Sure, performing CPR after cardiopulmonary arrest on a frail man in his late 90s was likely to be an exercise in futility. And, in retrospect, we should have been more aggressive at the nursing home about suggesting he change his status from?full code? to?do not resuscitate.? But that wasn?t the main reason this man?s death continued to gnaw at me.
My patient was gay, and as a gay geriatrician I had felt a connection with him unlike any I?d had with my other patients. We never directly discussed his sexuality; initially, I only knew that he was a lifelong bachelor and a retired history professor who had taught for many years at Emory University in Atlanta.
In time, as he let his guard down, I learned that what he considered his life?s work and true love was the restoration of the historic farmhouse he owned in rural Georgia, where he had an enormous garden that was his pride and joy. Eventually, this World War II veteran told me about his postwar years as a graduate student in Chicago, where he formed close relationships with a few other men.
He never had a long-term relationship, though, and lived alone for years. In the few months that he lived at our facility, the only family member I talked with was a niece who lived out of state.
What bothered me most was that this kind, erudite and generous man had died alone.
As a geriatrician, I?ve come to learn a bit about people?s fears about growing old and dying. I most often see it in my patients? family members, but I think that it exists in all of us to an extent. Physicians feel it, too. This unease may be one of the reasons the number of geriatricians is decreasing even as there is an acknowledged need for more providers who are proficient in the care of older adults.
Growing up suspecting I was gay, one of my greatest fears was to end up alone. When I came out to my parents, the one aspect about being gay that most worried my mother was the punishing solitude that she thought I would face as a gay man in the world. Life had other plans for me, however. I now have a husband and two beautiful young children, and in a bustling household like mine, finding some time alone is more often a blessing rather than a curse.
Maybe my strong connection to this patient was related to the guilt that I felt about my generation?s relative good fortune in having the freedom to come out and be honest about our lives, and the ability to lead them to their maximum potential. Gay men in my patient?s age group largely did not have this luxury.
We know now that older gay, lesbian, bisexual and transgender people are morelikely to be isolated sociallythan their heterosexual peers. They tend to be childless and may be estranged from family members, and often live with the enduring stigma that came with being anything but heterosexual in generations past.
Connectedness and a sense of community are vital human needs that, if anything, become more important as we get older. But by virtue of their frequent social isolation, many older gay people may be more likely in their later years to have little access to the very social networks that are important factors in successful aging. So, in a way, being old and gay can concentrate the biggest fears that many of us have about aging: that no one will care for us, and that we will die alone.
What can health care providers do to help? The task is complicated by the fact that these men and women may be all but invisible to us. Even people who were able to come out may find themselves retreating into the closet when they are forced to move into assisted living facilities ornursing homes. Health care providers must remember that just because a patient is old, he or she is not necessarily heterosexual.
With that knowledge in mind, we can be more respectful of the diversity of relationships that all our patients, gay and straight, hold dear.
I know my patient lived a rich and rewarding life, and it did not seem to me that he was anguished or regretful in his last days. But the story of how he lived his sexuality is not an unusual one for men of his generation. As my practice evolves, my hope is to meet more gay, lesbian, bisexual and transgender patients who are able to choose the relationships they want and who feel comfortable sharing their lives with me as their doctor.
Dr. Manuel A. Eskildsen is a geriatrician and an assistant professor of medicine at Emory University.
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