He was a plumber—strong, steady, used to hard work. His backhad always been a problem, the legacy of decades hunched beneath sinks andcrouched under boilers. Over the years, he'd had multiple back surgeries andlived with chronic pain in his back and left leg. Then came Parkinson’sdisease, and more recently, dementia.
Now in his 90s, he still recognizes his wife. She helps himwith bathing, dressing, eating—most of the basics. His hands tremble. He movesslowly. But he smiles when she enters the room.
Last month, something changed. The pain in his left legworsened. He couldn’t explain it—words are harder now—but his wife noticed thesigns: the way he grimaced, grabbed his thigh, how tight the muscle felt whenshe gently pressed it. She worried he might’ve strained something, or worse,fractured a bone. She scheduled an appointment with an orthopedic doctor.
The orthopedist was confident and brisk. He ordered X-rays,reviewed them, and assured them: “There’s nothing wrong with the leg or hip.”But he pointed at the man’s spine and said, “Now this—this is theproblem. Severe degeneration. No question that the leg pain is coming from hisback.”
He swiveled on his stool, typed into the computer, andturned back toward them.
“He needs an MRI. And I’ll place a referral to theorthopedic spine surgeon.”
That’s when his wife—who had been quietly taking it all in finally spoke.
“He’s ninety-four years old!” she said, stunned.
The surgeon didn’t flinch. He extended his hand and puffedout his chest. “My dear, I just operated on a 97-year-old. We do it all thetime.”
And just like that, he left the room.
This story is not about whether an MRI was the right decision. It’s not even about whether surgery could help.
It’s about what happens when clinical confidence overshadows clinical wisdom—when the tools of medicine outpace the goals of the person receiving it.
This man was a plumber. A husband. A person living with dementia and Parkinson’s disease. He experiences the world through a clouded mind and an aching body. He cannot report his pain in detail. He cannot weigh risks and benefits with nuance. But he still feels. He still suffers. He still matters.
And so does his wife. She is his voice. His advocate. She knows his day-to-day joys and his struggles. When she gasps—“He’s 94!”—it’s not just about age. It’s about context. She’s asking: Is this journey, the appointments, the MRI, the possible surgery, really in his best interest? Or are we chasing shadows because we can’t sit with uncertainty?
In healthcare, we love clarity. We love answers. We love to act. But for people living with dementia, especially in advanced stages of the disease, a person-centered approach means pausing before the referral, before the scan, before the knife.
It means asking:
- What matters most to this person at this stage of life?
- How is this pain affecting his quality of life?
- What non-invasive options are available?
- And , just as important, what does his wife think is best for him now?
This is not an argument against surgery or imaging. It’s a plea for humility. For humanity. For remembering that medicine is not just about what we can do, but what we should do.
Because sometimes, the most powerful thing a doctor can say isn’t, “We do this all the time.”
It’s:
“Tell me what matters to you and your husband.”
“Let’s think about what makes sense for his life.”
“You’re not alone in this.”
Person-centered care begins with asking what matters, not just what’s the matter.
