The Chaos of Medicine: Day One

Friday, December 30, 2011

Day One

July 2nd, 2011
Nervously, I step inside the room. The smell of bodily odors is even stronger than it was in the hallway. Before me lies a patient in bed. She seems to be staring at the wall. The nurse I met this morning - now my colleague, introduces me to the patient. No response. I am told that the patient has Huntington's Disease, a hereditary, degenerative disorder leaving her unable to speak, move or even think. This explains the apparent lack of response. I feel uncomfortable and I wonder how I should react. But even more, I wonder why I ever wanted to work in a nursing home.

Two months earlier I was looking for a job for the summer. Since I had decided that I wanted to become a doctor some years ago, I looked for a health care related job. The local nursing home had a position for 'patient care' available - there was never any clarification beyond that. I applied for the job after deciding that I was fine with everything they could ask me to do: washing people, cleaning up rooms (and poop), it was all worth the experience in patient care. After all I figured that someone needs to take care of these things and I know there are great nurses who thoroughly enjoy their profession. To my surprise - somehow I did not expect to be qualified - I was hired. A training day followed, where we learned the basics of dementia and patient lifts. After this, I received my work schedule. I was eager to start.

After this short and awkward introduction, we get to work right away. Soon enough I find out that I am indeed expected to wash patients. But first I can watch and assist a couple of times to get used to everything. Within three minutes, the patient is undressed completely. I watch the nurse, who routinely but kindly washes the patient. I try to hide the unwelcome, but almost inevitable sense of disgust when watching the cleaning of the patient's intimate parts and just hope I succeed in observing with a facial expression as neutral as possible.

As the day progresses, I find out more about the eight patients I will spend the next six weeks with. The poorly controlled diabetic with two fingers already amputated. The woman who has been blind for over 40 years and still struggles with this from time to time. The friendly old lady who came in for rehabilitation after a broken hip. She just heard that she is never able to return to her home due to progressing Alzheimer's. I try to help them the best I can. They are glad to have someone to talk to, someone who listens. I have never been much of a listener, but now I feel the importance. I tell myself to remember this:

-Listen to your patients. Pay attention to their needs. Never, ever get so busy you ignore this, because it is supposed to be your priority.

Eight hours later I had survived my first day at work. I felt very humble surrounded by so many sick and debilitated patients. I did question my abilities more than ever - am I able to provide the care these patients need? Will I be able to feel comfortable doing this job? How on earth will I ever be able to make life or death decisions as a doctor? I hope the next six weeks will provide some answers. Maybe.

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