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.

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