The Ageing Gynaecologist: a Paean

I grow old… I grow old… I shall wear the bottoms of my trousers rolled. Well, maybe not, but I do think that things unfurl differently with age. The world is just that little bit more tinged with memory, red-shifted as it were, softened with colours no longer as bright, but deeply embedded and integral. Constituent. Fundamental. I think apperception is what makes age unique… and valuable: the epiphany on the journey Northward.

Age is insightful, and wisdom springs from having seen most of it before -in different iterations, perhaps, but nonetheless engendering that Delphic facility of predicting consequences from seemingly disparate observations. The collation, in other words, of subtle details, trivial evidence, and past experience. Diagnosis, after all, is merely the compilation of relevant  information and insightfully categorizing it. And of course what is chosen for the algorithm determines its worth.

But perhaps this is an unrealistic assessment of what age contributes to a profession like medicine; perhaps the increase of years merely serves to isolate the individual in long-buried concepts, world-views that no longer obtain, knowledge that has since been superseded. The world is round, whether or not we grew up thinking it flat –knowing it flat… Knowledge changes, and unlike Fashion, it changes for a reason: the concretion and assimilation of evidence.

And yet to assume that age is somehow tethered to a stake -a chain that stretches only so far- is to dismiss the opportunity to lengthen the chain. Like a plant, enlightenment requires  two directions to grow, and we neglect at our peril, the roots underpinning  what we see -what we know– in our zeal for the fruits of the visible. The now. Current apprehension, after all, is built on something…

I would like to think that, in general, age recognizes itself -recognizes, that is, that its role has shifted. In some ways it is like the move from player to coach: experience teaching the inexperienced. It’s a natural progression and often subtle, requiring a restructuring of identity, a reshaping of expectations, a shifting of goals. As I look back on my own career I can discern temporally invisible phases ranging from the overly -and insufferably- merely knowledgeable, to the practically-acquired functionality necessary for independent performance of surgically appropriate tasks, to the realization that these same tasks need not be selfishly virtuosic but could be shared. Should be shared. This latter aspect, I suppose, is the belated awareness that wisdom entails distribution: dissemination of what time and experience have endowed.

I am more and more drawn to the value of those who have been deemed elders in traditional societies: people who are considered repositories of what is considered important in their respective cultures. They bring not only memories of things past, but the expectation that the past may be of use -if only by way of example- to the present. Without what was, what is remains rootless. Lost. It is a person with only a first name: bereft of family identification, unvalidated and uncredentialled in the larger picture.

As time passes and experience accretes, I think those of us senior enough in our chosen specialties can choose what procedures we wish to perform and refer the others to younger, more eager members with reputations to solidify -those who will become us in turn as the years roll past. We become their mentors -coaches- in the ever changing world of medicine. No less valuable for the alternate roll, there is nonetheless an understanding, an unspoken assignation. A different authentication.

Age in Medicine brings with it benefits not only to the Specialty but more importantly, to the patient as well. It brings among other things a willingness to talk and listen, a disposition -sometimes- to share stories and commiserate as only someone with long experience and a wealth of misfortunes can accommodate. It brings, one hopes, a thoughtful response to seemingly intractable problems, a measured approach to issues, untethered by current fashion, that may seem merely philosophical on a cursory appraisal, but ultimately profound and satisfying when considered dispassionately and with the benefit of the passage of time. It brings things that are often difficult to teach: bedside manners, respect for differing perspectives and, maybe, recognition that when we cannot cure, when we cannot fix, we can still be human. We can be understanding. We can still be a voice for hope.

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