As an internist with “added qualifications in geriatric medicine” I care for a great many elder individuals. In most cases, these are individuals I met 20 or more years ago and have been privileged to share their lives with them as they aged.

The circle of life is relentless and unforgiving, so there comes a time when these relationships end. In some cases, it comes when they can no longer care for themselves, and I suggest they move out of the area to be closer to a loved one who will provide support and care. In some cases, the patient moves from their home into a senior assisted or skilled nursing facility out of the area.

There have been a few situations where an adult child from out of the area shows up on the scene and transfers their loved one’s care elsewhere. These are the most difficult situations because the children are stressed and put out by the responsibility and inconvenience of suddenly having to care for their loved one. They do not have the longstanding professional relationship with me that I have with the patient. They expect quick and simple answers and treatment plans in most cases when for the most part we are dealing with complex issues involving many professionals and treating one condition fully often exacerbates another.

Then, of course, there are the patients who pass away. As detached as you try to be, those of us who care invest a bit of our heart and soul in each patient who comes to us for care. I see that investment made in the vast majority of my colleagues across all the disciplines and specialties. When you lose someone, even an ancient senior citizen, it takes a piece of your being with it.

I too am no spring chicken. I talk about Medicare from experience now. Morning stiffness is a shared experience, not a term in a medical textbook. Male urinary problems, once something you treated in older guys is now a way of life. My older colleagues are retiring. When making hospital rounds, I notice the prevalence of younger physicians.

My beloved pets age too. For the last 16 years, my pug (Pugsly) and my mixed-breed sweetie (Chloe) greeted me at the door, took long walks with me and provided fur therapy after a stressful day. Pugsly expired a year ago. His mate Chloe left this world in November. For a clinician well versed in Elizabeth Kubler Ross’s book On Death and Dying and dealing with life and death daily, the loss of a beloved pet should be easier. The pain is palpable. The sadness recurs, and the heaviness on the shoulders, eyelids, and heart wears you down.

I have several younger patients valiantly battling against horrible, malignant diseases. Their drive and courage to overcome illness and enjoy the time they have with family and friends are inspirational. They do not know it, but they are my role models for how to deal with the adversity of losing loved ones, human and pet, and sharing the diminishing independence and health that my long-time patients now experience.

Steven Reznick is an internal medicine physician and can be reached at Boca Raton Concierge Doctor.

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