Man. I forgot how nice it is to actually see human beings patients again. Staring at films and CTs and MRIs (oh my!) made me forget that there’s actual people that surround those images, not just bone structures, opacities, densities, consolidations, and strictures. We started out today at a local nursing home, rounding on some patients. Kind of wish I had already had my Medicine clerkship, but I’m usually a quick learner.

Depending on the patient, sometimes the surgical service will send a patient to the nursing home for long-term recovery, and it just so happened that I got to see a surgical patient from many months ago at the nursing home. It was definitely some delayed continuity of care, and he had no idea who I was, but it was great to see the spectrum and time-course of healing.

The great thing, I’m hoping, about this rotation, is its variety. We rotate through a nursing home, an inpatient ward, a hospice unit, a palliation clinic, a geriatrics clinic, hypertension clinic, and andrology clinic, as well as attend Internal Medicine conferences, so I get exposure to a lot of different geriatric sub-specialties.

Today we had an inservice from the hospice chaplain discussing how to take a spiritual history, how to understand some of the spiritual/religious concerns of the dying or elderly patient, and some advice on how to answer patients’ questions that are religious in nature. (I’ll be the first one to admit that I’m struggling right now with figuring out my own spirituality and belief system, with my interests in religion and spirituality a seemingly distant memory from college.) I’d feel much more comfortable dealing with patients’ questions about living and dying and the Unknown and God (or god(s)) than questions directed toward my personal belief system (I get a knee-jerk reaction to questions like, “Do you believe in Jesus,” or “Have you found Christ,” mostly because of obsessively-persistent Christians from my undergrad). As one of my residents pointed out, however, most often questions like these are efforts by the patient to feel out the physician–to see if the physician is “safe” to talk with about spiritual matters. It’s actually probably pretty similar to how LGBT folk try to feel out someone to see if they’re LGBT-friendly before opening up.

I couldn’t help but compare this service to Neurology and Surgery, and initially feel like the others were leaving out this spiritual component. I can see how in some cases, it’s probably a back burner topic: people want their gall bladder out, not a discussion of the Universe. (Or maybe they do?) Or perhaps it’s just that there’s not time on those other services to discuss these matters? At the least, however, I would think asking one or two questions about it (“Do you have any spiritual beliefs you would like to be respected during your care?”) might be useful, especially in cancer surgery or terminal illnesses.

On to clinic, where I saw one patient, an elderly, World War II veteran who had just turned 95. He has terminal cancer, but refused treatment, and two years later, still has no symptoms from it. We caught a previously undiagnosed problem with incontinence, but otherwise he was in reasonably good health for his age and condition. He said he didn’t fear death; he’d been a rifleman in the War and noted that “If you worried about dying while you were out there, it didn’t do you any good.” Kind of a privelege that I have the time to worry about death at all.

If anything, I can tell that this will be a month of lots of thinking about ethics, living, dying, and Life in General. Good for the soul.

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