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We write them off as vulnerable, non-sexual burdens – but the elderly are not just a problem to be solved

A new regular column, "Nurse in the City", by Brian Kellett.

Have you heard of the “pink pound”? Of course you have – you read the New Statesman. I’m guessing that you also know about the “grey pound”, the demographic that takes in the elderly of this country.

You will know about the “ticking time bomb” of the ageing population and about how pensions are becoming so expensive that many of us will have to work until we are 68 or older. The elderly are also seen as “bed-blockers” who take up hospital places (though half of their hospital beds have been cut).

As a community nurse in east London, I spend most of my working day seeing people in their homes. You learn quite quickly in this job that the elderly are just as diverse as the rest of us and that it is misleading to refer to them as a homogenous lump. I used to work in various branches of emergency medicine. Back then, I saw patients for a very short time. After many years, I decided that struggling with drunks and dealing with young people who thought that a blocked nose was an emergency worthy of an ambulance were starting to wear a bit thin. Now, I have the time to get to know my patients and they get to know me. In many cases, we are on first-name terms. And each patient is different.

There is a woman I visit who is intensely proud of how clean she keeps her house, despite living on her own and being nearly blind. She has a little rota in her head – on Wednesday morning, she mops the floor (whether it needs it or not); in the afternoon, she vacuums the carpets; on Thursday, she dusts her house from top to bottom, and so on.

Then there is the woman who lives in a very mucky house – the sort of place that has you wiping your feet on the way out – and until recently would refuse all help from us. Finally, she agreed to let some people in to give it a tidy. It’s still dirty but there’s been a big improvement. I like both of these patients equally. They show their independence in different ways; they are quite happy in their way of life.

There are also the sisters who live together and are as thick as thieves (I swear they are conspiring to do something, like in Arsenic and Old Lace) and the woman who was thrown out for marrying a man from India – her family could not stand the “shame”. They drove her not only from her family home but from the village she grew up in.

The elderly, apparently, are nonsexual. Perhaps someone should tell that to the chap who says he enjoys looking at pornography, though “nothing down there” has been working for years, or the other man who has a wife and children but still flirts with me (it probably doesn’t help that I keep insisting on looking at his naked buttocks as part of his care package).

I see atheists, Christians, Muslims, Buddhists, Sikhs and Jews. I see those with pin-sharp minds and those in the midst of dementia. I don’t need anniversaries to remind me of wars because I hear true stories about them on an almost daily basis. As I sit on the floor in front of my patients, bandaging their legs, I hear about how they became friends with German POWs, or how they drank themselves through Italy following their commander, or how they looked after their mates, or how they got to carry the “bastard big gun” because they were the tallest in their squad. For many of them, it was the formative experience of their life, not something simply to be trotted out every 25, 50 or 100 years and “celebrated”.

As I change their catheters, I listen to them talk about their time as union leaders; about strikes and how they did their best for their members. Some of them espouse political views that I disagree with. Sometimes, I nod my head and let it slide; at other times, I’ll have a good-hearted argument.

There seems to be a consensus that the elderly are vulnerable people who get abused in nursing homes, get pensions that are unsustainable, will freeze to death in a cold snap and take up valuable hospital beds, all at the expense of the “hard-working taxpayer”. But what we need to accept is that they are people and not just a problem to be solved.

Next week: Dr Phil Whitaker’s Health Matters

This article first appeared in the 19 February 2014 issue of the New Statesman, The Space Issue

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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear