Friday, February 15, 2013

Resident Post: Luke Amos

The last place I thought I would find inspiration for my geriatric rotation reflection was my Twitter feed.  The irony being that the majority of adults over the age of 65 are in all probability still foreign to social media.  But, that’s exactly where I found my motivation.  During my daily surfing/procrastination I came across a wedding announcement, of all things, that wholly underlined the words of one attending, “age is not a number”.  Over this month I’ve gotten to see up close and visit with patients in the clinic, skilled nursing facilities, and other clinical settings that resemble Ms. Bryant (97) and Mr. Haire (87) [see hyperlink to article above].  From the 92 year old gentleman who still smoked his daily cigar and drank his daily beer and slyly requested his bath aide be female to the truculent 85 year old retired nurse who pointedly required that all of her medications be laid out and explained.   
 It’s a poignant and heartwarming story that truly shows many things do not change as we age.  Nowhere is this clearer than in Mr. Haire’s unabashed honesty when it comes to bearing his true feelings.  Best expressed as, “I can attest that it doesn’t get easier even in advanced age.” I also truly appreciate the fierce loyalty and independence that comes across with the line, "The bride, 97, is keeping her name."  And together the bridge and groom being initially reluctant to be cast as a “couple” in their retirement community, as the article points out, a “couple” being a widow and widower who have dinner together.  The whole scene tepidly brings to mind first loves and high school gossip.  A reminiscence that at 90 is just as real and at times painful as it is at 16.   The lesson of age not being a number will be the life lesson I take away from my month on geriatrics.

Tuesday, February 5, 2013

Resident Post: Shaundre Brown

"In youth the days are short and the years are long; in old age the years are short and the days long." --Nikita Ivanovich Panin

As I near the completion of my geriatrics rotation, I have the opportunity to reflect on the many lessons that I have learned. What a great opportunity it has been to see the other side--to see what happens when our elderly patient with CHF/COPD/etc with limited resources leaves the hospital. As expected, discharge planning, particularly for the geriatrics population, is a key focus for the medical team starting at the time of the hospital admission. I have taken care of so many patients where I have wondered how they managed to continue to live at home alone. In our discharge planning, we often coordinate with PT/OT, speech and social work teams to help develop the best possible discharge destination for the patient, many times for our geriatric patients, we decide that place should be a nursing facility, either short or long term. Ideally, there is good communication between the medical team, patient, and family during the course of the hospital stay. A few months ago, I had a patient, Ms. X, who had end stage heart failure as well as a history of schizophrenia. She would come in to the hospital and it was "obvious" to all of the medical team that she "clearly" belonged in a nursing facility. She required help for all of her IADLs. She would feed herself but basically needed help for almost everything else. She would come in and we would tune her up. Then, everyone would talk to her about going to a nursing home. She always said no. Psych was consulted--yes, she had capacity. I saw her when her disease was at the very end stage, but according to the records this had gone on for many years. Some of us on the team would say "how can she continue to live that way?" or "why won't she let us help her?". One day she told me her reasoning. She said, "I ain't got long. What time I do have I wanna be at home". Very plainly, she laid out her goals for me, She told me that she did not need much, but she just wanted to be home. One of my attendings on geriatrics shared with me that our "frail" geriatrics patients actually do quite well at home. She said that I would be surprised to see how these patients can often even thrive when in their own environments. I saw many of these  patients in the geriatrics clinic--my attending was right. Hopefully, we can all continue to do our best to respect the wishes of our patients. It's so important to many elderly patients to spend their last days in their own environment. We as the medical team should exhuast all efforts to try to have patients at home whenever possible for as long as safely possible. We should hope that one day someone else will do the same for us as our years grow short, if we are so blessed.

Resident Post: Christi Bartlett

A few weeks ago I went to see an elderly patient with severe dementia who was a WWI veteran.  He was in a pleasant mood during my exam and on my way out the door I thanked him for his service to our country.  His face instantly changed and he began to weep quietly.  I could only make out a few of his words...

Laying there....


Birds pecking at their eyes....

And then he broke down.  Inconsolable.  There are some memories that even Alzheimer's can't erase.