Geriatrics: Well-Behaved patients

I wore my "interview shoes" to work today in order to break them in, and Anita teased me about not wearing my usual Danskos. This morning we had lectures at JLWest about behavioral changes in the elderly and the cost of living in nursing homes and assisted living centers. Not surprisingly, prices started at about $150-$200 per day, give or take another hundred or more for incontinence care, medication dispensing, trips to the YMCA, etc. Bottom line: the cost of health care for the elderly is very expensive, and will probably require a lifetime of saving in order to live comfortably.

Grand Rounds covered yellow fever and was actually pretty interesting. The afternoon found me back at the JW Clinic, where Justin, Corey, and I were each given 4 patients to see. My first patient was well known for refusing her meds and fighting with staff (and med students), so I was determined to be at my nicest when I saw her. As it turns out, she was very pleasant towards me and had no objections to having me examine her. A "Happy Birthday" balloon hung from her wheelchair, but since she has dementia she said, "I haven't had a birthday in a while." Then she saw her balloon and remembered. My second patient was severely impaired and though she smiled at me, I couldn't understand her speech when she did speak. My third patient was a Parkinsons patient who's been having awful hallucinations ever since his Seroquel got discontinued; he told me his legs had been shot off and he needed prostheses (yet both legs were intact). I had to see my fourth patient in under 2 minutes (it was dangerously close to 3:00 pm, our meeting time), but fortunately she just sat still and let me examine her. As I later found out, she was one of those patients who was notorious for spitting at med students, yet she was well behaved for me. Dr. K later said that the stars must have been smiling at me for two normally troublesome patients to be so nice this afternoon. =)

Rounds proceeded as usual, with one of Justin's patients being flirtatious towards all things male and even called Corey to her side to say that she was waiting for a handsome man to carry her home (we all got a good laugh out of that one). My Parkinsons patient has a son who's a radiologist in FW, so when he was told that Corey wanted to be a radiologist he seemed pleased. Unfortunately the radiologists in FW don't allow med students to shadow them, which is odd and Dr. K suggested that Corey tell our associate dean Dr. D about it. Another patient proudly showed off his past as a Marine with pictures around the room, though it took him a while to explain the USMC on his polo shirt (US Marine Corps). On the Azalea wing, we met Miracle the cat again, and on the opposite wing we saw two cages, each with a rabbit in them. Two resident rabbits, how cute! One of them was black (Blackie) and rather defensive, and the other (Thumper) looked like he had a bum leg. The two of them are caged most of the time until the evening, when they are put in a pen so they can play together. Dr. K likes to quiz us all on EKGs, which we're not all very proficient at, but Corey gets the worst of it since Justin and I are future internists and Corey won't have to read any EKGs after his intern year. We all agreed that we'll have to find Dubin's EKG book and read it before next week.

Tomorrow it's back to Lakewood