My Daily Dose of Vitamin P

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One of the wonderful things about being an internist in a geriatric practice is the continual, daily perspective on what matters in life. I work part-time, rounding on patients who are residing at a skilled nursing facility or in long term care. Often, I will only be caring for a patient for a few weeks, one in a line of physicians from the emergency department to the hospital to myself. I will then hand them back to their regular physician when they are ready to discharge.  Even though I may not know them for long, I do have the luxury of being able to spend more time with them, seeing them several times a week if needed, and focusing on what’s really important to them. I am supported, thankfully, by fabulous teams of nurse practitioners, nurses, and nurses’s aides; physical, occupational, and speech therapists; nutritionists and case managers that keep things running smoothly for these patients at the various facilities I round at.

When I first meet a patient, I have already read their prior chart, looked through their medication lists, and retrieved the details of their recent medical history from our electronic medical record.  I let them know that I’ve already looked through this material, so they don’t have to repeat their story for the umpteenth time (unless they’d like to).  I’m mainly there to find out more about them, how they are feeling that day, and elicit whatever medical concerns they have.  We can then focus more on how recent events have affected them and their loved ones.  Many of the patients I see are over age 75, with quite a number over 90, and so discussions of end-of-life planning are common.

One of the first questions I ask is, “tell me about yourself.” It’s an open-ended question that allows them to tell me what is most important about themselves from their frame of reference, not anyone else’s. Even in patients with significant dementia, they are able to answer this question with details about childhood events; they are not living in the present, but perpetually in the past. Others, whose cognitive status is more intact, can tell me about their current life. I hear details about children, grandchildren, pets, faith, volunteer work, and travel. I also listen to descriptions of grieving, loss of hearing and eyesight, medical illness, fear, and pain.

Interestingly, the one thing patients don’t tell me is what they did for work. They might be happy to tell me proudly what their children and grandchildren (and sometimes great-grandchildren) do for work; their family members are business owners, military service members, homemakers, teachers, doctors, lawyers, and everything in between.  I often prompt patients to find out what they did daily for the better part of their life. Most have been retired for 20 years or more, and that part of their life has become less important to them over time, fading into the distance like so many memories. For many years since retirement, their life has been filled up with family, new babies, friends, pets, hobbies, books, and much more.  Even the patients who didn’t have children are involved as great-aunts, or run the local pet shelter. It doesn’t matter if they worked as a contractor, researcher, dancer, professor, engineer, author, or dentist.  It doesn’t matter where they went to high school, college, or graduate school, or what grades they got along the way. It doesn’t matter how devoted they were to their work, what awards they won, or whether they achieved notoriety in their field.  None of this matters as much to them at this point in their lives. While they have regrets, what matters to them the most are the personal connections they have been able to sustain throughout their lifetimes.

These daily encounters often leave me thinking about how to guide my current life. Meaning, if I had their perspective – vitamin P – how would I live my life right now? I find I have more initiative to help my kids find their passions in life, and less tolerance for continuing in negative situations. I seek the company of those who understand and celebrate me for who I am, not those who want me to be something I am not. I celebrate exploration and discussion more than achievement, and I place a higher value on snuggling and long walks.

When I am done rounding and go home to my family, it is a joy to walk through the door. I have usually picked up our kids from school, after homeschooling in the morning. Dave has been working from home, or we switched times that day so he could attend a client meeting. The house is busting with multiple intensities of every type, and learning, work, love, and laughter are all mixed together in one crazy bundle of energy. I will be always grateful that I became a physician, not as much for the patients I helped, but for how they helped me. And I hope, towards the end of my life, to have lived in a way that would make them proud, too.

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