There were
weekly Radiology Meetings where Doctors presented Geriatric Cases prior to
having their (Patient) Radiology Results shown on the Projector Screen. Some of
the CT and MRI Scans were really eye-opening with regards to the amount of
Brain Atrophy that has occurred. Even though I didn’t get to see the Patient, I
felt really upset inside, a “Gut” Feeling of Sadness for how much Neurodegeneration
has occurred and how miserable he must be, to lose so much of the Knowledge and
Skills that he painstakingly acquire throughout his Life. What is his Quality
of Life like? Is it really worth it for him to keep living? Would his children
(if any) consider him to be a Burden? What is the Trigger for
Neurodegeneration, and why is there such Variation amongst elderly Patients of
the same Age, even in those that didn’t have Strokes or other Cardiovascular
Risk Factors?
Interestingly,
they also discussing an “Official” Statement from the FDA or some American Health
Organization that Statins don’t accelerate Dementia, even though there have
been numerous Anecdotes about this, and the Fact that a lot of Brain Matter
consists and requires Cholesterol to function. I was worried that there may be
a Cover-up by the Drug Companies, especially as Statins are a HUGE source of
Income to them, and wouldn’t want to be complicit in prescribing it if that was
the Case, but I don’t have the Evidence to prove either way. Maybe we’ll just
have to wait and see in the coming Decade…
I managed
to witness my first Code Grey during this Elective, which involved a Patient
with Dementia wanting to go Home to see her Children and Pet Dog, trying to
escape and screaming and being violent when being restrained by Nurses as she
was attempting to abscond in her Walking Frame. When Security came, she stopped
resisting and started crying. I felt so sorry for her, that she was so frail with
reduced Mental Faculties. She had Children to look forward to upon going Home,
but I wonder what about those that are Single like me? What will happen to me
if I (Goodness Forbid) get some form of Dementia in the future? How would I
cope and what resources will be available by then? The Resident actually walked
up to her and acted Calm, wanting to ask her what her concerns were and trying
to reassure her that her Children and Pet Dog were fine, and that it was
important for her to rest and comply with Treatment to facilitate Recovery in Order
to be discharged. I was really impressed by this Resident’s Actions in light of
this Commotion as it helped calm her down, so she didn’t need to take so much sedating
Medication.
With
regards to the Patient Case Mix, it was quite impressive. Although there were a
lot of Bread-and-Butter Issues like Diabetes, Pneumonia and Fractures, I also
saw quite a few Rare Conditions like POEM Syndrome and Multiple Myeloma. The
Neurogeriatrics Ward was a good Area to practice Neurological Exams to help
isolate the different Brain Areas affected by Strokes, which was also tragic in
my Mind coz I saw several Dysphasic and Dysarthric Patients again.
MMSEs (Mini-Mental
State Exam, a screen for Cognitive Impairment) was the most common Assessment I
did on the Geriatric Patients. I was similarly impressed by the Variety of
Responses and Scores. Although on the Surface there was a fixed List of Questions
and Tasks to attend to, there was actually more Flexibility required than I
thought, when phrasing the Questions and providing Accommodations without
overtly distorting the Assessment Process. Hence the preconceived Monotony was
non-existent.
For
Patients who were visually impaired, I had to write “CLOSE YOUR EYES” really
big on a Sheet of Paper. A Patient with severe Hearing Impairment required me
to speak VERY loudly and slowly into her Ears for a few of the Memory Tasks
(which weren’t allowed to be written). I came up with the Strategy that if she
couldn’t hear what I was saying, she could squeeze my Hand in which she did. She
was really happy that she could understand what I was saying and my Efforts to
Accommodate her, because a lot of Nursing and Medical Staff in the past thought
she was Demented or Delirious (!!!) when in Fact she just couldn’t hear what
they were saying, and thus comprehend their Requests. She said that I helped
her “Interact with Young People, and feel part of the Community”. It felt
really good that I was able to correct a common Misconception about her, so she’d
be less likely to be treated along the wrong “Medical Route”, especially for misdiagnosed Delirium.
I felt like
crying when I did an MMSE on a Dysphasic Patient who had a lot of difficulty
answering my Questions in the MMSE, like he was being locked from expressing
himself. I felt really guilty for doing
the Assessment on him, like I was forcing him to be reminded of his Inadequacies,
although from an objective Point of View, I shouldn’t feel guilty at all, as
everybody needs to be assessed at some Point so they can have a Management Plan
more specific to their Circumstances.
On the
other hand, there was a Female Patient who recently had a Stroke and was
Dysphasic, but was very Cooperative and “level-headed” when trying to do the
MMSE, which somewhat inspired me, that she was willing to try things out even
if she had a recent physical Insult, and may not have been good at it.
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