Tuesday, March 5, 2013

5/3/13 - An Encounter of the Patient Kind

As part of an audit I'm involved in at my local hospital I spent yesterday afternoon on the wards collecting data directly from patients.

Got the survey filled out by the first patient without too many issues so I moved on to the next bed with an awake looking person in it. I introduced myself and asked if it was OK if I had a little chat with them  and the relatives. The patient said "Of course it is, but relax - you look frightened to death", this put me at ease so I got started quickly. I'd just started to introduce the formal survey questions when one of the people with the patient said "You do know she's confused don't you?"

Now, the answer to this question was no. I could approach patients based only on how they looked and had no knowledge of any of their medical problems so I was just having to hope I was picking the right people; but wanting to keep their confidence in me I said that I did, and it was OK if she just answered to the best of her ability.

So my second solo interaction with a patient turned out to be my first interaction with someone with Alzheimer's. Initially it was really frustrating, I knew I needed to see lots of people that afternoon so didn't have that much time to spend with each one, but I'd started the survey so I was keen to finish it. Each question I asked resulted in a lot of deviation from the topic, and she often got distracted and started talking to her relatives instead. As we slowly progressed through she started telling me more about her family, and she asked about me and my family too "Do you have a mum?" she said. I could see that this lady was enjoying someone taking the time to talk to her so I carried on, getting survey questions answered when I could but really just giving her someone different to chat to. A couple of times she asked my name because she'd forgotten, the 3rd time we settled on "Rebecca" because if I said "Becky" (which I did twice) she heard "Betty" which she thought was lovely because "that's not a name you hear very often any more". I helped her open her bottle of lemonade, and pour it into a cup because she couldn't manage (I'm sure her relatives would have done it, but I was closer) and we continued talking about her family, and how lovely kids are at age 1, as well as how hard all those poor doctors have to work! We finally reached the end of the survey but I hung around for a bit longer, before I left she asked if I was coming back another time, and if I did could I come back and see her again?  She recognised that if I did she probably wouldn't remember me, but she'd like it anyway. Just as I was leaving her bedside she said she'd quite like to adopt me...

It was definitely a useful experience for me, I left her feeling a bit warm inside, like I'd achieved something (even if it was quite small). I think it was helpful that whilst she was clearly confused, and struggling with memory she was at a stage where, at least for some of the time, she recognised it; she apologised numerous times "I'm sorry, I bet you were hoping not to get with someone like me", each time she did I reassured her that it was fine, and I really was happy to stay and chat!  

It gave me a bit more confidence in my choice to apply for medicine too - I've been open about it being the science that fascinates me, but having experienced the human side of it first hand (I'd previously only been a silent observer!) I feel happier about the patient bit too (which after all is why medicine exists as an "industry").

The next patient I saw could also be described as a challenge, they spoke no English, but had a family member present who could just about act as a translator. I expect this is a situation experienced fairly commonly by doctors on the ward, and as I learnt, isn't always dealt with in the best way...

But that's another story...

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