Home Visits

Followed a home health nurse all day today. I'm still mulling over how it should affect my clinical practice (which was the point of the assignment). All I'm sure of right now is that I could never do a job like that - I give my nurse much kudos for having done this for 14 years. It is too much chasing tails, too many unsupportive families, and too many cockroaches.

One thing the home health visit does make you think about is how your patients cope with life after discharge from the hospital. For instance, one of the patients we saw today was a 24 year old female with uncontrolled type I diabetes. By 22, she had already suffered a stroke that paralyzed her left lower extremity. She was legally blind in one eye and going blind in the other from diabetic retinopathy. She was taking Erythropoietin weekly because her kidneys were already failing, and could no longer produce adequate amounts of red blood cells. These things initially stood out to me because I am a medical student who predominantly works in a clinical setting, and these are the clinical items of interest. But as we left, and she trudged off to lunch - the only person under 60 in this lonely, aseptic nursing home - I thought about how I would feel if I were in situation.

Given the "miracles," of modern science, she'll live well into her 40s. I have to wonder what kind of life that is. I fear that it will be bereft of all those events that make life truly meaningful - having a successful career (she used to be a Wound Care technician, and now she is permanently on disability and likely never to be employed again given her blindness), finding love, creating a family, traveling the world, etc etc etc. The worst part is, I'm befuddled as how I, as a medical professional, can truly help her achieve any of those milestones. I went into medicine because I wanted to give people the ability to lead the lives they deserve, but for a disease such as hers, she will never have a cure within her lifetime. She will never be able to lead the life that she would want. What can I offer her?

I'll think on this some more, but what I don't want to hear is the usual old cliches about how I can help her accept her new role in life with dignity. Having seen what I saw today, I no longer see much dignity in disease.