A day at geriatrics

For the last two weeks I’ve been doing healthcare of the elderly.  It’s been good; a nice return to general medicine where I can strut my stuff again from 3rd year and bolster it with what I’ve picked up so far from 4th year.

I began the day helping to cover an absent F1′s patients.  I was told to get an MMSE score for one of the demented patients in the ward.  It was a slow process and required much patience as the guy tended to confabulate if he didn’t understand what I’d said, which was most of it.  Eventually I got him to focus and got a score of 17/30 from him, which is indicative of his dementia.  I put it all in his notes and signed myself as having done it.  I hope I was useful.

After that I attended a memory clinic and was given a patient to fully clerk myself.  I’d need a full history, Addenbrooke’s memory score (like a very long MMSE) and a full physical.  After a kerfuffle getting a pen from a nurse (“this is the NHS young man, we don’t have spare pens.”) I sat down opposite the man and began to have a panic attack.  I don’t know what it was – I suppose it just dawned on me that I had a finite amount of time to get all this done and couldn’t get out of it now.  Weird.  Anyway that passed and I cracked on, doing a good job according to the consultant.  I got the impression he had very minor memory problems and was more depressed than anything.

After lunch I joined a ward round and lost browny points with the Reg for poo-pooing his 10mg dose of Citalopram for a patient.  The Consultant agreed with me and my 20mg suggestion, which didn’t help my cause.  After that I saw my first locked-in patient.  He was about 70 and had dementia too.  He could only look up for yes and down for no.

I started to read the Diving Bell and the Butterfly later that night.