Preparation

For the past week I've been neglecting about everything not having to do with school, which is also why it's been so silent over here. The workload right now is just crazy. Papers to hand in, tests to prepare, and then some more important essays. Luckily it's weekend now, so I've allowed myself a day to catch up with everything outside of school and studying. Med school is approaching so quickly right now and it's worth the effort.

In a month I will hear the topic I need to prepare for a test which could get me university entry (if this sounds unfamiliar, it's probably because you live in another country, you're not missing out on some secret test). In two months I will take the test and my final exams. In three months I need to do... nothing. In three months I'm going to prom and have my graduation ceremony and I will hopefully hear about my admittance to med school and I'm going to enjoy three months of freedom.

Although most of the times I'm not thinking about anything but the very near future, it's been nice thinking about the summer break. I'm not the person to do nothing for three months (or for that matter, a week), so I will probably be working quite a bit. I am considering getting a job at a local hospital, besides my job at the nursing home. Decisions, decisions. Also, I've been looking into the possibilities of being an exchange student. That would be such a great experience. Al this semi-planning gives me energy. I think I will be needing it to survive the next three months.

By the way, I would like to welcome my new followers. I can't believe my blog has already received over a thousand pageviews! It's so energizing to know that anyone is interested in my (often not so) medical stories ;) If you have any questions, you can always contact me.

Guest Post: Janet Hailstone / Nutribuff

The following guest post is written by Janet Hailstone. She teaches nutrition and cooking classes for Community Education at Dixie State College in Southern Utah. Please head over to her health blog and say hello!
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I've been a mother for the past 25 years. I'm also a health nut, so I haven't had to take my children to the doctor for illness for the past 20 years. But, that doesn't mean that I don't have to take them to the doctor. There are physicals for school, and then there are accidents.

When I had my first child, I brought him in for anything and everything. One time, he fell down some stairs and cut his lip. I was told there was nothing that could be done and that he would be fine. I soon got used to hearing that everything would be fine every time I brought him in.

I started to relax as a parent and knew that I didn't need to bring my child in for every little thing. I also waited to see if my children would get better on their own, before panicking over every little accident, flu, or cold.
Now, the ear infections were usually something my children didn't get better from. They just cried 24/7, and it was so nice to get the antibiotics that helped them get back to normal. And, while I did learn later that there were some simple home remedies for ear infections that were equally effective, it wasn't until my last child that I learned about the connection between dairy products and ear infections.

She was the only one who never got ear infections compared to the other three. The only difference was that while I was pregnant with and nursing her, I was trying the vegan diet. I learned how to get my calcium needs from greens, beans, grains, and vegetables. It seems that eliminating dairy was the cure for her to never get a single ear infection. Well, no matter how healthy your family may be, accidents can still happen. In my family of six; myself, my husband and our four children, only one of them was accident prone. When she was little, I noticed that she was slightly clumsy. She'd be dancing around and trip occasionally. She still loves to dance and is very good at it now though.

She just has a little problem with being the only one to have accidents while growing up. They've happened to her about five or six times through her lifetime. One time when she was around five years old, she was riding her bicycle in the cul-de-sac where we live. Somehow, she lost her balance and fell. She used her arm to steady herself. It looked broken. There was an abnormal bump sticking out of her arm.

She was crying, and we knew that we had to take her to the emergency room instead of a daytime doctor, since it was after hours. She was quiet and seemed calm while the nurse was taking her blood pressure. I remember being so shocked when they read how high her blood pressure was. I don't remember the exact numbers only that they were sky high.

I looked at her and realized that she was under a lot of stress, even though she just sat there pathetically. They did an x-ray of her arm and gave her a sling. It turned out that she only had a green stick fracture, where it's not actually broken, just bent. We were told at the first doctor visit to just take her home, and the arm would heal on its own.

We tried to do that, but every little bump was too tender and painful for her arm and she had troubles moving during the day and when sleeping. We made an appointment with another doctor the next day, who was kind enough to put a cast on it for her. This made her feel more secure and happier. I think she also liked the attention and ability to pick the color of the cast. It was a little scary when it was time to take the cast off. It seems like the saw was going to hurt her arm, but everything came off without a scratch. It's really nice to have doctors around when accidents happen or when there is a sickness or condition that can't be remedied at home.

Accidents and injuries can happen to anyone, even adults. If you like to exercise or run in races, anything can happen; kidney failure, knee or ankle sprains, and torn muscles. My previously accident-prone daughter works for a hospital as a house cleaner. She said whenever they have a big race or marathon here in Southern Utah, the ambulances are busy bringing people in and she has many more rooms to clean.

I'm sure you have your own stories about accidents that have happened to you or someone you know. Maybe you have spent some interesting time in the hospital, or getting treatment for a sickness or disease. You should share your story too, we'd all love to hear about it.

Random Talk

I am currently sitting in between piles of homework, most of it not very useful. I came home on Thursday from a great vacation. It was a much-needed break, because the next three months will probably consist of a lot of stress and a lot of work. That's OK, though. In three and a half months, I will have finished my exams and all that will be left is waiting for the results. I don't consider planning to be one of my strong suits. Three months is just short enough to make me realize that I do need to start working and as a result, this is the most productive I have ever been.

Of course, I am never too busy to spend some (too much) time online. Lately, I've been loving this blog. A physician with a great sense of humor, the type of doctor we need more of. Another source of inspiration is this blog. I love reading about his random acts of kindness and I support his initiative. Also, I spent so much time online I decided to change my layout. I kind of like it!

A few days ago I talked about death and how it's currently affecting me. I got an interesting response:

"To fear death, my friends, is only to think ourselves wise, without being wise: for it is to think that we know what we do not know. For anything that men can tell, death may be the greatest good that can happen to them: but they fear it as if they knew quite well that it was the greatest of evils. And what is this but that shameful ignorance of thinking that we know what we do not know?" - Socrates

Good point. Still, I've not been able to get over this weird feeling - reading a lot about cancer has not helped this. The positive aspect is that it reminds me to enjoy life now.

The Meaning of Life

Yesterday I had a three-hour shift. It is one of my regular small shifts which are arranged when the nursing home cannot fill up the schedule. Except that it wasn't a regular shift.

I entered the nursing home, expecting an easy-going shift. Usually, all I have to do is watch my patients and help them get lunch. I like this type of shift as it leaves me time to spend much-needed individual time with patients. For these people, I also need the time, since two of them have been physically fighting any chance they get. This day seemed like no other day. Everyone was very calm, which is very beneficial to especially patients with dementia. I discussed the patients with my colleague from the previous shift.

"Well, everything is calm and peaceful. Patient A is on a walk with her family. Patient C has been experiencing shoulder pain and we're keeping track of heart rate and blood pressure to rule out cardiac involvement. So far it seems OK, but keep an eye on him. Oh, and did you read the recent emails?"

I answered that I've not been working lately so I didn't read the emails.

"Patients D and E have passed away. Patient D died a week ago and is already at the undertakers. Patient E died last night and is still in his room. The room is locked."

Patients D and E. The patients who were fighting ever since E got here. Two patients in four days, no wonder it's calm. We talk about them for a bit. You never get used to deaths. I talked about this before after experiencing my first deaths. My opinion hasn't changed and I've been told that it will never get easier. Still, this is a very confronting way of deatg, with the patient still being present.

At the nursing home, life goes on. We can't stop every time someone dies. So I tak a bit with my patients and help them get lunch. Two plates less than usual. After lunch, many family members come visit the patients. I don't know many of the visitors. Two women enter. They look lost. "Can I help you?" I ask. They appear to be E's family. They ask me to open the patient's door. As I do this, I see the patient. He looks peaceful. His wife is very sad, his daughteris more relieved. I can understand their feelings. The patient has made it very clear that he never wanted to live the way he did for his last months. Still, it doesn't make his death OK.

I leave the room so the family has some privacy. In the living room, it is very calm, almost too calm. But not for long. Patient C needs to go to the bathroom. I help him get to his room. He tells me his left leg hurts. I find out that his pain, previously in his left shoulder, is now in his left side, radiating to his leg. His pulse is 115. I get a colleague who checks his blood pressure (normal). She decided to call the nurse, though, as his pulse and pain are a cause for concern.

My three hours are up and my colleague takes over. I leave the nursing home. I don't know how patient C is doing. Patient D and E are still dead. It left me thinking a lot about death and the meaning of life. What do I want out of my life? Why does it even matter? Will I ever be able to answer these questions?

The Chaos of Medicine

I know medicine is just like the real world. I personally experience the staff shortages. I know that money is important in achieving anything. But when I read this, I was shocked. In some way, my unexperienced, optimistic self never considered it to be a possibility, not in a developed country. Not in any country that is generally considered 'fair'.

Now I know I can't reasonably expect anyone to work for free. I am also aware of the fact that it probably takes a lot of educated people to produce any type of medicine, and that it costs a lot of money. Still I can't wrap my mind around the fact that medicine doesn't have some sort of special status that makes all these problems go away. Is it even possible to put a price tag on life? How can this be regarded as fair, and if not, why isn't this problem solved yet? I don't have all the answers. I am not pretending like I know how this problem should be solved. It just doesn't feel right.

And there you are, as a doctor. You've studied for 10+ years and know what could possibly cure your patient. Something as trivial as production prevents you from having access to the drug. What do you do next? With limited access, who do you treat? In theory, it might be ethical not to choose. But in practice, would anyone not use a supply of life-saving drugs?

I think it is a horrible situation to have to choose who you provide care to. I will probably never be a doctor in a less developed country for that reason. I am currently considering becoming a pediatric oncologist and many people find this to be strange. They ask me: "Why would you want that? It's depressing. I could never do that." But for me, there is a difference between the two situations. It is terrible if a child dies of cancer. It should not happen, period. That said, if a child dies, we know there is usually nothing more anyone could have done. But if someone dies because of a lack of access to meds that could cure him, it feels different to me. Medicine, in all it's chaos, should be fair. If diseases aren't fair, at the very least, health care should be.

Waiting for Med School

Right now I am very impatient. I've been told that my chances of getting into med school are quite good, but I I don't want to wait any longer. I don't want to patiently wait for six months until I probably start med school. I live in a country where medical school includes both undergraduate and graduate courses, therefore it starts right after high school. Which means I'm currently in high school. Lately, me and my classmates have been yearning to go to college. I like high school, but I've just outgrown it. Lately, I've been taking a couple of college courses, which kind of make me want to go even more. So I've been an internet addict all week, reading posts like these.

I can't imagine what I would do if I didn't get accepted into med school. Will I go on and study mathematics because I probably would end up happy? Will I get a job at a local hospital and try again next year? I don't know and I hope I never have to decide. Ugh. I guess everyone who wants to get into college feels this way but I just want to move on to the next stage. It does motivate me. A lot. Actually, I'm going to continue studying right now. And read some more med student blogs. Oh, procrastination.

Curiosity

It started way back, when I was quite small
I would simply ask “why?", one question, that’s all.
I would wait for an answer, sometimes it would come
“Because,” “I Don’t Know,” “Ask your father or mum.”

But it never stopped there The questions kept coming.
And answers were lacking, adults kept “ho-humming.”
It would start out quite simply and then get all muddled
I’d ask just one question and end up befuddled.

Why is the sky blue? or Why are plants green?
Why are they poor? and Why is he mean?
Why should I be good? Who put you in charge?

My mind would start racing as questions loomed large.
Why are we here? What ought I do?
Is there a rhyme, or a reason, or two?
Can it be learned, can I learn it, from who?
Will the answers be certain, or guesses, who knew?

My mind was unsettled, my brain never rested
But everyone moaned when their answers were tested.
I meant them no harm, I truly did not,
But I wanted some reasons for “why,” “which,” and “what?”
{source}

This exerpt from Dr. Seuss and Philosophy sounds so familiar. I've been into philosophy a lot lately, as you could guess with blog posts like these. By nature, I am very curious and I love thinking and analyzing.

While liking to be around patients is very important, being curious about medicine is just as important when considering to become a doctor. The difference between medical professions and most other professions is the likelihood of frequently and seriously impact a person's health, either in a positive or in a negative way. Every single fact you learn counts. every disease you memorize, every diagnostic test you master, it can all count when you need it. I love it. I've always liked to learn, but this way it's even more motivating.

Frankly, as much as I hate school at times, I don't mind adding a lot of education to my list.
I hope med school will provide me the opportunity to challenge myself. To broaden my knowledge and to spark my curiosity.

I can't wait to get into med school.

Judgment

This week I noticed a lot of judgment. A few days ago, this article was published in an online university newspaper. I came across the article by coincidence, as neither I nor anyone I know has tattoos. It is an opinion column harshly judging any woman who would choose to tattoo her body. The argumentation behind the writer's opinion is rather weak. Basically, there is no argumentation. According to Khoury, a woman is supposed to have class, by going to the mall and getting her nails done and wearing high heels, and according to her, tattooed woman are classless by definition. That's a lot of judgment.

Not surprisingly, a lot of people were offended by this opinion column. What did surprise me was the large amount of hate mail sent to Khoury, calling her "Stupid Cow" or "Fat and ugly". A day after the original article, Khoury wrote a response called The Day I Met the Internet. After reading the response, I understood her. I still do not agree with what she said, but that could have been me, enthousiasticly writing an opinion piece without thinking it through. Which is why I'm happy to stay anonymous while blogging. Still, it's a reminder. Medicine is a sensitive topic and I need to be very careful in not sharing any sensitive information.

The second article about judgment is a little more medicine-related. It is a blog post from the perspective of a sick girl's mother. She has written before about doctor experiences, which were often negative in terms of attention and respect - those are supposed to be bullet points at any doctor's priority list. After reading some doctor blogs, she comes to a few conclusions. Most of them have to do with judgment. It sounds all too familiar. I judge people too. I sometimes catch myself judging classmates and now that I think of it, I judge patients, too. I judge the patient who complains of bloating but always asks for a third portion during dinner. I judge the patient who pities herself and does nothing to make her life better. I guess it's human, and I try to hide any preconceptions. But still.

Do you recognize being judgmental? Do you think it harms anyone and if not, why not?

Medical Ethics

Ethics is a word commonly associated with medicine, especially the negative adjective form - unethical. A lot of things are unethical. Providing opportunity for abortion and not proving this opportunity. Not informing your patient about upcoming procedures. Most aspects related to medical ethics are regulated by law. Where I live (don't bother asking, trying to keep up the illusion of privacy;)), there is a specific law protecting the staff and patients of psychiatric hospitals. The dementia-care part of the nursing home I work at is also considered a psychiatric hospital, so we have to abide by those laws. I did not receive any information about the law yet (which is crazy, but that's another story), but I did learn a bit about it. When we install a motion sensor to increase the patient's safety (because of an increased risk of falling, for example), we have to fill out a form, signed by a physician. This is because it limits the patient's freedom. No problem so far.

Another rule is: never ever lock a door unless on doctor's orders. Again, because the limitation of freedom. Here's where it gets interesting, from an ethical perspective. One evening I was independently running my 'home', as we call it. About ten 'homes' have access to the same hallway, which is password-protected to prevent the patients from going outdoors (by the way, it's also where this happened). Conclusion: the hallway is safe. Still, it is inconvenient, because your patients are not together and can wander through that part of the nursing home. That's why some staff members elect to close the door so everyone is contained, which is easier as they know where everyone is. An illegal action, which is also unethical.

Up to that time, I learned to think about rules in a practical sense, because it was clear that I couldn't work there if I followed all rules. Not that it's a bad nursing home, but coworkers don't like when you say that you can't watch the patient drink their med solution because technically, it's not allowed. But overstepping both legal and ethical boundaries, no way. That day, a particular co-worker asked me to lock the door because "I couldn't work like that, right?". That's what is so scary about overstepping boundaries: when are you sacrificing your patient's well-being for your own comfort?

I think there should be stricter enforcement of rules and laws. I practically have no choice but break some rules, but it is much clearer if no one ever has to. Because sometimes unethical decisions are made based on work load or social pressure. But there is still responsibility. So, politely but without hesitation, I said no. No, I will not compomise my patient's freedom for my own good. Will I make the same decision in five years, or will I get tired of searching everywhere and just lock that door? I don't know. I hope not.

The First Month

I can't believe it's already a month since I started my blog. The month went by so soon, yet I can barely remember not having this place to type out my thoughts and experiences. I never kept or even considered a diary, but strangely enough, I love blogging. I love being involved in a community that has so much valuable information an experiences. I think I will like looking back at my first month of something that will hopefully last much longer. In my first month I: -Received 484 pageviews from 175 visitors -Posted 13 times -Welcomed my first 6 followers -Submitted my very first entry to Grand Rounds Why should this matter to you? It shouldn't, and probably doesn't. Just wanted to get it out ;)

Diagnosis: Unknown

I always used to wonder why it is so hard for some patients to get a proper diagnosis. I reasoned that when a patient is seriously ill, doctors will continue to look for an answer until they find the cause. Someone must know the disease, which means it is just a matter of referring to the right person, right? Gradually, I came to find out that medicine does not work this way. This is unfortunate because a lot of rare diseases are only diagnosed after many years, if they are ever diagnosed. So why is it so hard to effectively diagnose patients? After seven months of health care experience, I came across two main causes for this problem.

Medicine is a field of fast, ongoing progress. This is positive as survival rates for diseases go up and the number of undiagnosed patients goes down. But ongoing progress also means that medical professionals no not have all the answers. Diseases are complex and often have many manifestations. It is unreasonable to expect to make a diagnosis every time because currently, we can’t distinguish between certain ailments yet. It will take decades to be able to pinpoint some diseases, especially mental disorders, which can mimic physical disease.

Another aspect of diagnosis that can be overlooked by patients and family is the difference between theory and practice. In theory it is possible to monitor a patient closely and be on top of any changes until there is nothing new to discover. In practice this approach is undesirable (a lot of time investment on the patient’s part) and unmanageable (far too expensive). In practice, nurses and doctors have a large workload which limits their diagnostic abilities. They are human and hence can be sleep-deprived or having a bad day (or both). 

These factors add up to a frustrating situation for the patient with a rare disease. They ‘win’ the lottery twice: not only do they get sick, but the process of getting diagnosed is often long and complicated. One thing to speed up this process would be research. Research is crucial to gain knowledge and develop diagnostic tests. Money is necessary to conduct research. That’s why attention for rare diseases is good. Not only will attention and explanation help with much-needed empathy towards patients, but it also raises money. 

29 February. Rare Disease Day 2012. Spread the word. Get involved.

Vulnerable

Today I found an email in my inbox. It seemed normal, guessing by the title and sender, but I did not know the sender. I opened the email and found a very offensive photo with a text that's just... creepy. Even if I would desire to share its contents, I'm pretty sure that's illegal.

But that's not the worst part. It was adressed to all students of my school, and there was a discussion going on on Facebook. At least five teachers were jokingly mentioned as potential senders of the email. I was (and still am) shocked. How could someone do that? It also made me realize once more how vulnerable everyone is since the invention of internet. There's no way to reach over 200 people by letter in one night. Still, as opposed to with conversations, information is saved much too easily. These are teachers who did not ask to be online and certainly did not ask to be accused of sending these horrible emails. I sincerly hope that the sender of the email and the people rudely accusing teachers will be punished.

So why am I sharing this here? I'm not sure. I guess in a way (being completely egocentric, I know) I realize how vulnerable I am, purposely writing about myself on a blog, for everyone who wants to read about it. I did make a very conscious decision to remain anonymous and still blog as if everyone knew who I am, but still. Only one person has to find out your real identity and do the wrong thing and a lot of people know who you are. Your co-workers. Your future boss. What I am writing now might be totally inappropriate in ten years so I do wish to remain anonymous. Or am I overly concerned? I do of course keep in mind patient confidentiality and I only write about what I don't mind telling virtually anyone.

I would like to ask my current 3,5 readers (I love your support!) a question. How do you think about blogging and anonimity? Do you worry about your blog affecting your life in negative ways? What do you think about privacy and social media in general? Please leave a comment below!

Contentment

Right now I am watching Mystery ER. I watch a lot of medical shows (both fiction and non-fiction) and I absolutely love them. Figuring out what's wrong, absorbing as much information as possible, but also dreaming about the future. Medical professions are known for their popularity. Ever seen a TV series about garbage men? For some part I consider the general enthusiasm naive. Medicine, for reasons I mentioned before, is not equal to dreams, and not everyone realizes this.

That said, I look forward to med school so much. Because of course, the general dream of being a doctor is not completely unjustified. I look forward to learning how to use a stethoscope. I look forward to assisting in the emergency room. I look forward to growing personally and professionally. I look forward to learning everything related to the human body, and even wearing a white coat to symbolize it all.

Another thing I love is preparing to get into med school together with others. It is just motivating to talk about how you want to achieve the same goal. It fuels the desire to try just a little harder, work just a little more. Med schools are very selective, and however frustrating it can be at times, it is also a game. A very important one, which makes winning the game even more crucial. A very long game, as the preparation can last for over a year.

That's why it is so important to have a community to remind you of your goals when needed. I love my blog for this: it allows me to structure my thoughts and get useful responses. I also love forums: they allow me to interact with people in different stages of the 'doctor process'. But most of all the friends who critically listen to what you say and support you. Even in the pre-medical school part, I learn so much. I feel very content knowing there is so much more to come.

Happy Birthday Sweet Nella

Two years. And many more to come.

I fell in love with Nella two years ago, and it's just amazing to see her grow up. Happy birthday sweet girl! P.S. Nella's family started a great fundraiser, and by now they have raised over $180.000. One hundred and eighty thousand dollars to support individuals with Down syndrome. How great is that? Click here for more information.

Why I Hate Medicine

Now I know this goes against what I said before, but some parts of medicine are almost unacceptable. They are nearly unjustifiable, regardless of the good moments. I do not know how solve the problems, nor do I pretend to know. Still, even with my limited health care experience, I can see there is something seriously wrong.

Just like anyone properly preparing for university, I read about how (in my case) doctors experience their profession. I am surprised by what I read. Apparently, a lot of great physicians quit their jobs because of the increased workload. More patients in less time means not taking the best care of your patients or skipping breaks to have more time. With the first option there will be less gratitude and satisfaction, the second option is a sure way to a burnout. Either way, the original rewards of medicine are limited because of the workload.

In addition to this, the education of soon-to-be doctors is not exactly patient friendly either. I am sure there are many avoidable mistakes happening during the education of medical professionals. I am glad I did not make any serious mistakes yet during my seven months of dedicated improvisation, but to be honest, I'm also surprised. So how can all of this just happen?

My guess: money. Doctors are expensive. There are a lot of people who want to become a doctor, so this shouldn't be an issue. The only reason left is that increasing workload limits the costs. This seems to make sense: nobody would be thrilled to not increase workload but charge patients instead. Either way, the patient loses. And isn't the patient the center of medicine?

In an ideal world, doctors have enough time for patients so they can take good care of them. To achieve this, a doctor now has to agree to earning less and less. A great risk, considering the costs involved in education. I never wanted to become a doctor for the money, but is it worth having to worry about income? I do think so, but medicine is not only about passion anymore. It's about planning and scheduling and finances (and I haven't even covered law suits yet). That's what I hate about medicine.

Life or Death

Actually, life, death and everything in between. It is one of hard things when dealing with vulnerable people. Sometimes people are unmistakenly alive in every aspect. They are independent and lucid and completely able to do what we consider to be normal. Then there are deaths.

Deaths are, without exeption, very tragic. A friend's mother, still far too young, dying after a car accident, a little boy dying of cancer, but also the woman with progressed Parkison's who can't move, can't speak, can't think, can't understand. Yes, it might be better for her and for her increasingly worried family. But that does not make any death OK.

But is death really the worst thing imaginable? There are a lot of gradations between life and death. In a lot of circumstances, death is obviously worse. I cannot imagine a world where a good quality of life is exeptional. I know there are times and places where it is a luxury and I am very thankful to have such an easy-going life. But even in my limited world, certain ethical questions are raised. Is a poor quality of life better than death? Who gets to make decisions like that?

Personally, I draw the line at being sane. I would be able to live with physical handicaps, but dementia could very realisticly drive me crazy. The thought alone of losing my memory and the safety of reasoning... I don't think I would want to live like that. But when do you decide to die? When you are still lucid, you are not yet at the point where you think life is pointless. Then, when the dementia has progressed, nothing you say makes sense as you lose the skills to think long-term. This is probably why so many people are in this debilitated state of confusion. Or would they be OK with their bodies deteriorating until death?

I don't know how geriatricians deal with this. I'm not even sure whether I could be one. How can you go against your moral standards every day? Life can be so mean.

Family

October 11th, 2011
After school, I head straight to the nursing home. I had been called while at school: did I mind to pick up a short shift in a few hours? Of course, I couldn't say no. I never say no to extra shifts because I actually enjoy my job (and I don't have to do my homework for a few more hours). Also, it was an afternoon shift. I like the afternoons best as it is the only time of the day there is not much to do, which means you have time to play games and have conversations with the people you have to disappoint too often. "Sorry, no time, I will come to you ASAP." Today, I have even more time than usual. One patient has to go to the dentist to have her dentures fitted and the family specifically requested for a staff member to be present. Would I mind going with her?

Thirty minutes later, the patient's daughter arrives. She is also coming with us. I wonder why she requested a staff member to come along. The transport is completely arranged and there was nothing specific I needed to do. But by then, I had already learned that requests from family make sense most of the time. I introduce myself to the daughter and we prepare to leave.

We sit in the taxi. The daughter starts talking with me. Do I work there full-time? I tell her I still go to school and hope to become a doctor. She is enthusiastic about this. I seem to enjoy my work very much. I confirm this and we discuss health care in general. She tells me about her son, who is both mentally and physically impaired. From her way of speaking I know she loves her son very dearly, but she is still struggling with lost dreams. Dreams of her son becoming independent and being healthy and achieving whatever he wants. She wants her feelings to be heard and acknowlegded.

When we return to the nursing home one hour later, I know why I had to come along to the dentist. Although it seemed like I didn't do anything - technically I was completely unnecessary - I think I know why I had to come. In the 90 minutes we were gone we, as in the daughter and I, had an ongoing conversation. The patient with dementia enjoyed our companion but could not actually take part as her dementia had progressed too far. The daughter was very uncomfortable with this and just really needed to talk to someome.  Sometimes, matters are more complicated than they seem. Especially when dealing with patients of their families, things are rarely straightforward. They don't teach you that in any school. Still, it is important. The family probably won't remember my name, or if I knew everything without asking for help, but the impressions of that day last a long time.

Why I Love Medicine

About three years ago I decided I want to become a doctor. Before then, I never really considered to go into medicine, for no particular reason. Then, suddenly, all my interests came together. I have an endless fascination for biology (the human kind, not the endless plant talk!). I always enjoyed science, from mathematics to physics to biology, but my test results have always ranged from exceptional to below-average, without any consistent trend, because I perform much better on oral exams. I like thinking and have always wanted a job where I could keep learning. It all made perfect sense intellectually.

And then I got my job at the nursing home. In a way, it changed my vision on medicine completely. There are things you just miss when you're in school.

The supposedly grumpy old man, whose face lights up when he sees you because you 'are careful and patient'. The lady who barely seems to have anything left, who one day proudly shows a picture of her great-grandchild. The moments when patients with dementia are relatively clear and calm and content. Or when you suddenly have the time for some one-on-one time for a less time-consuming patient who needed help but didn't dare to ask for it 'because everyone is always so busy. Those moments are far more important than my difference in aptitude for math and biology or other unimportant matters. It's the small moments in the chaos of medicine. I even consider nursing if med school doesn't work out. Try to explain that to my rational self.

The New One

It's been six months since I started working at the local nursing home. Originally a summer job for six weeks, but I never left. Gradually, there is a transition from being 'the new one' to being experienced enough to solve most problems independently. I can imagine this transition is faster than in most professions because of something most health care professions have something in common: there are not enough people to carry the workload.

During the first few weeks I was surprised about the amount of responsibilities I would have, as I was completely untrained and inexperienced. During evening shifts, I am alone, attending to about 8 patients. I need to know what they can and cannot eat and drink. Without any medical training, I need to be aware of the consequences of diseases. I was also unpleasantly surprised about finding out how easy it is to access patient records. No background checks before I was hired and no limitations to browsing through information of every patient I worked with. Why would they ever do that?

As I worked more, I had a lot of contact with more experienced nurses and assistents. Sometimes I would hear them complain about a colleague who was completely unmotivated and made no attempt to hide it. Still, that person had not and will not be fired. Why? There is no one to replace them. I realized this was the reason why I get so many responsibilities: they have no choice. Not enough trained personnel. The access to patient records is also related to this problem. Patient records are essential in providing good care. When temporary employees are considered substitutes instead of helpers, they do need the access.

The most important question in this situation: is it really a problem? I do think it is. The steep learning curve may be necessary and there is supervision during day shifts and there is always someone available when questions arise. This is not unlike medical school and I have learned a lot during the last six months. My real concern is the vulnerability of the patients with this construction. People are hired too easily. 16 years old? No problem! History of abuse? As far as I know, they would not find out. If they do hire someone who does not belong in a nursing home, this person is only fired in case of serious misbehavior, because there needs to be replacement. During evening shifts, you are alone 90 percent of the time with 8 patients. In my opinion, this system carries a large threat.

Just An Ordinary Day

A woman I don't know comes walking towards me across the hallway. "Help! Hėėlp! I'm being abused!"
I am at the psychogeriatric part of the nursing home. In other words, the place where patients with progressed dementia have a safe environment adapted to their specific needs. In theory, because it is hard to manage a group of patients often harmful to themselves and others.
The woman, who has now reached me, is clearly upset. I quickly screen her, as I learned to do over the past months. I look at her and try to assess her mental status. Her incoherent answers to my simple questions tell me she does indeed suffer from dementia. (Important lesson: never assume. I can imagine that upset family members would appreciate a different approach.)
"Hèèlp! Police! Oh, finally. Someone who can help me. Let's go to the police station together."
I try to calm her and convince her that it is not a good idea to leave the nursing home. From the fact that she starts trying to hit me, I conclude my approach is not working. I find out where her room is and take her there. As if a switch was flipped, her mood changes instantly. No one is abusing her anymore. She continues wandering around the building like nothing had ever happened.

Just ten minutes of an ordinary day. They left me thinking. Only then I realized how vulnerable this group of people it. The chance that she was actually abused is small - she also talks about how she should get home to her little kids - but still. If she was abused, would I believe her? Probably not. Everyday there are many concerns like this. Even if it is just an ordinary day.

Welcome

Welcome to this blog!
It is the result of my passion for both medicine and writing. I hope to start med school in september. After that I probably want to become a pediatrician, but there are many options so I want to keep an open mind. I currently work in a nursing home as a patient care assistant. Basically it means I am responsible for and provide care to 6-8 patients. This is my story about life, death and everything in between. About great days and not so great ones. About both small and important moments in a soon-to-be med student's life. Thank you for visiting! If you have any questions, please leave a message in the 'comment' form and I will get back to it.