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.