Comments on Elder Home Care

Ah, the end of another illustrious week. I spent this week removing my cadaver's heart in anatomy, cutting it open and learning (what seemed like) every single blood vessel in the region of the chest (thorax) that lies in between the lungs, called the mediastinum. We learned a lot of other stuff, too, and the crazy part is that we could have gone into much deeper detail. I am doing an injustice by merely commenting on how fascinatingly complex the human body is, on all levels, from microscopic to macroscopic, there are SO many things going on. I love it. I think the most exciting thing in anatomy, this week, was being able to hold a human heart in my hands and actually trace the route that blood takes as the heart pumps. I've been taking my stethoscope periodically and listening to my heart in different places to hear all the valves as they open and close, which is the lub-dub you hear on a stethoscope. (nerdgasm)

Other things I did this week include lots of ultimate frisbee, studying, and an afternoon of house calls. The house calls were really cool, we visited two different elderly patients in north Philly, and checked up on them to make sure they have the appropriate health care support systems in place to keep them in their homes as they manage all the illnesses that come with growing older. I wrote a little essay as a response to my experiences, which is included below. Disclaimer: I only had 250-300 words to work with. I ended up using ~430 and I still didn't have enough space to get all my feelings out. At the very least, here's a limited representation of what we saw at the first patient's house. (I've edited it a little bit since I last wrote it, to give a more complete picture of what I saw.)
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As we exited the car and walked up the steps to Mr. S’s house, I abruptly realized I had no idea what to expect to see inside. Even though we had just been briefed on Mr. S’s situation, I was not ready for the moment when I finally laid eyes upon this 99 year-old man who was expected to die within the year. I walked in prepared to absorb everything, to be able to fill out my visit checklist, but most of all I wanted to soak in the real essence of the home visit so that it would be imprinted in my memory.

The checklist has us fill out a functional assessment of Mr. S’s ability to perform specific ‘instrumental activities’ of daily living (interaction with the outside world) and ‘activities’ of daily living (taking care of oneself). We observed that Mr. S is blind, almost entirely bed-ridden, incontinent and possibly progressing into a more lethargic state and deteriorating mental health – all of which means that he is largely incapable of initiating any interactions with the outside world (though many people come to him, which will be touched on shortly), he cannot prepare his own medications, needs a lot of assistance to get out of bed and move to a chair a couple feet away, can eat tender food but needs help guiding the utensils to his mouth, and depends on others to bathe and clothe him. All of these conclusions are based on what I've gleaned from his situation, and not from actually spending time with Mr. S. For me, the most striking part about entering his room was seeing him in his bed and realizing that he would almost never leave that bed for the rest of his life. As his situation dawned on me, I felt encumbered by all the things this man deals with from day to day and found myself wondering how he views himself.

Despite all of these challenges Mr. S has an incredibly large, varied, and most of all, loving, support group. He depends on 24 hour care, and has a total of 3 home health aides that come in shifts to perform a myriad of functions: a hospice nurse who helps with medication and other assessments, a social worker, church members who volunteer time to help him out, neighbors, and a number of dedicated family members (which is amazing, considering that Mr. S has no children). All of these people are here to see that Mr. S can achieve his goal of dying at home. It's weird to think about caregivers as allowing someone to die, but the ultimate point is that he will be comfortable and happy til the very end. Evidenced by how many people love him, Mr. S is clearly deserving of all this respect. (If not a 99 year-old, then who is?) The community support that is around to ease Mr. S into his final days is truly a humbling and grand effort.

There were a number of things that hit me as I experienced that home visit. Perhaps the most surprising (pleasantly surpising) was how much the community loves Mr. S. It made me realize how integral a community can be in the life of an individual. Though this experience made me think a lot, I am obviously only starting to understand home-care. Nevertheless, I can see that it definitely depends on a strong support network like the one I saw on my first visit. It's good to see that home care can be a viable (and we found, cost-effective) alternative to a nursing home, hospice or hospitalization.

Well, that's all for today. Time to go celebrate this 'free' weekend, because the next one will have exams looming over my head!