Recently, I had the occasion to make one of my very infrequent trips to the emergency room. As always the case to date, I get to walk out afterwards, after a very long period of hurry up and wait. Not everyone is so fortunate. One of the things one tends to find in emergency rooms is old people. So many more of life's slings and arrows become an emergency when one is frail, and old people are increasingly frail. Fall over? Emergency room. Sudden infection? Emergency room. And so on and so forth.
Nurses and doctors are inordinately overworked, and there is a long backstory to this state of affairs in which the American Medical Association, generations of regulators, and hospital owners all play the villain in turn. Emergency rooms are a great place to watch the consequences of this in action. A hospital as an entity is caring in the aggregate. There are formal systems of triage, but a great deal more informal triage based on which of the human wheels are presently squeaking. People fall through the cracks in ways large and small.
Waiting is what one does, largely, in an emergency room. A great deal of waiting. Particularly if one walks in and has every prospect of walking back out again. The older woman across from me in the waiting room did not walk in. She was in a wheelchair, and frail to the point at which walking was out of the question. She was alone. The nurses had wheeled her out at some point after intake, and there she was, waiting like the rest of us. In her case, increasingly unhappy in the stoic, quiet way of the elderly. The nurse had left her bag slung over the back of her wheelchair, in such a way as to be inaccessible to a frail older person, unable to apply the modest amount of strength to turn and lift it over. Trivial for you and me, impossible for her.
It was hard to tell that she was unhappy. It didn't show in her face. But after a few times of noticing that she tried to tug at the bag strap, and with no relative or friend in evidence, left alone, I went over to offer assistance. Perhaps others there might have had I not, but none did. I lifted off the bag, put it carefully in her lap, and left her to it. She rooted around, took out slippers and dropped them to the floor - which may as well have been on the other side of the ocean for her, inaccessible, and beyond reach. Then found her phone and started working with it. At least a frail person has that!
Unfortunately that turned out not to be the case. A little while later she caught my attention and asked me to call her house. She was difficult to understand, in part because of accent and the COVID-19 rules that lead to everyone still being masked in hospitals, but any conversation was difficult for her. She did not say much, and was slow with what she did say. It wasn't always clear that she understood me. Still, she gave me a number, and I called it. It was out of service, I told her as much, and she seemed to grasp why it wasn't working for me. She then fumbled with her memory, half-trying variations on the number, but not completing any of them.
I asked about her phone, a modern iPhone. Did she have the number in her address book? The phone had a lock code, the usual panel of numbers to enter. She tried that, as she had been, and the phone promptly locked her out for five minutes. Modern security at work. As we waited for that timer to complete, I talked to her, retrieved her slippers and put them on, as she indicated that this was desired. She did not really respond meaningfully to much else of what I said. At one point, she told me clearly that she did not feel well. I flagged a passing staffer and asked him to find someone, and nothing came of that by the time the phone was accessible again. Caring in the aggregate!
I watched her try to enter the phone code again, and she did it in a way that strongly suggested that she did not recall the code at all, or was perhaps not grasping the nature of the lock screen, entering the numbers in ascending order until the iPhone locked her out again, for longer this time. At that point, I went to find an actual nurse myself, and wouldn't take no for an answer. To her credit, the nurse put away what she was doing and came out to see what could or should be done, and had the good idea to look in the intake records for a phone number to call.
The old woman was wheeled away, and I didn't see her again. I walked out somewhat later, the more fortunate and less age-damaged of the two of us. I am not a physician and cannot diagnose dementia, but aspects of the interaction were those of someone who no longer has the full function of their brain. Just considering the physical, she was frail to the point of being unable to support herself, but that in combination with mental deterioration, leading to no longer being able to recall a phone number or even work a modern phone, is a sobering thing to see. Left on her own, she was helpless, and someone had simply left her there.
Fundamentally, this is why we advocate for greater research into the means to treat aging, to produce rejuvenation therapies based on the most plausible approaches to that goal. No-one should find themselves in the position of the old woman I met in that emergency room, a prisoner of her own old age, a shadow of who she once was, left alone and at the whim of those who cared only when prompted to do so.