Sunday, April 28, 2013

Medicine Waxes Poetic (Yeah, Like That Never Happens To Me)

     Well, it's been a really long time since my last post, but this past school-year was pretty insane, so I guess I have an excuse. Friday was the official last day of classes of my second year of medical school. Which means now it's just a steady push to taking the USMLE Step 1 exam and reaching what has been the light at the end of our current academic tunnel - third year. Actually rotating on the hospital floors.
     It can't come fast enough, because sitting for hours in our dungeon classroom was starting to wear down our last nerve. But as I've posted here before, there are always bright moments, the ones that remind us why we med students put ourselves through this.
     Geriatrics (the practice of medicine as it relates to elderly people and their health) was not anyone's favorite course, and making the trip to a nursing home to meet with our patient once every couple of weeks could sometimes be seen as an inconvenience.
     Still, as the course finished, and we were required to reflect on our experience, some of us realized that we had definitely learned something or at least found something to shape our learning as doctors. (Of course, there were always a few patients who were temperamental, uncooperative, or who attempted to seduce the young medical students assigned to them...).
     Anyway, my partner and alphabet-buddy (our names are side-by-side on the class roster) Kellie thought we could best reflect on our patient in the form of prose poetry. It's no Whitman or Wilde or Kafka, but it definitely conveys the lessons we learned from a rather interesting elderly woman.

EM. A Reflection.
That was what our experience with EM was.
"Hi EM. We are medical students from UB, do you mind if we ask you some questions today?"
"Sure, I've got nothing else to do. Have you been here before? You look familiar".
"Yes, we've been coming every other week for a few months."
Ironic that we gained so much from getting to interact with the same patient for the whole semester when she struggled to remember who we were.
Ironic that we learned so much about her and her life and her personality, yet she could only remember our faces.
Ironic that our experience with her defined so many aspects of medicine that had before been abstractions.
Perseveration, dementia, activities of daily living - intangible before EM exemplified them.
Ironic that by now we may only be abstractions and faint memories to her.
"Now we are going to ask you about your level of independence, do you need assistance dressing yourself?"
"No. How old am I again?"
"You're ninety-one."
"Ninety-one! Oh, I don't believe you! I guess I am doing pretty well for my age"
"Yes you are. How about cooking, do you need cook for yourself?"
"No, they take care of all of my meals here."
"Good. Do you need assistance using the telephone?"
“No, but I have three sons and I call them every week.”
“That’s great!”
“How old am I?”
“You’re ninety-one”
“Really? Wow!”
EM has dementia and repeats herself often.
EM showed us that in medicine it’s important to practice repetition.
The same steps should be followed and the same questions should be asked, no matter what the situation is and who your patient is.
“EM, compared to other people your age, overall do feel like you are better or worse off than them?”
“I think I am doing pretty well for myself. I am pretty healthy. How old am I?”
“You’re ninety-one.”
“Really? I don’t believe you! I’m doing pretty well then aren’t I?”
“Yes you are. Do you feel like you have trouble with your memory?”
“Well, I am getting older, and everyone has trouble with their memory when they get older and I guess I am no different.”
“Ok, now we are just going to ask you a few questions to assess your mental status. Can you tell me today’s date?”
“No. Living in a place like this, you don’t need to know the date. Everyday is the same.”
A person with dementia can be very misleading.
The information EM gave us wasn’t always correct.
If what the patient is saying doesn’t seem right, you have to go look for the truth.
“I am going to name three objects, can you repeat them back to me? Apple, penny, table.”
“Apple, penny, table.”
“Good, now remember those, because I will ask you them again. Can you spell the word world backwards for me?”
“Great, now can you tell me those three objects I had you remember?”
“No, but they weren’t really that important for me to remember, were they?”
“Well, no, I guess not. That’s ok.”
“How old am I?”
Familiarity allows you to learn so much more about a patient than their health.
Familiarity helps you realize that your patient is trying to cover up their disabilities with their personality.
Familiarity can mean expressing amusement at a patient’s joke.
Or the realization that the patient can’t confront their own illness.
Familiarity is knowing when EM’s illness is talking for her, and when she genuinely means what she says.
“Well EM, this is our last time meeting with you. Thank you for spending the time to meet with us this semester.”
“Of course, I like helping young people learn. Did I tell you that I have three sons?”
It’s people like EM that are the real teachers in medicine.
The ones that make us realize that patients are more than just their conditions. More than just symptoms. More than just a diagnosis to be reached.
Symptoms and diagnoses can’t express approval or accept gratitude. But EM did, every time.
This experience has further fueled our excitement for our future careers and for the relationships we will build with our patients.
The irony of learning medicine, the repetition of our day-to-day, the search for what a patient actually means, the familiarity to find it.
All of these and more EM taught us, and fueled our desire to learn and do our best.
“You’ll both be great doctors some day.”
And she meant it.