Volume 5, Issue 15, September 1990
Heart for Nurses?
biologists, at least ethologists, are familiar with K. Lorenz's
famous "Kindchenschema." Among other functions, it protects
small, helpless children from aggressive acts of their caretakers
who may be tired and nervous from endless crying, feeding, cleaning,
listening, watching, and so forth.
A second group of people is similarly vulnerable: the elderly, or
very old people, who indicate helplessness, e.g., by using a stick
(as a third leg, according to the riddle of Oedipus). They exhibit
distinct features, variable in grade and combination, yet representing
a definite "life-phase phenotype" (see Appendix). Can
they also expect by their habitus alone to elicit a smile, to facilitate
body contact and caressing behavior? Or does the hypothesis apply
that the (very) aged do not enjoy such a "sympathy guarantor"
because their appearance in our phylogeny is so recent?
Data from paleoanthropology and prehistory seem to indicate that
individual life spans seldom exceeded 30 years. Historians describe
an almost exponential increase in longevity over the past century.
Biology adds that individuals having contributed their share to
rearing offspring (including grandchildren?) may even reduce resources
for their progeny by "going on" beyond this 30-year period.
Thus, if old age was not selected for by evolution and its phenotype
therefore remains "unknown," natural proneness to help
beyond familiarity (read "kin") will be improbable. Even
worse, do not certain features of otherwise healthy, elderly individuals
(e.g., spotted skin, sensory weakening) happen to overlap symptoms
of disease or dysfunction? This might further promote distance-keeping
behavior by others.
Now my reasons for addressing the HEN Forum: I did my physician's
residency training in a hospital where in April 1989 three nurses
admitted to having killed more than 40 patients by the misuse of
care (drowning by "oral rinsing," overdosing with hypnotics
or insulin). Murder - yes - and the Austrian mass media made it
the issue of the month; yet, the following circumstances are cause
the average age of the victims exceeded 80 years;
- the nurses, who lacked diplomas, worked at the hospital for years,
at low wages;
- for the most part the patients who were killed were "troublemakers"
during the night.
Now, what is really known about attitudes toward the elderly during
nonkin, nonfriend, professionally dictated, cumulative, prolonged,
mostly unidirectional interactions? Four biological grandparents
are the greatest number an individual can have, but rarely they
are together in one place, and virtually never do they all rely
exclusively on that individual's presence, company, help
Appendix: Outline of an "old-age scheme" (incomplete)
·the face (most important landscape of human life, first
permanent stage for personal encounters)
·skull: visible as a result of fat reduction, eyes sunken
·hair: increased and bristly (nose, eyebrows, ears) or reduced
·disproportion: ear and nose cartilage continues to grow
·hands: bony, conspicuous joints, veins, and nails
·skin: dry, scaly, slack, spots (some growing, becoming elevated,
multiplicating (these "signs of age" are so
typical that the first title for
the paper was "growing points in gerontology"),
·arms and legs: thin with conspicuous joints; muscles flabby
erect posture (symbol of humankind): height reduction, exaggerated
·disproportion: torso shortened (limbs retain their length)
Behavior (everyday activities, expression of will and emotion)
·in general: slowed, rigid or shaky (tremor, insecurity,
loss of power)
·eyes: tendency to become fixed or furtive
·arms and legs: mobility impaired (hip, knee, shoulder stiffness)
·gait: inelastic, unvarying, "heavy", walking aids
·reaching: tremor of arms, but firm grip, clenching
·eating: bowed sitting, shaky hold an utensils, impaired
·urinating, defecation: troublesome
Communication (speech as carrier for intellect, personality,
·rhythm: slow, pausing, repetitious, monotonous
·topic selectivity: food, intestines, feces, family, neighbors,
doctors, materialism (accommodations, money, jewels)
·orientation difficulties: time, place, people, memory and
·emotion: propensity toward high pitch, loudness, imperiousness,
aggressiveness, intolerance and/or defensiveness, lamentation,
whimpering and/or detachedness: humming, "whistling".