Lessons in caring from a young man dying of ‘the old man's friend’

Abstract

he description of pneumonia as ‘the old man’s friend’ is attributed to Sir William Osler (1849-1919), a Canadian physician (pictured right), who wrote: ‘Pneumonia may well be called the friend of the aged. Taken off by it in an acute, not often painful illness, the old man escapes those “cold gradations of decay” so distressing to himself and his friends.’ Pneumonia is often called the old man’s friend because, if it is left untreated, the person with it usually lapses into a state of reduced consciousness, slipping peacefully to death in their sleep, giving a dignified end to a period of often considerable suffering. The privilege of caring for people is bestowed by the public on healthcare assistants, assistant practitioners and nurses. The public trusts us to provide care that is kind and compassionate; people want to feel safe when they are in our care and they want us to respond to their individual needs. Reflecting on the ‘old man’s friend’ and what caring means to me brought me to think of a patient I had the privilege to care for in 1984. This was a man who died of pneumonia, yet he was not old, he was 22 years of age. His family had disowned him and the only people he had with him at the end of his life were the care team; he died of pneumonia at two o’clock in the morning. The pneumonia was related to a condition that was then called GRIDS (Gay Related Immunodeficiency Syndrome); this was later changed to AIDS (Acquired Immunodeficiency Syndrome). During the first decade of AIDS and HIV, fear, anxiety and ignorance were widespread among the general public and also in those who provided care. Caring for this man (this young man) did provoke fear and anxiety in me and all of this was due to ignorance; we knew little about this disease that appeared in unexpected clusters of cases of Kaposi’s sarcoma and pneumocystis pneumonia among young gay men. Having the privilege of caring for this scared, lonely, very ill man was an absolute honour. I learned so much, not from textbooks but from him, listening to his life story, his fears, his hopes. Having to carry out some very intimate, invasive procedures, administering medicine (lots of it) that we had no idea how his body would react to and having to instil hope was a challenge to say the least—for him and us. Palliative care was in its infancy in the early 1980s; people with AIDS were not admitted to hospices. And developing and nurturing a long-lasting relationship with this person was impossible, he was so ill and he died very quickly, as his immune system failed him. Caring for this man was the most challenging and the most rewarding aspect of my whole career. We have the privilege to become involved in our patients’ lives and to advocate for them, with the aim of ensuring that they receive the best care possible, with them at the centre of all that we do. Providing care that is kind and compassionate will help the person in health, wellness and illness. Patients reward us by sharing their life experiences with us and in turn this will make us better human beings. This young man died as a result of the ‘old man’s friend’, but he was cared for and loved. His life and his death have had—and still have—a massive impact on me and, I hope, on the care that I offer others. BJHCA Sir William Osler on ward round at Johns Hopkins Hospital, Baltimore, US,