THEGERIATRICSCLINIC—OR,asmyhospitalcallsit,the
CenterforOlderAdultHealth(eveninaclinicgearedto
people eighty years orolder, patients view words like
“geriatrics”orjust“elderly”askance)—isonlyonefloor
belowmysurgeryclinic.Ipassedbyitalmosteveryday
foryears,andIcan’trememberevergivingitamoment’s
thought.Onemorning,however,Iwandereddownstairs
and,withthepermissionofthepatients,satinonafew
visits with Juergen Bludau, the chief geriatrician.
“What brings you here today?” the doctorasked Jean
Gavrilles, his first patient of the morning. She was
eighty-fiveyearsold,withshort,frizzywhitehair,oval
glasses,alavenderknitshirt,andasweet, readysmile.
Smallbutsturdyinappearance,shehadcomeinwalking
steadily,herpurseandcoatclutchedunderonearm,her
daughtertrailingbehindher,nosupportrequiredbeyond
hermauve orthopedicshoes.Shesaidthather internist
had recommended that she come.
About anything in particular? the doctor asked.
Theanswer,itseemed,wasyesandno.Thefirstthing
shementionedwasalower-backpainthatshe’dhadfor
months,whichshotdownherlegandsometimesmadeit
difficulttogetoutofbedorupfromachair.Shealsohad
badarthritis,andsheshowedusherfingers,whichwere
swollen attheknucklesandbentout tothesides with
what’s called a swan-neck deformity. She’d had both
knees replaced a decade earlier. She had high blood
pressure,“fromstress,”shesaid,beforehandingBludau
herlistofmedications.Shehadglaucomaandneededto
haveeyeexamseveryfourmonths. Sheneverused to
have “bathroom problems,” but lately, she admitted,