Daniel Sommer is a Foundation Year 2 Doctor at Charing Cross Hospital in London. He is an aspiring Geriatrician.
Geriatrics was a difficult placement for me as a student. The way we learn in medical school makes cardiology and gastroenterology rotations an easy place to learn what we need to learn. The problems are fairly logical and the solutions are also fairly logical. My simple medical student brain could comprehend it. I didn’t quite cut it in Elderly Medicine. The patients and their issues (both medical and non-medical) are often complex, with multiple interactions and facets, requiring “illogical” treatments and strategies that don’t always follow rules or make sense. Without a pretty astounding understanding of physiology, pathology, ageing, sociology and public policy, it will all go over your head. What I saw was a bunch of crumbly, demented old people who didn’t seem to get better. Shame on me.
With just a little more insight and experience, I suddenly realized that logical and simple was not for me. Never has the phrase “medicine is not a science, but an art” rang so true to me than with medicine for older people. Knowing that I probably wanted to be a geriatrician, I was very apprehensive about finally working in my chosen field. I really didn’t know what to expect. So many “what if…?”s were running through my mind.
I started in December 2013 and my first day was rather overwhelming. Our daily 9am board round (where doctors, nurses and therapists sit and discuss all the patients on the ward) was an education. I was learning and entire new language: “micro-environment”, “HNA form”, “tilt-space chair” – I had to make a mental note to come back and ask what all that meant later.
The first patient on our ward round was an 88 year old retired nurse with dementia who had been admitted 8 days previously following a fall which had led to an occult ruptured spleen (now removed) and a fractured neck of femur (for conservative management and no weight-bearing). We met as she was walking back from the toilet with her zimmer frame – “no weight bearing” doesn’t mean much to an 88 year old with cognitive impairment desperately clinging to her independence. She had spiked a temperature over night. This was not the “hands off medicine” that I thought I was experiencing as a medical student.
The medicine is fascinating, but it’s the patients themselves that really draw me in. Taking the time to sit down and listen to them and to hear their stories is a privilege. Hearing about life hiding behind a bookcase on the Polish-Russian border at the start of World War 2 is humbling. Seeing pictures of another patient dancing her way across the stages of the world as a prima ballerina with a prestigious ballet company allows me to see the person behind the illness. I learn so much every day about the world, about history and about humanity from my patients.
Don’t get me wrong it’s not all rosy. There are definitely lots of frustrations. Whilst I love the problems and the way that geriatricians approach them, I sometimes find the solutions unsatisfactory. I think a lot of it stems from chronic underfunding of social care and a system that sometimes seems designed to go against the best interests of older people. I feel myself getting too frustrated about cot-sides for home hospital beds and befriending services that require you to have a friend before you can be referred .
The future, however, is bright. Wherever one ends up in medicine, the frustrations are roughly the same: “It’s not the patients, it’s the system”. In a rapidly ageing society, I can’t imagine any group other than geriatricians to be the ones who find the solutions to these problems. I can’t wait to be part of the solution.