How do you define “healthy?” Good cholesterol and low blood pressure levels? No family history of cancer? Balanced diet, regular exercise, sufficient sleep? Sure. But what about less obvious – and perhaps less easily quantified – traits like easy laughter, positivity, or an intact sense of humor? I don’t have a research-based answer here, but I’m beginning to suspect that truly healthy people possess these things as well, perhaps setting up some kind of positive feedback loop that makes them even healthier. Case in point: during preceptorship this past year, I met arguably my healthiest patient to date. His age? He’s pushing 100.
Act I: Clinic, early afternoon. Pan in on a med student, pre-patient encounter, sitting at a computer screen. I am scrolling through the patient’s chart while mentally compiling a list of questions I need to remember to ask.
The 90-plus year old patient is here today for routine physical exam and flu shot. His past medical history includes an appendectomy in the 1930’s and arthroscopic knee surgery in the 1990’s. No other hospitalizations. Non-smoker. Family medical history short, list of medications and allergies even shorter. “Great,” I thought, “this should be pretty straight-forward.”
Act II: Patient’s room, cue entry:
I open the door to find a smartly-dressed elderly man.
“Hi, I’m Rachel.” (Wash hands, shake hands). “I’m a second-year medical student working with Dr. X today. Would it be okay if I chatted with you for a bit before the doctor joins us?”
Patient smiles, scooches a little closer.
“Sure! Who are you?”
After reintroducing myself – in a slower, clearer voice – I settled onto the backless, rolling chair and began the interview.
“So Mr. Y, how are you today?”
Act III: 30 minutes later . . .
I am both embarrassed and a little pleased to admit that in those thirty minutes I did not get to reviewing his medications or discussing his family history. I didn’t even begin the physical exam. So…what the heck was I doing? Well, listening. And quite raptly I might add. This man was a true storyteller; his ability to use his entire body – voice, hands, face, even feet – to tell me about his life, his kids, his kids’ lives, etc., was completely enchanting. When I did manage to slip in pertinent medical questions – “Have you been having any joint pain, Mr. Y?” – he responded with something like:
“No! Oh wait, I suppose that when I go dancing – which is usually twice a week, mind you – my shoulder does tend to feel a little sore by the end of the evening but that’s only because most ladies just can’t keep up with me. You see I do a four-step foxtrot, not a three-step like they teach nowadays, and I end up having to lead with a slightly stronger arm if you know what I mean . . .”
You can see why I got slowed down a bit. And, perhaps, why it didn’t really bother me all that much.
Act IV: Dr. X to med student – “Are you seriously still not finished?”
I did finally get through all my questions, as well as my exam. It may have taken me forty-five minutes beyond the allotted fifteen, but I learned a great deal along the way. Specifically, this guy was healthy. And I don’t just mean his commendable vegetable intake and daily Vitamin D supplementation. His eyes were twinkly. He smiled a lot, particularly when talking about his children. During our conversation he was engaged and alert, leaning towards me to swat my leg with a bit of paper for emphasis. And he laughed, the belly kind. During his heart exam I did notice that his heartbeat was a bit wonky (medical-ese for irregular), but my preceptor later assured me that this slight abnormality was in fact perfectly normal in our ninety-plus year old patient population – particularly those who go out dancing twice a week.