Resident Post: Maharshi Bhakta

I did Geriatrics last month as an Intern and I am elated for having this rotation earlier on in my Residency. Topics and discussions that we had in Geriatrics were unique and separate from rest of the rotations I did as an Intern. For example, when seeing a patient in the clinic we automatically assume everyone is going to live to be 100 years old. This is certainly not true however when considering screening test it rarely comes to mind to evaluate the life expectancy of the patient and whether the patient will be able to get the treatment if screened positive. Also, after completing Geriatrics, I find myself evaluating patients ADLs and IADLs not because I never learned them in medical school but I never grasped the importance and relevance of that affecting the patient's health and social situation.  During the clinics with Dr. Hayley and Nursing home visits with Dr. Kalender-Rich, I had opportunity to focus on issues pertaining to geriatrics such as driving ability, dementia and incontinence. I feel like I became more clinically astute in assessing and managing those issues.  

Resident Post: Cipporah Gordon

The reality of Aging

 The realization we are all going to be “old” someday, G-d willing, is usually a thought placed under layers of other more eminent and relevant ideas. However, when walking through a nursing home this thought quickly surfaces faster than the speed of light. One notices each resident’s room is adorn with photos of the very lives they created generation upon generation. There most always is a black and white photo of a man in military uniform that catches your attention, and can be used as a starting point for conversation.

 

The elderly individual varies in their ability to interact with you; some diagnosed with Alzheimer’s dementia and are unable to accurately answer questions, but some elderly individuals are in good health and can give you their whole life story, whether you ask for it or not. Strangely enough both of these individuals impact you the same. The deep wrinkles on their face are indicative of the many expressions felt in their lifetime from happiness, sorrow, fright, to excitement, and you truly begin to wonder what kind of life they had prior to coming here; how many kids? Homemaker or serviceman? Do they remember the depression and WW2? the Holocaust? They become a non-published version of a history book in their own right.

Further, the elderly person with Alzheimer’s dementia gives you a few extra thoughts to ponder. Thoughts such as, what a challenge for their family to see their loved one without the very memories that makes them who they are… and what if this would happen to me? Or someone dear to me? This is truly a hard disease not only for the patient but for those who love them.

 
It is the circle of life to age and to die, yet feeling like one is going to “get old” one day seems unreal and I am certain it did to the very people I saw. Maybe living our life like we are “aging”  each day would afford us the perspective of doing the “things” that really matter to us,  and with those that matter to us most. For certain, we are all on a time clock never knowing when the alarm will go off, only hoping it will not be today. So to age is a blessing- It was an invaluable experience to have met  these individuals over the course of my geriatric rotation and I can confidently say the realization I will be “old” someday does not have as many layers covering it as it did 4 weeks ago.

Resident Post: Pooja Bhadbhade

The last month of Geriatrics was surprisingly rewarding.  I get so used to the fast pace of inpatient medicine, so shifting to Geriatrics was a new concept because I realized you have to approach the patient differently.  I quickly realized that you ask different questions and look out for specific things when seeing a geriatrics patient.  For example, I never thought about asking about ADLs or IADLs when doing an H&P, but knowing this will help guide your plan for a geriatrics patient.  In addition, one concept I will find useful is the concept of prescribing cascade which involves prescribing medications for symptoms caused by other medications, and I didn't realize how often this happens until I came across this concept.  Also, I realized the importance of considering a patients age and life expectancy when it comes to treatments and screenings.  It's easy to get in the routine of common recommendations, but it's important to step back and look at the patient as a whole and consider where they are along life's continuum. Finally, it dawned on me that growing old is not easy because many patients are limited on what they can and can't do and things that define them or activities they have enjoyed their whole life may not be possible anymore due to their functional status and as a person who is active and constantly on the move, I can't imagine what it's like not to be able to enjoy those activities.  However, almost every patient was accompanied by a loved one or someone who looked after them who worked at making their elder comfortable and safe which is encouraging.  

Resident Post: Alan Doty

As I look back on the last four weeks on the geriatrics rotation, I am amazed at the complexity of the medical management involved in the elderly patient care. As a physician, we have the unique experience to see the many aspects of care from the family members involved, hospitals, long care facilities, home health, and even hospice and the absolute importance in the effective coordination involved in managing all of the aspects of care. During my time time on this rotation, I had the opportunity to visit with many patients and families, all of them so welcomed the care and I never saw any loved one express anger or frustration, even with sometimes devastating diseases that they were dealing with. The history and experience that the older generation has is so important. Just to sit and listen to there stories is amazing. Not only do the benefit from having someone to talk with and relay the experiences, but the insight and value of hearing those experience can not be measured. My greatest hope is that we, as physicians, don't loss the ability to spend time getting to know our patients and their families.

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. 

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."

Resident Post: Tamim Mahayni

As I reflect on my geriatrics experience, I’m left with a sense of amazement to the strength of the spouses and families I met throughout the month.  Every patient I had the opportunity to visit was accompanied by a spouse, sibling, or other loved one that was able to recount the activities of the past year in a detailed manner leading to a meaningful visit for both the patient and physician alike.  Never did I encounter a family member frustrated with the task of taking care of their loved one, and for this reason, it is essential for the physician to provide gratitude every visit to the loved ones.  I can only imagine the degree of difficulty it is to manage the daily life of an elderly family member with cognitive deficits, and the families I met do this on a daily basis.  I can only hope that I’ll be able to provide the same level of care to my loved ones when the opportunity to do so arises.