Clerkship Updates: Geriatrics

I cannot believe 2019 is almost at an end! This year has just flown by! I just had an incredible rotation in Geriatrics. It consisted of 2 weeks on consults and 2 weeks managing patients on the Geriatrics wards or off-service units. There were also two 1/2 weekends on consults.

Geriatrics was challenging in many ways:

  1. Patients often have complex medical histories
  2. Patients often have varying degrees of neurocognitive disorder (dementia)
  3. Patients are often frail and at risk of falls
  4. Patients may have delirium which can be difficult to tease apart from possible underlying neurocognitive disorder
  5. Patients are dealing with many challenges such as incontinence which can be demoralizing for them. For some patients, continence may be their last act of independent functioning.
  6. Patients are often on multiple medications (polypharmacy) whose side effects can put patients at further risk of falls or delirium.
  7. Patients are faced with what we often write in the charts as “disposition”. Where will they be going next after being discharged from hospital? They are often too frail or dependent to go back home therefore may be facing the reality of moving to a residence or nursing home. There can be complex family dynamics as the details of this transition is worked out.

Despite the complexity of geriatrics, I found this to be a truly rewarding rotation as I developed close bonds with my patients and got to know some of them very well. I was really touched by some of the conversations I had with my patients and how much I learned from them. I worked with a fantastic interdisciplinary team and found the geriatric physicians to be extremely compassionate. I also developed clinical skills that will be very useful in my future practice as a family doctor.

I am now on my last rotation of clerkship! It is an elective in Allergy and Immunology and has been an extremely fascinating rotation so far! More details to come!

Featured image courtesy of Emory University School of Medicine

Clerkship Update: Palliative Care

I had an incredible experience on my palliative care rotation. Going into it, I wasn’t sure what to expect. Whenever I informed people what rotation I was in, many wrinkled up their faces and said, “Ooh, it’s got to be depressing being around so many dying people”.

I have to say that my experience was quite the opposite. It is a different way of practicing medicine. Rather than focusing on curing a patient, one is focused on making them as comfortable as possible as they navigate the last months, weeks, days, hours and seconds of their lives. I found it a true privilege to accompany people on this journey.

I very much enjoyed how much time I got to spend with each patient and their families on a daily basis. It was certainly never easy discussing a short prognosis but in some ways, families found relief in having an idea of their loved one’s trajectory and in knowing they would be kept as comfortable as possible. The main things that impact heavily on dying patients, particularly in the context of terminal cancer, are pain, nausea, lack of appetite and a progressive sense of loss as they decline in function. Although it can be  difficult to do much about the loss of function, it is staggering to see how much better a patient feels when their pain and nausea can be controlled.

On this rotation, I worked with an excellent interdisciplinary team of doctors, nurses, social workers, PABs and art therapists.  I was truly inspired by their dedication and compassion for our patients.  I certainly struggled with my emotions when I lost a patient (which was almost on a daily basis) especially seeing the profound impact on the family members left behind. I truly treasure the meaningful connections I had with patients and their families on this rotation.

I also had the opportunity to participate in home visits. There was something especially touching about being able to go into a patient’s home and deliver care to them in an environment where they feel most at home.

Overall, my palliative care rotation was one of my best experiences in medical school. I encourage medical students out there wondering what electives to take to strongly consider taking it. It will change your perspective on life.

As my fourth year of medical school continues, I feel my confidence as a doctor-in-training progressively growing. There is still so much to learn of course. One of the great things about medicine, is the challenge of constantly growing and learning new things. As I ponder the current stage in my training, I am so grateful to be on this path to becoming a doctor, as difficult and challenging as it can be.

Featured image courtesy of https://www.medstarfranklinsquare.org

The Gift of Study

Great advice for premeds, medical students and residents!

Medicine From The Trenches

Introduction

Many who read this blog will begin their studies of medicine in a few short weeks while others will move into new roles perhaps with more responsibility and duties. I wanted to take a few lines to write about moving into your new roles be they medical student, intern (PGY-1), resident or attending physician.

Preparation

A mentor from my first days of medical school, actually during orientation, said in his soft southern accent, “Now go out and grab a copy of The New England Journal of Medicine and read it from cover to cover.” “You won’t understand it at first but keep reading it and studying the words of medicine.” Little did he know that he had just added more fodder to my constant journal reading and now had stoked a fire so huge that I could have been consumed in the flames, so to speak. As I look…

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