Friday, December 26, 2008

Research Training

This has been another slow week. My PI and I have decided that I'm definitely going to do the delirium research. Coincidentally, my class got an email earlier in the week from the CCLCM research coordinator with a link to that same geriatric research fellowship for med students. Like I said, it's only for three months, but funding is funding, and I'll be applying for another fellowship anyway. Other than that, not much is going on. Most of the first and second years are gone on vacation, so it's pretty dead here. I finished my research training on Tuesday and ran some errands. I have also been going to do post-operative delirium assessments with one of the research fellows. These patients are not demented, so it's a lot easier running the mini-mental on them than it was on the demented patients I was seeing during my geriatrics rotation!

At least it is finally warming up. Last weekend we had an ice storm and temperatures in the single digits with a -25 degree windchill. Today it's like 60 degrees. Cleveland has the craziest weather. It's no wonder that everyone I know is sick.

Friday, December 19, 2008

First Week of Research

This has been a very slow week. I've been working on writing a research proposal for my research year, which will be next year. I want to do a project on developing a screening tool that predicts which patients are at highest risk for developing post-operative delirium. If my PI goes for it, I'm also going to apply for a geriatrics research fellowship. It's only for three months, but hey, money is money. Fortunately my PI can afford to pay me even if I don't get it. A lot of people in the research group are out of town, including the person I need to talk with, so I have a lot of free time. I think I've watched about half a dozen movies this week, which is probably more than I've watched during the rest of the whole year put together!

It's snowing like crazy right now. Someone told me that this is going to be a bad winter, and so far, it looks like they're right.

Friday, December 12, 2008

End of Geriatrics

I'm now officially done with geriatrics. This week was similar to the first week: seeing inpatients in the morning and outpatients in the afternoons. I did get to observe a driving test one morning, which was an interesting experience. A psychologist conducts the interview, and if the patient passes that portion of the exam, then they go out into the lot for a driving test.

The patient was a very sweet man who insisted that he could drive just fine, and he didn't understand what the fuss was all about. He seemed perfectly normal to me when we were chatting before the interview. The psychologist performed the mini-mental on him, and he got all of the questions right except for missing a couple of items on recall. Then the tests got harder. The psychologist asked him to name as many animals as he could, look at pictures, and answer other questions. As I watched and listened, it became apparent that this man really was mildly demented. The questions he was struggling with were mental tasks that no one should have had trouble doing.

In spite of performing poorly on several of the tests, the patients still insisted that he was fine to drive. This is an example of lack of insight, which is common in Alzheimer's patients. In other words, he did not recognize his own loss of memory and other cognitive abilities. Patients with some other forms of dementia (non-Alzheimer's) do sometimes retain insight and are aware that their thinking has declined.

Ultimately, the psychologist asked him about things like how many tickets he had gotten recently, and how many accidents he was in recently. It turns out that there were some of each. The patient's cognitive decline was apparent enough that no driving test was necessary. He was told that he had to give up his license, which unsurprisingly upset him. It was very sad.

The only other new thing I did this week was to go to UH to do some consults on inpatients. I hadn't ever rotated at UH before, and it was very trying. First of all, they don't have electronic charts. You wouldn't think that would matter very much, but it does when you're trying to read about a geriatric patient whose chart weighs more than you do! It didn't help that a bunch of papers were randomly stuffed in there every which way, and half the notes were scrawled in chicken scratch that I couldn't read. Making sense of it all was hard enough that I only saw two patients all afternoon, even with staying an extra hour. (The attending wanted me to stay even longer, but I had more than run out of patience by then.) All in all, this experience made me greatly appreciate how much nicer it is to use electronic medical records like they have at the VA and at CCF!

Friday, December 05, 2008


This week, I have been rounding at the VA in the mornings, and then going to Elderhealth in the afternoons. Elderhealth is a community center where UH has an outpatient facility for geriatrics patients. There is a general geriatrics clinic similar to the one at the VA, and also geriatrics subspecialty clinics.

Monday afternoon, I worked with a geriatric psychiatrist. Well, to be more exact, I shadowed a geriatric psychiatrist. This was my least favorite day. Not only did I not get to do anything, but some of the team members were kind of patronizing toward the patients. Tuesday, I worked with a geriatric neurologist. That was a lot more fun. The attending was cool, and he had me interview and examine a challenging patient who had several findings. He also had me write a note, which was less fun, because they don't use electronic medical records at Elderhealth. My patient's chart must have been at least two inches thick. I hadn't realized how spoiled I became at CCF (and even the VA), where we have electronic charts!

Wednesday, I worked with a general geriatrician who also goes out to nursing homes. She was great also, letting me see patients and teaching me a lot. Thursday I went with her to the nursing/retirement home. It was a lot nicer than I expected. If I had to be in a retirement or nursing home some day, I wouldn't mind living in this one. They had a computer room, a library, even a beauty shop, all on site. The patients all knew my attending and were excited about us coming to visit. I spent most of my time interviewing a couple of her patients who she thought would be interesting. One of them had no short term memory. It made having a conversation kind of frustrating, because she could tell me things from decades ago, but she couldn't remember what we had discussed a few minutes ago. I spent a lot of time telling her over and over again who I was and what medical school I attend.

Today I was at the VA all day. We have a new inpatient attending who is into teaching. He pimps us a lot, but it's mostly stuff we should know, like blood pressure drugs. Our patients were on two different floors, and he likes taking the stairs, so I got to spend some more time on the VA stairmaster. The other good thing about him is that he finishes rounds quickly.

I guess winter is here. It's been kind of flurrying every day, and now the snow is sticking. Definitely time to pull out my snow boots.