The Aged in Medicine are Orphans as Well

boy and girl eating on table



My job is increasingly that of geriatrician. Emergency departments, if we believe the stories in the media, are places where one finds fascinating poisonings, multiple gunshot wounds, endless cardiac arrests and (if certain television series are any indication) nearly endless romantic entanglements and supply closet fondling.

While there is some of that. Well not really the last bit…hospitals are gross and who’d want to do that there anyway? While some hospitals have more of the ‘exciting stuff,’ than others, much of what I and my amazing colleagues do is treat the injuries and illnesses of a rapidly aging population.

Although that may sound mundane it really isn’t. As humans live longer and medical science advances, managing the infections, heart disease, lung disease, stroke, fractures, head injuries and other assorted travails of the elderly becomes ever more complicated. Indeed, we’re getting better at it. We’re just not so good at adding quality of life to quantity, but that’s another discussion for another day.

We also do more than manage the medical issues. Every day, every night hospitals have to deal with the social crises associated with aging and infirmity. Whether it’s how to arrange home health after a broken arm, or where to place the confused and violent patient with dementia, there are few easy answers as skilled nursing beds fill up, neurologists and psychiatrists are few and far between and perhaps most poignant of all, men and women are aging all alone.

Whether this happens because they had no children, lost their children to disease or injury, or are estranged from their families, it comes to the same. Many seniors with disability or chronic illnesses have no advocates and little hope of flourishing in their later years.

As I was contemplating this I had a minor epiphany. And since it’s almost Sunday, I’ll throw in some James (brother of Jesus).

“Religion that God our Father accepts as pure and faultless is this: to look after orphans and widows in their distress and to keep oneself from being polluted by the world.” James 1:27

That seems fairly straightforward. It’s a statement free of politics. (Unlike so much that comes from my fellow believers in these dark days.)

But as I thought about my aging mother, my aging in-laws, the men and women I see in the ER, confused and frightened, lonely and without help or hope, I realized what I was missing.


greyscale photo of woman standing behind woman sitting on chair


Almost every aged man and woman we see in the emergency department is an orphan.

Sure, now and then Ms. MacKenzie at age 82 is accompanied by her mother who is a spry 102 and attributes it to clean living and a shot of vodka every day. But that’s the exception.

Most of them have no living mother or father. And that’s more than a statement of genealogy. It means (assuming that they had decent, functional parental units) that the people in the world who cared the very most about them are long gone from this life.

Sure, these aren’t orphans in the classical sense. They’re adults and they’ve lived long enough to have retired, and to have diseases and maybe to have dementia. Sometimes they have a little money.

But in a very real way they are just as orphaned as a child who lost her parents to a car crash. And as their mental and physical states decline they become ever more like children. Unable to feed or clothe themselves, unable to obtain food. Unable to stay clean. Inconsolable in their fears and anxieties. Without income, or with minimal money. The parallels are strong.

I don’t know the answer here. But I think that at the very least, seeing an elderly man or woman as simply a different kind of orphan might just make us a little more sympathetic to the plight of millions struggling in the latter years of their lives.

Have a great week!


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