I’ve been sixteen for thirty years.  At age eight the road was paved with a ripe philosophical certainty my mother mistook for stubbornness.  Now I imagine myself infinitely staving off the dark circles under my eyes with sheer gusto, leaving wrinkle removers for the less spirited. Yet, a twinge of my lower back catapults me into a kaleidoscope of disability as I find myself hunched and twisted supervising a resident doctor place a large intravenous line in the neck of our patient.

One debilitating spasm kickstarts my mind into calculating which portion of my future spending will be allotted to Lidocaine patches for pain control and afternoon outpatient visits for steroid injections.  These visits would lead to spinal surgery, use of a cane, and eventually life confined to a stretcher.  Suddenly, I am ninety-two.  My spine is gnarled, and helplessness now inhabits the space where gusto used to be. The world around me would redefine my societal worth without my permission.  A revision that has left many of my female patients cheated of the identity their younger selves spent years creating.

Arching backwards to shake the spasm and my thoughts back into reality, I took roster of the women in my emergency department that evening.  They would be my tribe until morning.

The nurse had placed a foley catheter in our patient in room sixteen after being found lying in her own urine.  Tunnels of infected tissue and bacteria creep into her blood stream from ulcers that erode her backside and force repeated visits to the hospital.  Her daughter twitched with irritation waiting for me announce that her mother would need to be admitted.  A green light to leave.  Urinary incontinence had left the daughter drained from changing her mother’s diaper twelve times a day and teaching her toddler how to use the toilet.   

Room seven’s husband wanted me to know that they had been married for more than sixty years.  As I finished updating him on his wife’s lab results and plan for discharge back to the nursing home, he asked that we get her an extra blanket.  They had met at a friend’s dinner party where he had admired her ability to talk politics and smoke an after-dinner cigar, while her girlfriends opted to prepare the dessert and coffee.  Today she does not know who she is, where she is, or that Herbert Hoover is no longer president.  When I mention the details of their first date, she smiles politely and corrects me: “Oh, I’ve never been married.” 

Everyone had been avoiding room five. That night she had been cooking pizza in the oven when the fire department burst into her smokey apartment to find her on the ground with a bruise on her scalp.  Since we met, she had been protesting the great injustice of her cervical collar which protected her from any further injury to her vertebrae.  Each time I addressed her concerns, she would quiet for a moment and fully engage in our connection, until I pulled the curtain which would prompt another shriek for help.  Just as she had forgotten to turn off the oven, she had forgotten her name, my name, and that she had once been on the other side of the stethoscope treating traumatic brain injury patients.   

In room twenty, our patient’s body had been a bulwark to abuse and expectations for perfection her whole life.  Multiple strokes had left her paraplegic and a master of predicting her next urinary tract infection.  First a hot flash, then a migraine headache, and within hours her grand daughter would be pointing out the cloudiness in her urinary catheter.  Unlike many of her cohorts tonight, dementia did not characterize her presentation, but this was replaced by a portrait of penance.  She apologized for taking my time, for asking for help, and for her inability to shift position on the stretcher without assistance.     

I close the curtain, and suddenly I’m thirty going on ninety-two, preparing my own apology speech.  For aging.  For incontinence.  For forgetting. For immobility. For being an inconvenience. My mind is slow, my joints creak, my hearing has faded, and my eyes are fogged by cataracts. My grandchildren no longer engage in conversation with me at the holiday dinner table and my daughter is afraid I’ll burn myself when I offer to help with the mash potatoes.  The leather of my running shoes are cracked, stiff, and tucked in a box labeled Memories and Motifs. The love letters from boyfriends past describe a woman who no longer exists.  I end up in an emergency department where I am on a roster of forgotten women. 

The siren of an incoming ambulance jolts me from my tizzy of extrapolation, and they wheel in our next patient. The charge nurse has pre-ordered a broad net of blood work and the resident doctor jokes that he will order a ‘granny scan’ for the patient now in room three.  The paramedic chuckles to the technician: “Another old lady who fell on blood thinners, [their] specialty tonight.”  As if she already knows the archetype she has been asked to play, she screams: “What did you say?!? I think I’ve lost my hearing aid!”

From a distance, I apply a Lidocaine patch to my lower back and I walk into the room.  Our newest patient is 102 years old.  She lives alone, and used to swim a mile at the local beach every morning until six years ago when her son worried her heart couldn’t take the stress of September ocean temperatures. I intend on greeting her with my new philosophy that no apologies are necessary. The nurse leaves the room and it is just us two old ladies.  She pulls me close: “You want to know something doc?  I don’t wear a hearing aid. Hearing aids…are for old people.”