‘This happened on December 30th 2003’ she began, the American drawl initially disconcerting from such a very British icon. ‘That may seem a while ago but it won't when it happens to you. And it will happen to you. The details will be different, but it will happen to you. That's what I'm here to tell you.’
Although I'll own that a play about losing your spouse and daughter is not the obvious choice for a wedding anniversary treat, the opportunity to see Vanessa Redgrave as Joan Didion in The Year of Magical Thinking this Autumn was too rare to pass up. So we listened as she quietly raged against the injustice of her husband's sudden death, her grief creating a type of magical thinking that meant she had to keep his shoes and clothes for his return. I was reminded, as we sat there, spellbound in the stalls, of Robert Klitzman's reflections on some doctors' own version of magical thinking.1 Klitzman suggests, among other things, that through our professional training and the socialisation that forms an intrinsic part of medical rites of passage, some of us somehow come to see our metaphorical white coats as protective against illness and death. We perhaps feel magically invulnerable to disease. He cites numerous stories of magical thinking including a sick doctor admitted to an ICU who looked up her symptoms dispassionately on a personal laptop and considered writing herself up as a case report. It also helped me make sense of a particular incident a few years ago when I refused to get on the porter's trolley but insisted instead on taking my black pointy boots out of the patient locker to clip clop along the corridor I usually walked as a local GP. Surely if I had my trusty work boots on, I could be on my way to the right sort of theatre? I wonder if that's why the Obituaries are one of the most read sections in the BMJ? Do we sit there silently wondering how such and such a doctor could possibly have contracted this or that illness, or died before their three score years and ten?
So perhaps we are programmed, more than most, to think that we are invincible — will never get ill, never grow old, never need to find sheltered accommodation, or, God forbid, a nursing home. Does our predisposition for magical thinking alter the way we think about old age and therefore older people? I'm not sure, but it may be worth a little evidence-based reflection.
We know that by 2011 the mean age of the UK population will have exceeded 40 years for the first time in history. Over the next 25 years, the number of people over 65 years will increase by 60%, from 9.6 million to 15 million, and account for 20% of the total population.2 Currently, about 5% of older people (480 000 UK citizens) live in residential homes3 and 23% of calls to an abuse help line are made from residential care homes.4 Is this our problem? Should we all engage more actively with the issues? Or do we feel protected in some sense by our magical white coats, our reduced ability to perceive death and old age as something personal? Indeed, I wonder if the Let's Respect Campaign,5 which highlights the principles of best practice in the care of older people with mental health needs, would be as powerful without the promotional memory box. Open the box and you are greeted with haunting photographs of older people clutching pictures of their younger selves or of a long dead khaki-clad husband. The emotional images pierce our magical white coats and remind us all who we are and who we will become.
Perhaps next time I visit our local nursing home I won't try and get back into my car quite as quickly. Perhaps I will spend longer talking about the photograph on the shelf, asking about feelings not symptoms. Perhaps I will remember Joan Didion's words that although the details will be different, it will happen to me.
- © British Journal of General Practice, 2009.