We chatted as we waited. She owned a small business downtown — or she had. She was in the process of retiring, having been unable to do much work in recent months because of illnesses. She’d been hospitalized twice in the past year, she said. Nothing catastrophic, yet somehow after the second stay things had never quite gotten back to normal.

The geriatrician in me noted that she had some trouble hearing, even more difficulty seeing, arthritic fingers and a gait that favored her right side. But her brain was sharp, and she had a terrific sense of humor.

Finally, the cab arrived. The driver watched as I helped her off the curb — a slow process because of her cold-stiffened joints, the walker and our bags — and then he sped away. I stared, dumbfounded, and pulled out my phone to call the company and complain.

“It happens all the time,” the woman said. Just then, a taxi from another company turned the corner. He slowed down for my outstretched hand, but when he saw my companion he, too, screeched off into the night.

Doing the right thing

It didn’t take a rocket scientist — or even a geriatrician — to figure out why taxis didn’t want to pick up this elderly woman. Doctors and medical practices often invoke the same reasoning: The old move too slowly, making efficiency impossible. And more often than not, there are complications.

“I’ll give you a ride,” I said, having refrained from making the offer until then at least in part because of that uniquely American quandary: What if something happens to her and her relatives sue?

Her face lit up. “Oh, no,” she said. “I couldn’t let you do that.”

It took almost as long to maneuver her into my front seat as it did to get across town. She directed me to an apartment complex on a steep slope. She lived near the top, up flights of steep, poorly lit steps.

I phoned my mother to reschedule and called home to say I’d be late. Getting up the steps was slow going. Along the way, I learned that the woman had been to the podiatrist that afternoon because she could no longer cut her own toenails. I told her I was a geriatrician and discovered that she got all her medical care except podiatry at my medical institution. I knew her primary-care doctor and several of her specialists.

As I wrote in an e-mail to my general internist colleague the next morning, getting the elderly woman “out of my car and up the forty-nine stairs to her apartment took nearly an hour because of her grave debility. She is very weak, has audible bone-on-bone arthritis in all major joints, frequent spasms in her left hip, minimal clearance of her right foot and could not move her left foot; I basically had to hoist her.” I had no idea how she ever made it up the steps unassisted and couldn’t imagine how long it might take when she did.

She was silent for a moment. Then she said, “That sounds too good to be true!”

Seniors need different care

I know most of the woman’s doctors. Each one is compassionate, smart and dedicated. Indeed, her diseases were largely under good control. Yet her health was declining, she was missing appointments and she was less and less able to care for herself and her apartment. Several of her clinicians recognized this, but none took action. This was not because of personal or professional failings. Their actions — and inaction — were the inevitable result of their medical training and our medical system’s sometimes myopic focus on medicine at the expense of health.

Medical education prioritizes the same specialties today as it did a century ago, when life expectancy in the United States hovered around 50 and when tuberculosis and childbirth were among the leading killers. People in their eighth, ninth and 10th decades are as dissimilar, physiologically and socially, from middle-aged adults as children are, yet while all medical students learn pediatrics and adult medicine, there are no universal requirements for geriatrics training. This makes no sense demographically or medically.

There are 48 times more octogenarians now than there were in the first half of the last century, and older patients are the age group most likely to be harmed by medical care.

A happy ending

At her first visit to the geriatrics practice, the woman made clear that arthritis and pain were her biggest problems, so she received steroid injections in her two most painful joints and a pain medication safe for older adults. Her specialists previously had noted that her blood pressure was quite high. It turned out she wasn’t taking several medications because she hadn’t been able to get to the pharmacy for them. The geriatrician arranged for home delivery from the pharmacy and also took her off several medications that at her age were no longer necessary or recommended.

The geriatrician also learned that on days when the woman couldn’t manage her stairs at all, getting to the medical center was outrageously costly: She had to pay taxi drivers $3 dollar per step to carry her first down and later back up the steps to her apartment. Since there were 49 steps, this meant $147 each way, not including the fare for the ride itself. Fortunately, from now on she wouldn’t need to visit the medical center as often, since the geriatrician and other caregivers could treat her incontinence, stable lung disease and other chronic conditions, and monitor her for cancer recurrence, during home visits. With the money she saved on transportation, she could hire more help at home.