.

Long Form Sundays

On Death Podcast

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