Home Visit

One of the requirements of the family medicine residency is that we make home visits to two of our patients. I just finished the second visit last week and it was a really wonderful experience. My patient is 81 years old. She has 7 children scattered across the USA. Her youngest son lives with her and takes care of her - including cooking, laundry, cleaning, and help with bathing. For 81, she is pretty spry - both physically and mentally. She walks every day, goes to church every Sunday, and can tell you all about her 7 children, 20-something grandchildren and 12 great-grandchildren. Her medical problems include diabetes, high blood pressure, high cholesterol, and a history of strokes. I first met her in the emergency room in July when she had severe back and abdominal pain that turned out to be shingles. She was looking for a new doctor, and I offered to see her in clinic. I haven't seen her too many times, but the last time I saw her, I thought it would be a good idea to check out her home situation. I had some questions about the management of her medications - it seemed like she wasn't taking some of them as prescribed. Unfortunately, some elderly individuals are not well cared for by their family members. They may be exploited for their social security checks or other assets, or their family members may use prescription drugs for themselves. My patient's son seemed to be very caring, but I wanted to see for myself. I learned a lot about my patient and her family during my visit. The house was adequately adapted for an elderly patient - including wheelchair ramp up to the door, bars on the walls and shower for support, a shower chair, and a low-lying bed to prevent falls. These amenities alone demonstrate the family's willingness to invest in their mother's health. Then again, as I got to know my patient better, I began to realize that she is not about to let anyone push her around or neglect her. She's a tough lady with a strong personality and sense of family loyalty. Even so, there appears to be some discord in the family. Her son feels that the rest of his siblings are not doing their share to help out, despite the fact that one of them lives across the street. He may be too proud to ask for help, but he feels that they should offer. Caregiver burn-out is quite common, even when the patient is relatively healthy. But my patient's son seems to handle the responsibility well. He has some of his own activities that get him out of the house a couple of times a week, and that is probably very important for his mental health. My patient's uncle is a pastor, and she has attended his church for most of her adult life. She is well-loved in her church family, and for her 80th birthday, they celebrated with eight days of honoring her in various ways with treats, cards, prayers, encouraging words, acts of service, games and favorite memories. Her son showed me the photos and commemorative plaque they made for her. In fact her house is adorned with family photos - demonstrating how important her family is to her and how proud she is of them. At the end of my home visit, I asked if I could pray for my patient. We gathered around her - the son, a granddaughter who had come in during our visit, myself and my faculty advisor/preceptor. It was an honor and privilege to pray for this saint - for her physical and spiritual well-being, for her family and loved ones, and for the Great Physician to pour out his blessings on her and through her. I know I was blessed by this short visit, and I believe my patient was blessed as well. I think her son felt encouraged and validated in his efforts. He was able to voice some concerns that we had not addressed in the office. Our clinic social worker attended the visit and was able to provide some advice on resources for home care, equipment, prescription plans and insurance issues, which was a tremendous help. The home visit is so much more intimate, personal, and meaningful than any office visit! I wish it were possible to always see my patients at home, at least once in a while. Although we are only required to do two home visits as residents, I hope I will be able to fit in many more!

Spring is here!

Finally, I am coming out of hibernation! Spring is definitely in the air, intern year is almost over, and I have a renewed sense of joy and purpose. March was my last month of adult medicine. I was totally dreading it - hard work, long hours, working with a private group of hospitalists rather than my own family medicine faculty. I really prayed for a good attitude and an open mind, and God definitely answered that prayer. I had a good month overall. Lots of really tough, sick patients - that I was actually able to manage with some confidence (not completely, but MUCH better than when I started residency!). My attendings were all pretty good to work with. I learned a LOT. Just comparing how much more comfortable I feel now with most of the common conditions we see in the hospital, and even with the critical patients in intensive care, I can truly say I've come a looooonnngg way since July, and it feels good! Even so, I had a heart-felt celebration when the month was over. It is awesome to be done with adult medicine for the year. Of course, there will be at least four more months over the next two years, but somehow that doesn't bother me right now. I feel as if my load is suddenly lighter. One of the things I love most about family medicine is the variety. In the midst of my crazy adult medicine month, I got to do a c-section on one of my clinic patients, circumcise her baby and then see both mom and baby in the clinic a few weeks later. What a cool job I have! Now I am on cardiology, which promises to be a pretty relaxing month. I'm doing mainly outpatient medicine - that is, clinic. So no late night pages, no discharge summaries to dictate. I do have to be at the clinic by 6 AM for lectures, but that doesn't seem so bad when my day ends at 5 PM instead of 8 or 9 PM. I hope to learn how to conduct treadmill stress tests and echocardiograms (ultrasounds of the heart). And of course, I want to get really good at managing congestive heart failure, angina, acute heart atttacks, high blood pressure, and arrhythmias since we see a lot of that in practice. I still have to do 5 call nights this month - including two weekend calls. But three of them are on pediatrics and one is obstetrics, so at least it's different. For the last 4 months, all I've done is adult medicine. And my calls last month were brutal - non-stop patients to be admitted from 5 PM to 6 AM (that's after a full day's work and before another half-day of rounding, etc.). I guess it could be worse, and calls are when I learn the most about managing medical problems. But I'm glad for a break from that routine for a while! Some highlights of the past few months include: a visit from my parents, a visit from my good friend and former roommate, Melissa, warm weather - starting to run and bike again, and Bible study with some of my fellow residents. We're going through a book called Connecting with God. It has increased my longing to commune with God more deeply and consistently and has made me appreciate how much God desires to communicate with us, his children. From the beginning, God spoke the creation into existence; then he spoke with Adam and Eve, Abraham, Moses. He gave us his Word to communicate who he is and what he wants from us and for us. And he sent his Son to show us in person the way to the Father. And now he gives us his Spirit to guide us and teach us. I just need to learn to listen and tune my ears and adjust my perception to hear what he wants to say.