I went to a nursing-home visit this evening. It was a high-care facility where all the residents are highly dependent on the nursing staff for even their most basic daily activities like going to the toilet, feeding, and showering.
Walking through the front door, I was immediately surrounded by that characteristic "old folks home smell," a mixture of antiseptic solution, stale air, urine, and the occasional heavy scent of air freshener someone had sprayed in a vain attempt to make the air more breathable. With my olfactory glands quickly and fully saturated and desensitized, I walked with my GP down the hallway starkly lit with fluorescent lights and decorated with generic paintings of flowers. The paint on the wall and the lighting together gave off an eerie green-hued tinge to everything inside.
We went from room to room, visiting the dozen or so residents my GP was responsible for. Some gave a half response to our questions, others were loquacious and intent to chew our ears off. Some had their mental faculties more or less intact and were sitting in the dining room chatting to other residents, others were so demented they were only a shell of their former selves lying in bed completely unaware of their surroundings. Some had pictures of their families and flowers next to their beds, a result of their families trying to make their corners of the rooms as homely as possible. Others seemed not to have anyone left in this world, with the walls and nightstands on their corners of the room completely bare and not a sign of visits by anyone was detectable.
My GP started to review the drug charts. Anti-depressants, sedatives, and stool softeners seemed to be the staples of the elderly population in the nursing home as they are in the community. One by one, the charts are reviewed, the drug dosage adjusted; then the stack of charts are set aside like a pile of freshly-finished homework.
"This place is so depressing." I commented to the nurse.
The nurse chuckled, "Well, it can be depressing. But you get used to it."
For the residents here - some of whom depend on anti-depressants to even get the energy to chew their bland meals, who are on sedatives and kept in a low-stimulus environment so they can sleep their days away and so the overworked nurses would not have to deal with any delirious residents, to whom a 5-minute visit by the doctor once a month may well be their only contact from the outside world other than the nurses - the remainders of their lives are no more than a disorienting drag from one meal to the next in an infantilized existence. The flickering images on TV no longer mean anything; it might as well be showing an alien world on Mars. Are the residents with more or less intact mental faculties thankful for being alive each day, or are they envious of the demented ones who are blissfully ignorant of their terminal predicament?
The visit came to an end. As I walked past the front doors, I took a deep breath of the fresh cool night air. I reminded myself again that I am here as a health care profession (albeit one in training) and despite my personal opinions, these residents are here to stay; all we can do as doctors and nurses are to make their last days as comfortable as possible.
Wednesday, August 29, 2007
Thursday, August 23, 2007
What Am I?
It seems that people sometimes don't quite know what to make of me - Chinese? American? Recent immigrant to Australia?
How about all of the above?
In conversation, sometimes people would ask me,
"Are you a Yank? You sound like one."
or
"Where are you from? You don't sound like you're from around here, by the sound of your accent."
Other times, the conversation would go like this:
"Where are you from?"
"California, but I'd lived in Washington, DC, for seven years before coming to Australia."
"But, where were you born?"
"China."
"Ahh," as if a mystery has been solved and they now know exactly what kind of a person I am.
I've also gotten comments like:
"I didn't think you're American; I thought you got your accent from your parents."
or
"I thought I heard an accent when you speak, but it's not Asian."
or
"You were born in China? But you're so American." (as if they are mutually exclusive.)
Over time, I came to understand that the question "Where are you from?" means one of five things, depending on the person asking the question:
1) Where were you born?
2) Where do you consider home?
3) Where do you go to visit your family?
4) Where have you lived the longest?
5) Where did you grow up?
With me, people are rarely satisfied with the first answer I give. They tend to ask any of the above five questions in different variants until they get the answer to what they really mean.
So, how about this when someone asks me where I am from:
"I was born in China. I lived there until I was fourteen, when my whole family moved to the US. I spent the next fourteen years between California and Washington, DC. I then moved to Brisbane for med school and am planning on staying in Australia afterwards. I consider myself Californian because it feels like home, that's where my family is and that's where I'd spent my formative years when I developed my self-identity. I respect the Chinese tradition of family hierarchy and filial duties, at the same time I embrace the American ideal of individualism but reject the wanton consumerism and materialism; I also identify with the Australian sense of egalitarianism. I'm Chinese; I'm American; and I'm becoming Australian."
I suspect not too many people have the patience to listen to all that as a response to a seemingly simple question.
Dinner tonight: pizza with a base of Lebanese bread topped with mozzarella, garlic, artichoke, sundried tomatoes, olives, and fresh coriander, rocket, and basil.
How about all of the above?
In conversation, sometimes people would ask me,
"Are you a Yank? You sound like one."
or
"Where are you from? You don't sound like you're from around here, by the sound of your accent."
Other times, the conversation would go like this:
"Where are you from?"
"California, but I'd lived in Washington, DC, for seven years before coming to Australia."
"But, where were you born?"
"China."
"Ahh," as if a mystery has been solved and they now know exactly what kind of a person I am.
I've also gotten comments like:
"I didn't think you're American; I thought you got your accent from your parents."
or
"I thought I heard an accent when you speak, but it's not Asian."
or
"You were born in China? But you're so American." (as if they are mutually exclusive.)
Over time, I came to understand that the question "Where are you from?" means one of five things, depending on the person asking the question:
1) Where were you born?
2) Where do you consider home?
3) Where do you go to visit your family?
4) Where have you lived the longest?
5) Where did you grow up?
With me, people are rarely satisfied with the first answer I give. They tend to ask any of the above five questions in different variants until they get the answer to what they really mean.
So, how about this when someone asks me where I am from:
"I was born in China. I lived there until I was fourteen, when my whole family moved to the US. I spent the next fourteen years between California and Washington, DC. I then moved to Brisbane for med school and am planning on staying in Australia afterwards. I consider myself Californian because it feels like home, that's where my family is and that's where I'd spent my formative years when I developed my self-identity. I respect the Chinese tradition of family hierarchy and filial duties, at the same time I embrace the American ideal of individualism but reject the wanton consumerism and materialism; I also identify with the Australian sense of egalitarianism. I'm Chinese; I'm American; and I'm becoming Australian."
I suspect not too many people have the patience to listen to all that as a response to a seemingly simple question.
~~~~~~~~~~
Dinner tonight: pizza with a base of Lebanese bread topped with mozzarella, garlic, artichoke, sundried tomatoes, olives, and fresh coriander, rocket, and basil.
Tuesday, August 14, 2007
Tonic for Perpetual Health
As part of the GP rotation, I had a visit today to an audiologist, one of the allied health professionals in town. An audiologist does hearing tests, fitting and fine-tuning hearing aids for people with hearing loss.
I sat in on a hearing test on a young man in his mid twenties who had lost most hearing in his right ear after a few years of working in a saw mill with only occasional use of hearing protection. Afterwards, the audiologist took out the file for the next patient.
"This next patient is a very interesting lady. Now, just take off your medicine hat for a minute. Other than needing hearing aid, Mrs. S____ is in exceptional health. She told me her secret on her last visit. There's something she drinks every day to keep her health, and she swears by it. Whatever ails you, diabetes, cancer, high blood pressure, anything, her drink cures it. She gave me a small bottle of it."
Okay, it must be another one of those juice of the month that claims to do everything for you. I waited for him to pull out some exotic juice from a far-away land.
Beaming, he opened a drawer and pulled out a clear bottle with a red label containing some clear fluid. The label proudly declared "Stolichnaya Russian Vodka." "Vodka?" I said incredulously. "Yup." Well, I guess you could call Russian vodka an exotic juice from a far-away land.
The audiologist opened the door. Mrs. S____, an elderly woman walked in and sat down. "Did you drrrink the vodka today?" she asked the audiologist in her thick Russian accent. "No, not today," the audiologist confessed.
Giving him a disapproving look, Mrs. S____ then turned to me and asked, "Do you drrrink?" "Not vodka," I answered. "Why you don't drrrink? It make you strrrong! One cup a day, I drrrink."
After the session, Mrs. S____ turned to me as she walked out the door and said, "Next time, I brrring you some."
Where else but in primary care would patients offer health advice to their doctors?
Tonight's dinner: broiled salmon with Chinese five spices on Chinese cabbage and blend of jasmine/brown rice.
I sat in on a hearing test on a young man in his mid twenties who had lost most hearing in his right ear after a few years of working in a saw mill with only occasional use of hearing protection. Afterwards, the audiologist took out the file for the next patient.
"This next patient is a very interesting lady. Now, just take off your medicine hat for a minute. Other than needing hearing aid, Mrs. S____ is in exceptional health. She told me her secret on her last visit. There's something she drinks every day to keep her health, and she swears by it. Whatever ails you, diabetes, cancer, high blood pressure, anything, her drink cures it. She gave me a small bottle of it."
Okay, it must be another one of those juice of the month that claims to do everything for you. I waited for him to pull out some exotic juice from a far-away land.
Beaming, he opened a drawer and pulled out a clear bottle with a red label containing some clear fluid. The label proudly declared "Stolichnaya Russian Vodka." "Vodka?" I said incredulously. "Yup." Well, I guess you could call Russian vodka an exotic juice from a far-away land.
The audiologist opened the door. Mrs. S____, an elderly woman walked in and sat down. "Did you drrrink the vodka today?" she asked the audiologist in her thick Russian accent. "No, not today," the audiologist confessed.
Giving him a disapproving look, Mrs. S____ then turned to me and asked, "Do you drrrink?" "Not vodka," I answered. "Why you don't drrrink? It make you strrrong! One cup a day, I drrrink."
After the session, Mrs. S____ turned to me as she walked out the door and said, "Next time, I brrring you some."
Where else but in primary care would patients offer health advice to their doctors?
~~~~~~~~~~
Tonight's dinner: broiled salmon with Chinese five spices on Chinese cabbage and blend of jasmine/brown rice.
Friday, August 10, 2007
GP Land
It's been two weeks since the start of GP rotation and I'm digging it. Coming out of mental health rotation, I am glad to get back into the medical side of medicine. Dr. R., the GP I am following lets me see patients on my own (under his supervision, of course) and do a lot of the procedural work like cutting out skin lesions. Sitting in my own room seeing patients is the perfect way for me to try out this whole GP thing.
One aspect of general practice that appeals to me is that you never know what's going to walk through the door next. One patient could just have a cut that requires suturing, the next patient could come in with four chronic conditions that require full reviews. Another aspect that appeals to me is the continuity of care. When a patient comes in with something that probably requires an operation, you refer them to the surgeon. When they come back later for a follow-up visit, you get to see the patient in recovery and check whether your clinical suspicion was right in the first place.
Today a patient came in complaining of bumps on his back that had been there for years. One of them grew bigger and painful over the last week and he was concerned. After taking more history and examining the bumps, the big one being about three centimeters in diameter, I made the diagnosis of sebaceous abcess, or in layman's term, a giant inflamed zit. I called Dr. R. into the room and presented to him my findings. He agreed with my diagnosis and proceeded to explain to the patient that it was not anything bad and the best way was to leave it alone. Standing next to Dr. R., I asked, "In what situation would you decide to drain it?"
He looked at me, as if thinking "ooh, you're going to be sorry you asked." Then said, "We can do an incision and drainage now, do you want to do it?"
Not knowing what I was getting myself into, I said, "Sure!"
Up the patient went onto the procedure table. After I injecting the local anesthetic, Dr. R. explained to me, "Just use the scalpel to lance the abscess, but watch out, it could be under a lot of pressure and the collection of pus could come out with a lot of force." Handing me the scalpel, he said, "You'll know when you've lanced it. You'll smell it. If you need anything, just come get me in my room," then walked out to see the next patient.
I was left holding the scalpel thinking about the giant zit exploding in my face. Gingerly, I positioned myself to be out of the possible trajectory of the pending explosion, then pushed the scalpel down the center of the abscess. No explosion happened. I breathed a sigh of relieve and my nostrils were filled with the sour and acrid smell of pus. Yup, Dr. R. was right. For the next ten minutes, I poked and squeezed the abscess and wiped away the cheesy blood-tinged pus. Finally, having squeezed the last drop of pus from the abscess, I put the scalpel down. Dr. R. walked in, checked my handiwork, and said, "Good job, Tony." Now I knew why he had wanted to leave it alone and let it pop by itself. I asked an innocent question but got the answer the hard way.
Well, it was all part of the learning process. At least the patient felt better right away and did not have to deal with the pressure on his back anymore. Though next time I may want to do it in a place with better ventilation.
Tonight's dinner: broiled mackerel in ginger marinade on Chinese cabbage and sweet potatoes.
One aspect of general practice that appeals to me is that you never know what's going to walk through the door next. One patient could just have a cut that requires suturing, the next patient could come in with four chronic conditions that require full reviews. Another aspect that appeals to me is the continuity of care. When a patient comes in with something that probably requires an operation, you refer them to the surgeon. When they come back later for a follow-up visit, you get to see the patient in recovery and check whether your clinical suspicion was right in the first place.
~~~~~~~~~~
Today a patient came in complaining of bumps on his back that had been there for years. One of them grew bigger and painful over the last week and he was concerned. After taking more history and examining the bumps, the big one being about three centimeters in diameter, I made the diagnosis of sebaceous abcess, or in layman's term, a giant inflamed zit. I called Dr. R. into the room and presented to him my findings. He agreed with my diagnosis and proceeded to explain to the patient that it was not anything bad and the best way was to leave it alone. Standing next to Dr. R., I asked, "In what situation would you decide to drain it?"
He looked at me, as if thinking "ooh, you're going to be sorry you asked." Then said, "We can do an incision and drainage now, do you want to do it?"
Not knowing what I was getting myself into, I said, "Sure!"
Up the patient went onto the procedure table. After I injecting the local anesthetic, Dr. R. explained to me, "Just use the scalpel to lance the abscess, but watch out, it could be under a lot of pressure and the collection of pus could come out with a lot of force." Handing me the scalpel, he said, "You'll know when you've lanced it. You'll smell it. If you need anything, just come get me in my room," then walked out to see the next patient.
I was left holding the scalpel thinking about the giant zit exploding in my face. Gingerly, I positioned myself to be out of the possible trajectory of the pending explosion, then pushed the scalpel down the center of the abscess. No explosion happened. I breathed a sigh of relieve and my nostrils were filled with the sour and acrid smell of pus. Yup, Dr. R. was right. For the next ten minutes, I poked and squeezed the abscess and wiped away the cheesy blood-tinged pus. Finally, having squeezed the last drop of pus from the abscess, I put the scalpel down. Dr. R. walked in, checked my handiwork, and said, "Good job, Tony." Now I knew why he had wanted to leave it alone and let it pop by itself. I asked an innocent question but got the answer the hard way.
Well, it was all part of the learning process. At least the patient felt better right away and did not have to deal with the pressure on his back anymore. Though next time I may want to do it in a place with better ventilation.
~~~~~~~~~~
Tonight's dinner: broiled mackerel in ginger marinade on Chinese cabbage and sweet potatoes.
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