Q&A with Aisling Fleury

Questions and Answers

What are you doing?

Making breakfast.

It’s 7 pm. Why are you making breakfast?

I’m making porridge. I like to get up and go in the morning. To make good porridge you have to leave it to sit. I’m trying a new recipe today because I have had porridge the last four weeks in a row. A new recipe using quinoa and apricots, which I love.

Is it called geriatrics, aged care or elderly medicine?

There’s also gerontology. In trying to rename geriatric medicine… aged care…elderly medicine, we’re looking for a nice word to define that which we’re all terrified of. Getting old. But failing to acknowledge age is itself ageist. I still call myself a geriatrician. I don’t think that elderly medicine sounds any better than geriatrics.

You love it don’t you? Why?

There is a huge problem of youth being promoted as the be all and end all. Many of my 95 year old patients have a much better sense of self. Goals of intervention, goals of what their quality of life is, view on the world, views of what they consider suitable outcomes of treatment. Looking after them and being involved in helping them come to those decisions is an absolute joy.

The tea question. Milk first or second?

Definitely milk second. Milk first, you never know that you’ve put the right amount in.

Preferred biscuit?

Penguin.

Penguins? Not Tim-Tams?

I remember Penguins from when I was a child. And the absolute joy of getting them, because mum was always into health food.

Why do old people suffer in emergency departments?

A combination of environmental factors, time, and skillset. But it’s primarily environmental. The emergency department is not set up to spend two days in. There is no meal service, lights are always on, there is no down time, it is really noisy, the beds are uncomfortable. So for an older person whose senses are muted, their vision may not be good, they can’t hear properly, they’ve lost their dentures so they can’t eat, they are in pain, they have cognitive issues…

Have emergency clinicians become blind to all this?

I think you have to because otherwise you couldn’t turn up to work. Burnout is an occupational problem. It isn’t a lack of caring. No one has come into nursing or health related professions not wanting to do their best by people. Ultimately it’s moral injury. It is coming to work and not having the resources or the organisation to do your job. And then you’re always asked to give a bit more, do a bit more.

So what should be done?

The health service hasn’t recognised that older people are their core business. The health service still sees older people as bed blockers. They keep on building bigger emergency departments and more beds in hospitals when they would be much better off creating more subacute capacity and community capacity. The reason that a lot of old people are in hospital is that traditional family structures have broken down. Building a bigger emergency department doesn’t make things easier. It just creates more space for the same problem.

And how should we look after ourselves?

That’s a really good point. In order to look after other people you have to look after yourself. Self care involves taking time out. I try and get my trainees out and have a half day, or a late start. It’s not much, but we need to value our trainees. And we need to prioritise our own exercise. You have to find something that allows you to move. I personally think – as a peri-menopausal woman – that strength training is really important. When you are angry, lifting heavy stuff is really fulfilling.

Apart from angry weights, any other exercise?

I played touch football for 15 years. 5 years ago I took up climbing, rock climbing. That became a bit obsessional. In Covid I moved down the Gold Coast and I decided – having tried for years – that I would become a swimmer. So I started swimming in the ocean. So now – swim twice a week, lift weights twice a week, and climb once or twice a week. I try to work out most days. It makes me happy.

What’s the scariest climb you have done?

There’s a climb on Mount Ninderry, in the Sunshine Coast Hinterland. Called dontworry.com. That has this bit where you… it’s high but then you step around a corner into like… air. Scary. Horribly exhilarating.

Where would you like to spend your last days?

By the beach. With the sun on my face. Listening to the waves.

Aisling Fleury will be presenting at the Spring Seminar on Emergency Medicine, Noosa, 18-21 October 2022.