There is, perhaps, no more common or expected site on a warm, late summer afternoon than that of a man mowing his lawn. When I came upon just such a scene during a solitary walk not too long ago, I nonetheless found it distinctive for two reasons. Firstly, the gentleman mowing the lawn was elderly. In fact, very elderly. A conservative estimate would be well past 80, closer to 90. He was also a small, thin man who seemed to weigh not much more than the lawnmower he was pushing, and had a prominent kyphosis that necessitated him raising his head in order to see forward, making the task all that much harder.

The second remarkable thing was that he was not simply mowing his own lawn, but as pushed the machine back and forth, it was apparent that he was also mowing the lawn of his neighbor.

While I was passing by, two random encounters occurred in rapid succession. The neighbor whose lawn he was mowing drove into the driveway, returning home. A lady emerged from the car, perhaps in her late 30’s or early 40’s, and after extracting a baby from a car seat hurriedly thanked and waved to the gentleman who acknowledged with a smile and dismissive wave of the hand, as if to say “think nothing of it”. She quickly disappeared into the house with her baby and packages, leaving him to the lawn.

At the same time, a young boy, perhaps 14 or 15, was walking past on the sidewalk, headphones on, deeply engrossed in whatever was playing on his device. As he passed, he actually slowed down for a moment, took off the headphones and glanced back at the scene of the lawn mowing, shaking his head briefly, and then turned back resuming his walk and his musical solitude.

I have no idea what he was thinking, or what caused him to pause, but whether it was reflection or simply irritation from the noise of the mower, that elderly gentleman somehow, unknowingly and however briefly, shook that young man from his self-imposed isolation.

It occurred to me that in that very brief scene we’d been afforded a glimpse into the characteristics of three generations, or four if you count mine.

Authors William Strauss and Neil Howe have popularized the concept of Generational Theory in their enormously popular, if controversial, 1991 book “Generations”. Fundamentally, they advance the notion that groups of people born into the same culture at about the same time are subjected to common sociologic influences and global events that serve to shape that group in a characteristic manner. In their original book and a number of follow-up works, they trace history as a series of such generational periods.

In Strauss and Howe terminology, the young man passing on the street is a Millennial (Millennials Rising: The Next Generation, 2000), born 1982-2004. The neighbour lady is a Generation X-er (1961-1981), and I am a Baby Boomer (1943-1960).

greatest2The elderly gentleman, the central focus of my brief summer encounter, is a member of what Strauss and Howe dubbed the G.I. Generation (1901-1924), but has come to be more commonly referred to as “the Greatest Generation”, a term attributed to Tom Brokaw who used it as the title of his excellent 1998 book. In his 1960 inaugural address, President John Kennedy was speaking of this remarkable group when he spoke of a generation that was “born in this century, tempered by war, disciplined by a hard and bitter peace, proud of our ancient heritage…”

These folks were born between the First World War (1914-1918) and the late 1920s. The dominant influence during their childhood was the great economic depression of the late 1920s and 1930s. Just as the depression was lifting, and as they were reaching late adolescence and early childhood, they were drawn into the global cataclysm that was the Second World War. Whether or not they were direct combatants in that struggle, the life of everyone living at that time, male or female, was affected and influenced by those events. greatest3The early and formative years of that generation was therefore characterized by struggle, joint effort against great social threats, encounters with great personal and public loss, and shared suffering. For those 12 or so million men who returned to Canada and the United States after the war, and for the families they rejoined, there was also the sense of success brought about by common effort, and a confidence in and loyalty for the society they’d struggled so hard to support. For those survivors of European countries who’d been part of the same struggle, many turned to Canada and United States as places where they could, through their own effort, earn a place for themselves and their progeny in that “great society”.

Shaped by these influences, the members of this generation are patriotic and self-reliant, taking on responsibility for earning through the efforts of one’s own greatest4labour, eschewing social assistance, but supportive of those truly in need. They did not feel the need to speak of their early war experiences or the suffering they’d encountered at that time, as touchingly described by James Bradley in “Flags of our Fathers”. They believed in family, were fiscally conservative, religious and led by example. They parented the Baby Boomers, and attempted, with variable success, to impart their values to that generation. Like the gentleman mowing his lawn of his neighbour, they are generous and address needs without being asked or thought of reward. They have a sense of duty to those who did not survive the struggles they have witnessed. In short, they endeavor to “do the right thing”.

Those still surviving are also our patients.

One of the great and unanticipated benefits of our First Patient Program at Queen’s has been to facilitate encounters between our young students and members of this special generation. In reading the reflections provided by our students, and learning of the relationships that have been formed, it’s clear that these patients have imparted invaluable insights far beyond any knowledge of their medical conditions. Here’s a sampling of “lessons learned” provided by our students:

Perhaps just as importantly for me, I found Mr. X to be an excellent mentor, who taught us that to be good physicians we must go beyond understanding a patient’s medical problems to appreciate the holistic patient experience, including social and family histories.

Being with this patient made me appreciate how much patients benefit from, and value the time that you take to educate them about their treatment and their medical condition. I will hold on to these experiences and remember how it felt for our patient on the opposite side of the healthcare system. I think that some of the experiences that I’ve had in the First Patient Program will help me shape into a more compassionate, patient, and understanding physician.

Who ever knew that old patients were so cool?

Don’t assume you know what an elderly person is capable of. Always ask

Set aside your stethoscope, and connect with your patient beyond his/her diagnosis

Talk with the patient, not at the patient. Even better, listen more than you talk, and both you and the patient will be better for it.

There are many changes associated with normal aging, but it is important to remember that these don’t necessarily represent pathology. Patients who are elderly can also be healthy, and it is essential for physicians to understand the numerous community resources that can help facilitate happy and healthy aging

A chronic illness is truly that. It is a consideration in every decision, of every day. Living with a lifelong disease requires day-to-day adjustment of plans and a lifetime with medicine by your side

Seniors can be Apple fans, too. Technology can play a huge role in helping people stay connected to the world and their loved ones, especially if they are frail and find it difficult to leave the house

I don’t know the name or personal history of the lawn-mowing gentleman I encountered that afternoon. I do know that he is part of a generation of remarkable people whose life experience was far beyond that of myself, my contemporaries, or that of our children. That afternoon, with a selfless, generous gesture and quiet example, he continues to give and to teach us what it is to care and contribute to our society.

These remarkable people who lived through two global wars are the parents and grandparents of my generation of “Baby Boomers”, who are now involved in the education and leadership of these emerging, highly talented and technologically sophisticated “Millennials”. When I was in elementary school, I recall that each Remembrance Day veterans would visit our classrooms, dressed in their dark blue jackets, berets and decked out with medals. They were soft spoken and sombre, never glorifying themselves or their war exploits, but rather trying to express their respect for their fallen colleagues. The word that kept creeping into their dialogue, and the word I still recall so many years later, was “sacrifice”. Those gentlemen were veterans of the First World War, and are no longer with us. Soon, our Second War veterans will also be gone. Let us listen and learn from them while we have the opportunity.

Lest we forget.









Anthony J. Sanfilippo, MD
Associate Dean
Undergraduate Medical Education