Scutmonkey Chronicles

Commentary on healthcare in general, life as a medical student, and issues of concern thereof. Readers warmly encouraged to contribute their "best" and "worst" experiences with the healthcare system (who knows, some budding young doctor might learn something from your pain...?) Submit via comments section, or email me at oarlock@gmail.com if you'd like to become a regular contributor. Welcome, and don't forget to double-glove!

Saturday, March 10, 2007

Things Looking Up and Geriatric Medicine

Got new residents for the March schedule. Things are much improved since then. Goes to prove, you can be reasonably competant AND reasonably happy. Life is so much better when you can smile openly and even ask the occasional stupid question with no fear of reprisal.

Due to the location of my current hospital, 80% of our patients are over 65. This means an intense learning experience in geriatric medicine, and all that entails.

In general, I like working with older patients. They are usually pretty calm and understanding about the fact that nobody is going to be able to snap their fingers and put them back to their 20 year old state of being, whereas of the 40-60 crowd many seem to think that is possible and should in fact be the standard of care. Even if they have been eating nothing but baloney sandwiches and twinkies for the past several decades.

One thing I have learned about working with older folks is that you have to learn to take some of the things they may tell you with a grain of salt, but also not completely ignore statements that may sound a little "off."

An example: a patient on my service, who I'll call Miss Liz for HIPPA purpuses. Miss Liz is sweet and generally pretty with it for eighty-nine. She has also been a nursing home resident for the last eight years and has not driven a car for the past twenty.

Yesterday, I went to see Miss Liz and she told me with much excitement how, the night before, she had been involved in a twenty-car pileup in a neighboring town. She proceeded to relate details about live chickens running across the highway and a very handsome state trooper that seemed to be interested in Miss Liz, in a romantic way.

OK, so it was pretty clear that this didn't happen, at least the night before. But one thing it did tell me was that Miss Liz had made a sharp downhill turn as far as mental status in the twelve hours since I'd seen her. And that is important! As it turned out, she'd been on a very strong antibiotic (levaquin) that does strange things cognitively to older people. I had to go through a whole song and dance with her attending to get it changed, but when he came and saw her and saw for himself how different she was, he agreed.

A less educationally poignant but pretty funny geriatric story about another patient on the floor, Miss Jane. At ninety-four, Miss Jane has some interesting habits, things that when she first arrived we attributed to possible alzheimers. First thing in the a.m., she liked for the nurses to do up her hair in pigtails. While being wheeled through the hospital for her various tests, she liked to grab the butts of the male doctors and shout "Yoohoo!" As it turned out, Miss Jane is not senile. She just figures she should enjoy every day to the max. More power to her.

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