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The Red Hat

Cohen, Pieter A., MD

Teaching and Learning Moments

Dr. Cohen is associate program director, Internal Medicine Residency Program, Cambridge Health Alliance, Cambridge, Massachusetts.

The interns were not looking forward to the home visit, and, to be honest, neither was I. As part of their training in medical school, these interns had visited a few of their patients in dilapidated and depressing homes. The visits during medical school had opened their eyes, but had left them worn. I wondered how this single required home visit during a month of working on medicine wards would prove fruitful for these two interns. They had asked on the way, “What’s our goal today?” I wondered the same.

We pulled up to a housing complex for the elderly. Mid-September mums bloomed around the well-manicured entrance. On the eighth floor Mr. F. welcomed us into his meticulously clean apartment. He introduced us to his wife, who was staring absently at the television set. In her ruffled nightgown, she turned to us and smiled.

Mr. F., oxygen-dependent and wheelchair-bound, was recently admitted for a COPD exacerbation. While at the hospital, he had explained that he managed his home and cared for his wife, who had Alzheimer’s disease. We had been concerned about the scene we might find. Except for an occasional smile, Mrs. F. sat silently in her armchair, but Mr. F. never mentioned the challenges or heartbreak that might come from caring for a loved one with dementia.

Instead, after he recounted recent trips to Cape Cod with his children, Mr. F. told us he had participated in the Battle of the Bulge as an engineer in World War II before working more than 30 years as a draftsman for General Electric. We discussed the financial challenges of his fixed income and increasing medical expenses. When we reviewed his pillbox, we found that he had restarted all his prior medications and made none of our recommended changes since his recent admission.

Above photos of Mr. and Mrs. F.’s three children and six grandchildren, one of the interns noticed an outrageous red hat hanging on the wall.

“Does your wife belong to the Red Hat Society?” she asked.

“Oh, she sure does. She loves going out with her girlfriends.”

On the drive back to the hospital, the intern recounted the night she had met a large group of elderly women, all wearing extravagant red hats. The women had explained they belonged to the Red Hat Society, a venue for elderly women to have a “ladies night out” to gallivant around town.

The next morning the second intern brought in a poem, “Warning,” by Jenny Joseph, to share on attending rounds:

When I am an old woman I shall wear purple

With a red hat which doesn’t go, and doesn’t suit me.

And I shall spend my pension on brandy and summer gloves

And satin sandals …

Later I went back to Mr. F.’s home to share this poem with him. I handed it to him, but he said he’d prefer I read it aloud. He sat quietly, and when I glanced up, he was smiling warmly. When I finished, I thought his eyes were tearing up and I sat quietly, imagining he was thinking of his wife, and waited for him to talk about her. “Your students are welcome here any time,” he said.

Pieter A. Cohen, MD

© 2006 Association of American Medical Colleges