The elderly patient: in situ ============================ * Pamela Brett-MacLean * © 2007 Canadian Medical Association or its licensors Dr. Mark Nowaczynski began to take photographs of his elderly patients in their homes in 1998 with the aim of documenting their vulnerability as they lived isolated and alone, attempting to maintain their independence. An Assistant Professor in the Department of Family and Community Medicine in the Faculty of Medicine at the University of Toronto, he was driven by photography's potential to influence social change. Nowaczynski was inspired by the work of documentary photographer Lewis W. Hine, a teacher who turned to photography as a way to document the plight of children, some as young as 3 years old, who worked long hours at the turn of the 19th century. Hired by the US Child Labour Bureau, Hine produced “photographs of children working in cotton mills, beet fields and coal mines [which influenced] legislators to make child labor illegal.”1 In a similar fashion, Nowaczynski hopes to raise awareness of the hidden lives of vulnerable, house-bound elders and the pressing need for home care. His photos were displayed at the conference, *The Greying Nation: Transitions of care in later life*, in Edmonton (Mar. 21–23, 2007). The National Film Board of Canada's documentary, *House Calls*,2 which followed him as he visited and photographed his patients, won the Donald Brittain Award for Best Social/Political Documentary Program at the 2006 Gemini Awards and a Freddie Award (Caregiving) in 2005. ![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/176/11/1617/F1.medium.gif) [Figure1](http://www.cmaj.ca/content/176/11/1617/F1) Figure. Miss Constance C., January 2005: Prior to 2003, Miss C. lived alone in a small apartment, on a meagre fixed income. The central focus of her life was her cat Oscar, who she affectionately called “my boyfriend.” Nearly blind, sick and frail with heart disease, she fell and broke her arm. She was moved to a retirement home, without her cat, and awaited final placement in a nursing home. Her photo was published in the newspaper, and a local non-profit agency offered Miss C. a subsidized apartment, with supportive services, and — they allowed cats! Miss C. and Oscar were happily reunited. Her health improved in the supportive environment and she enjoyed two good years on her own with Oscar. In this photo, Miss C. has suffered a stroke, and her health deteriorates. She realizes “Maybe I won't be around very long.” Photo by: Mark Nowaczynski ![Figure2](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/176/11/1617/F2.medium.gif) [Figure2](http://www.cmaj.ca/content/176/11/1617/F2) Figure. Miss Constance C.'s empty room, April 2005: Virtually bed-bound, Miss C. had to move to a nursing home and give her beloved cat Oscar away. She died a few weeks later. Photo by: Mark Nowaczynski ## REFERENCES 1. 1. Sontag S. *On photography.* Toronto: McGraw-Hill Ryerson;1973. p. 63. 2. 2. *House calls* [film]. Montréal: National Film Board of Canada; 2004. [www.nfb.ca/housecalls](http://www.nfb.ca/housecalls)