Geriatrics. It is actually its own medicine subspecialty. Treating old people all day, every day. We are now required to do it as residents, so I just completed my 2 week rotation of Geri. Most of these old foagies come from nursing homes, and half of them comein for either an infection, or severe constipation. That's right. Crazy constipation, to the point of fecal impaction. That is pretty much the world of geriatrics. If you can treat constipation, and you can identify an infection, congratulations, you are a Geriatrician. (No offense to any Geri peeps out there).
Ulcers and constipation. The bread and butter. Sounds like fun eh? Some of these old folks get so constipated, they get severely fecal impacted (stool impacted and stuck in the "vault", sometimes all the way back up the colon). Usually this can be solved by a few enemas, and some fancy laxatives. On occasion, it is so severe, you need more direct intervention. How so you ask? Well glove up, gown up, because you are going in! Yeah it's gross, but sometimes it has to be done manually. Which means gettin your fingers up in there, and dislodging that shit! (pun intended) But that is what medical students are for. God bless 'em... Sometimes it is so severe, and the pressure is so great, after a few seconds of stimulation in there, there is literally an explosion of relief. It'll pour out like there is no tomorrow, and fast. I've seen it happen, the patient is the happiest person alive, as the other patients dart out of the room in disgust. Anyway, I didn't have to do that this month, but thought I'd revisit some lovely imagery that we all know and love.... Umm, ok moving on....
So one thing we did do during Geriatrics was "skin rounds". Which is basically goin to see bedridden patients for a few hours to assess and discuss their pressure ulers, the staging, and the treatment. It is a pretty big deal in these chronically ill patients, so it was good to learn more about them. So it was 3 of us residents and a few med students, with the attending. We saw two patients on this day. The first was a young guy who had a spinal injury, so was bedridden. He was talkative, he could move him self around quite well. We took a look at his sacral decubitus ulcers and did what we had to do. The attending noted that this is not a typical geriatric patient with ulcers, as they are usually very old, demented, and not very talkative.... Ok, so noted. Off to see the second patient now. She was about 86, with severe dementia and was bedridden. As we walked into the room we called her name, but she lay there with no response, mouth half open, not moving. The attending said that this is more like what bedridden patients with ulcers are like. So we get around the bed, she continues talking and everyone starts to glove up in preparation to turn her. I continue staring at the patient, and something just didn't seem right. Sure she is old and demented, but did I see her breathe yet? I slip my fingers on to her wrist to feel for a pulse. The attending asks me "What's wrong? Do you think....." When she looks again, she then realizes that I may be right. Everyone pauses, and I shake my head. "No pulse, and I haven't seen her breathe yet... Anyone?" Patient was dead dead. We quickly confirm with the nurse her DNR status, and that was that. She was probably gone for at least a few hours. The med students were in a little shock, and the attending a little embarassed. But that is what old sick people do. They die. She probably went comfortably, quietly, as her heart stopped beatIng. The best way to go if you ask me.
So that is really the world of geriatrics. Today I start Neurology for the next 2 weeks. Strokes, Seizures, and maybe a random funky neurological disease or two.....
Recent Comments