Saturday, April 13, 2013

Resident Post: Matthew Butler

Starting my geriatrics rotation, I wasn’t sure what to expect.  Many of the people we care for in internal medicine are by definition “geriatric”, so how could this rotation really be much different, right?  What I discovered during this rotation is that sometimes taking care of your patients doesn’t mean simply mean ordering the right tests, making the correct diagnosis, and giving the evidence-based medical therapy.  There is more to that, especially when dealing with older patients.  I found myself looking past the basic medical evidence and instead thinking about what would truly be best for each patient.  Maybe that blood pressure medicine, strict diabetic control, or allergy medication is doing more harm than good; or does the benefit of ordering that invasive test really outweigh the benefit in my frail 82 year old patient? No, not every 80 year old is the same regarding their functional status and treating each patient the same is bad medicine. 
I also came to realize that looking past vital signs and lab test is necessary to really care for my patients. When someone is falling at home or having a difficult time caring for themselves, the answer is oftentimes not simply in the “results” section of the chart.  It is buried in the patients’ history and their home situation. Who is there to provide care at home?  What can be done to make your living situation safer? Are there things we are prescribing that are actually making this worse?  These are the questions I had to ask myself.  In essence, I re-discovered the “art of medicine” and re-focused my treatments to the individual, which is so vitally important in the geriatric population. 

Tuesday, April 9, 2013

Resident Post: Jennifer Schrimsher

"A place for everything and everything in its place," she said, as if her grandmother's maxim would somehow save her husband from his fate.

The questions the doctor asked further solidified what she had feared. She couldn't bear to watch it being committed to record, "There you go, with the typing again. Do you really have to write this all down?"

Her schoolmarm demeanor would falter at times. A dab of the tissue beneath her glasses, "I go through a lot of these, these days."

His adulthood was slipping away. Not into old age, but adolescence. His ornery boyhood charm was evident. A former college professor, his specialty was computer science. He could no longer remember how to operate his own.
She clutched her tissue.

The dirty clothes hung with the clean. She knew by the way he folds his sleeves.
The accidents found in the hamper. 
The nest egg squandered unbeknownst to her.
The stop sign he ran on the way. "Well there was no one coming."
He smiled.
She dabbed.

His toenails had become unsightly. She had mentioned they needed trimmed that morning. He had complied. He took off his socks to show his handiwork, nails cut to the quick.
He smiled.
She dabbed.

As she broached the subject of the future, the retirement village by their son, the living will... she clung to his arm. His "big, strong" arm, she said. The arms that had built their house, helped raise their children, protected her for so many years...
He smiled.
She dabbed.
And she dabbed again.
And he just smiled and took her hand.

"It'll be okay."