“I’m 92, you know?”, a patient says to me as we’re having a dance whilst I’m helping her to get washed and dressed in a less than conventional way. I can barely stand on one leg to put my other into a pair of jeans, and this lady is swinging her hips and singing whilst putting a jumper on.
She is an inpatient, one day post-excision of a vulval lesion (a rare form a cancer of the vulva) and recovering well – as you might be able to tell. Vulval cancer can be caused by persistent infections with the same virus that causes cervical cancer – HPV. But risk also increases with age, smoking, and skin conditions affecting the vulva.
The lady in front of me dancing is a piano playing, travel loving Scotswoman with enough stories to fill the British Library. I am in awe at her sense of humour and independence, a great-great grandmother to be.
On the train home from placement on the day I met her, I thought long and hard about age and the assumptions we make surrounding it. If this lady had dementia, would we have considered surgery as a possibility? I had imagined that at 92, I would quite like to sit in my garden with copious amounts of tea and be left in peace. I hadn’t even considered that I would undergo any treatment other than the District Nurse coming to give me a flu jab. But, having been physically and mentally active all her life with a huge role in her family too, it’s no wonder my patient has gotten so far. She was enjoying life in her residential home, a fate people often dread, and wanted to spend a few more years with her pals doing cross-words and eyeing up Nadal playing Wimbledon on the telly. Outlooks change, people are different, no two 92-year-olds want the same thing.
It also made me think about women’s health as we get older. We refer to female genitalia as ‘down-below’ or worse, ‘the undercarriage’ and it leads to hushed tones, whispers and perhaps patients not being able to tell us if something has changed. A change in discharge, a change in a mole, new PV bleeding or sore. Barriers are being broken down all the time in women’s health. From national and social media campaigns to increase cervical screening, to Coppafeel campaigns for checking your breasts, I’m in constant awe of their fantastic work. But how many of us have holistic conversations with people over 65 about their gynaecological health?
Consenting for surgery is a huge decision at any age, especially when the ‘C’ word is hanging over you. But this lady was proof that a well informed and supported patient can thrive. Age is just a number and I’m going to endeavour to not let a number disguise the person underneath.
Rachael Palmer, @PUNCrachpalmer