I did my 8
Weeks’ Geriatrics Elective in the massive 11 Weeks’ Break between Semesters 11
and 12. Interestingly, the Senior Geriatrician who approved my Elective WAS 1 of
the 2 Examiners in my Long Case Exam (!!!), but he actually delegated my Supervision
to another Geriatrician, so I didn’t see him much apart from the weekly Radiology
Meetings. The Elective was held at the Geriatrics Department away from the main
Hospital Campus, and although I was given Opportunities to follow the
Geriatricians onto the (Main) General Medicine Wards to see Referrals, I didn’t
pursue that coz I felt I was much more attracted to staying at the Former
Location. Likewise, there were Opportunities to attend Outpatient Clinics for “Memory”,
“Falls”, “Incontinence” and “Wounds”, but I only attended a few Sessions of
each before getting drawn away to the “Main Stage”.
Geriatrics Outpatient
Clinics were well Organized. Incontinence Clinic was probably the least
interesting to me coz the Majority were Female Patients (despite the fact that
Men can have enlarged Prostates --> Overflow Incontinence) and they had
Stress or Urge Incontinence. I was able to witness and take a few Histories,
but wasn’t allowed to examine their Pelvic Region or operate the Machine which
detected their PVR (Post-Void Residual, ie urine remaining in Bladder after
Urination), so I felt rather left out of the Diagnostics Process.
Falls
Clinic was very good coz I got to see how the Geriatrician use a systematic
Approach to exclude numerous causes of Falls (Medical and Environmental Causes),
along with observing how he did Physical Exams, not just Upper and Lower Limb,
but also Falls-Specific ones such as “Timed Up-And-Go”, ie more Action and
engaging.
Wounds
Clinic was fascinating visually, plus the Fact that there was a
Multidisciplinary Team working at the time (Doctors, Nurses, Podiatrists,
Pharmacists), it felt like a “Medical Party” : P . There was a very passionate Wounds
Specialist whom I initially thought was a Dermatologist (Skin Doctor), but was
actually a Pharmacist. He made the Effort to explain the Pathophysiology of
Venous and Arterial Ulcers, what he was doing in each Step with his Creams /
Ointments / Special Bandages and how it would help the Skin, whilst I furiously
wrote Notes. I walked into another Room and was awed by the Podiatrist as he
skillfully shaved off Slivers of dead Skin from Diabetic Patients’ Calluses on
their Foot. I think he might’ve thought I was overly eager coz I was peeping
close to observe the Slivers curl off. That Podiatrist could perhaps be a Sculptor
as an alternative Career : ) . Whilst the Callus was being shaved, I was also
took a partial Medical History of the Patient. It was disturbing yet intriguing
how some of the massive Venous Ulcers were slow to heal in the Elderly
Patients. The Venous Ulcers were typically superficial up to ~10 cm in Diameter,
but all that “Raw” red, shiny dermis looked REEEEAAALLLLY PAINFUL even though
our Textbook said it’s not supposed to hurt much. I was shocked at the
Fragility of their Skin, when I saw a Nurse accidentally tore a bit of the
Patient’s skin with a Scissor while cutting the Wound Bandages, so delicate
like Tissue Paper. Whilst the Patients were being treated, I was able to take
casual Medical Histories from them, focusing on Risk Factors for Ulcers and
Falls (which lead to Skin tearing off). The Visual Details and the Patients’ Information
was very stimulating.
In the
Memory Clinic, I played a more passive role in observing the Geriatricians do
Memory and Cognitive Assessments, although I was amused by the Variety of
responses given. I “LOL’ed” in my Mind when an elderly male Patient was asked
to point at the Picture that was Nautical, and responded “Hmmm this is
difficult. I can see the Boat over here, but a Crocodile is technically
Nautical as well…”. There was 1 male Patient aged ~70, who I suspect is an undiagnosed
Aspie who has an ASD Daughter, presenting for his Radiology Results, that most
likely ruled out Neurodegeneration. I was curious to see if he exhibited signs
of Dementia, but the Geriatrician said that Clinically and Radiology-wise he
looked fine, although there were concerns by his (NT) Wife that he has some
sort of Cognitive Impairment due to his supposedly poor Relationship /
Interpersonal skills during their entire Marriage. He had that round Macrocephalic
(large head) Appearance and Flat Affect common in Aspies, and the same Special
Interest his whole Life. I felt like bursting out and saying that he may have
AS, but knew that it was technically unprofessional to do so, so left him
alone. I know it was just 1 person, but it was a relief to know that he wasn’t diagnosed with Parkinson’s Disease or Fronto-Temporal Lobe Dementia (yet?) because
my personal research suggests that ASD / ADHD people are apparently at higher
risk of these 2 Dementias, very sadly : ( It was also very emotional when the
Geriatrician had to inform another Patient their Diagnosis of Alzheimer’s
Disease, its Implications and Initial Management. She tried to put a lighter
spin on the Diagnosis, in that he just had to do Things differently, like using
Public Transport instead of Driving, but his Family Members were shedding Tears
and hugging him, likely knowing that these were Attempts to Soft-Pedal his
Diagnosis, which is typically terminal within ~7 years IIRC…
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