Geriatrician Samir Sinha takes Jean's blood pressure in the living room of her small, north Toronto apartment. Not long ago, the chronic pain made the 86-year-old want to die.
But on this overcast spring day, Jean is chatty and upbeat as she sits in her reclining chair with the comforts of home: a large glass jar filled with jellied candies and a laptop computer, which sit on nearby tables. Only her Himalayan cat seems out of sorts, darting in and out of the bedroom, wary of new visitors.
Dr. Sinha, director of geriatrics for Mount Sinai Hospital and University Health Network, is seeing Jean because he was asked to by Mark Nowaczynski, clinical director of House Calls: Interdisciplinary Mobile Team Serving Frail Seniors, a not-for-profit program.
The pair are providing a type of 1930s health care - the house call - a rarity in Canada today.
Under the government-funded program for which Dr. Nowaczynski works, patients have access to a full health-care team that includes a social worker, an occupational therapist and nurse practitioner.
He and Dr. Sinha are working to develop a hybrid model of home-based care for frail house-bound seniors.
Though this new job came with a cut in income for Dr. Nowaczynski, who closed his practice four years ago, he absolutely loves it.
"I am not proud to say that I am one of the few physicians in Canada that provides home-based care to frail seniors full-time," said Dr. Nowaczynski. "We are facing a looming crisis that we need to work hard to avert."
One crisis he averted when he met Jean two years ago was her desperation to end her life. Once he got her on the right medication, she realized she didn't want to die - she just wanted to be out of pain.
"You saved my life," she told him during the house visit.
Over the next 90 minutes, Dr. Sinha takes an inventory of Jean's medical problems and past injuries and does a memory test. He makes a list of recommendations, which includes having an occupational therapist to see if she can rearrange furniture in her bedroom as she falls about once a week due to "backing up" on her bed with her walker.
After Dr. Sinha sees her, he says she "I think she could live at least five to ten more good years with ongoing support of Mark and his team and myself and others."
Next visit is Steven, who, at 92, has congestive heart failure. He still lives in the north Toronto bungalow he bought with his 80-year-old wife, Anna, three decades ago.
"You have a lady with Parkinson's whose the primary caregiver for a husband who's bed bound," Dr. Sinha said.
He notices a striking photograph of a man in a Royal Air Force uniform and asks about his experience.
Steven was in the Polish Air Force, and later was a bomber pilot for the RAF, explains Anna, her husband smiling gently.
The doctor's question doesn't only help jog a patient's memory: It brings a dose of humanity to a medical reality.