Unpeel the Onion

An 89 year old lady presented to me with a problem, “My hands are too soft, my knitting needles keep slipping through them,” she said. I must admit this is the cutest problem I’ve ever come across. When I examined her hands, they reminded me of my baby’s hands when he was born, soft, warm and gentle. The wrinkles showed me 9 decades of life but it was when I looked into her eyes that I could sense a sadness, an emptiness that made me want to explore deeper.

With only 10 minutes to consult - which is what family doctors in the UK get per patient - I could have simply reassured her and sent her away however I couldn’t because I could sense this was not the real reason that she came to see her doctor.

At first we chatted about this and that and then I started to unpeel the onion.

Living at home on her own, no children, some friends, hobbies including reading and knitting, loved to cook but didn’t anymore. I asked her “why?” - my most used word in consultation.

4 years ago her husband, her best friend for 48 years died. He loved to eat and she loved to cook for him. Cooking was now a painful experience for her. She wasn’t able to talk about him anymore because everyone around her, including her previous GP, told her to stop and move on. With tears rolling down her cheeks, she apologised for talking about him but she was fed up. She didn’t want to talk about anything else and felt the world was pushing her to forget him.

She was not depressed, she was grieving and I simply gave her time to talk. I cannot put into words the spark in her eyes, how alive and animated she became as she told me stories about their life together. She couldn’t have been more grateful to be told that she didn’t need to forget him. She wanted acceptance of the situation and in her words, “how do you move on at 89? And what if I don’t want to move on.”

People are like onions and getting to the root of their problem is the single most important thing a doctor can do for their patient. Some interventions in life are intuitive and frankly common sense. Many would have opted to treat this patient with an antidepressant. What she needed was reassurance, hope and some counselling.