A Future Practice Shaped by the Summer Institute

By Wendy Ng

While I always maintained an interest in working with older adults, my exposure to seniors remained generally limited to indirect experiences relating to years of volunteer work in physical rehabilitation units, and to seeing critically ill patients in an ACE (Acute Care of the Elderly) unit in London, Ontario.

The 2007 Geriatrics Summer Institute for medical students this past week in Vancouver, British Columbia changed me. I gained a fresh new perspective on this growing sector of the health care field, and I was inspired with new interest in exploring the challenges and rewards that a career in geriatric medicine might offer. As a medical student, geriatric medicine seems to be a field constantly overlooked by my colleagues. While many of my classmates speak of cardiology, respirology and nephrology, there is often little focus on a subspecialization in geriatrics.

On my first evening in Vancouver, after moving my luggage into a lovely residence across from the ocean at the UBC campus, I met several new instant friends — students from most of the nation’s medical schools. It was exciting to see the enthusiasm brimming in our jetlagged faces! Here we were in Vancouver, ready to sightsee and to meet other students over the course of a weeklong geriatrics conference. All of us had individually worked with seniors in one capacity or another; it was fascinating to compare such a breadth of different experiences that had brought us to one place.

Starting off with an interactive session on careers in geriatrics, followed by a forum on successful healthy aging by seniors who were living well, the first day of the conference was a revelation. As a medical student who often only met elderly patients struggling through health crises, I found that this forum offered an immensely valuable view of content seniors who were both happy and actively contributing to their communities — a view rarely available to most medical students.

In smaller groups, we travelled to Vancouver area hospitals to shadow geriatricians, to learn about the facilities, and to meet patients. I traveled to the Queen’s Park Care Centre in New Westminster. The cases were complex. An elderly man, accompanied by his wife and daughter, struggled with the mini mental status exam. "Oh no, not this again," he fidgeted. "I don’t want you young ones testing me and laughing at me, thinking that I’m stupid."

In a different visit, an older gentleman brought in his dependent wife, asking about naturopathic remedies for his loved one, with the intention of memory improvement. In the geriatrician’s office, her attention span was limited and she said little, unable to stay awake long enough to answer many questions beyond a smile. "What do you think of this, doc?" the gentleman asked. "I heard that placing a magnet on the back of her neck will improve her circulation, and her memory." He was looking for hope.

Yet another gentleman asked about the legalities and intricacies of euthanasia, after having watched his quadriplegic brother struggle with death. "I don’t want to die like he did," he explained. "I should be allowed to go when I want to go. I can’t live like a vegetable." Professionally, personally and ethically, every patient was different. Every patient had different abilities. Every patient’s family was different. Every patient affected my emotions differently. Again and again, I saw incredible value in seeing patients as whole people, shaped by both their past and present experiences.

The next day, I visited S.U.C.C.E.S.S., a culturally specific community care centre for elderly Chinese patients. It was exciting to see structured programs established to keep older adults active and independent for as long as possible. In particular, it was gratifying to see how sensitive caregivers were to Chinese customs. For example, they served soup with every meal for its traditional role in benefiting one’s health in centuries of Chinese history, although soup was not necessarily seen with such importance in Western practice. It was clear that such targeted care truly benefited the nursing home residents, and is a growing trend across Canada.

On the final full day of the conference, I visited the Short Term Assessment and Treatment (STAT) Centre at Vancouver General Hospital, where a multidisciplinary health care team looks after older adults arriving from the local community. I had the opportunity to interview a gentleman about his functional status. Upon introducing myself, he was unable to tell me where he was, how long he had been in hospital, or the date. It was difficult to encourage him to answer my questions directly, without wandering on circumferential thoughts. While he readily affirmed that he was able to dress, feed himself, go to the toilet, take his medications and perform other activities of daily living, his responses were somewhat questionable based on further questioning.

"Do you require assistance in taking your medications?" I began.

"No, of course not. I can do all that," he responded with confidence, never losing eye contact.

"What medications do you take?" I probed.

He could not offer a clear answer, again drifting into unrelated tangents that I could not follow. Eventually, it became evident that he likely had dementia, and I was reminded of the importance of obtaining a collateral history from a family member or a friend. Later, I discovered that he needed assistance in almost every aspect of his daily life, and required constant care. Nonetheless, I was impressed with his impeccable style of dress and his upstanding social skills, despite his frustrating limitations.

Through the week’s problem based learning sessions on aging at Vancouver General Hospital, my fellow students and I discussed issues ranging from accessing resources in the community for seniors to how to report a driving impairment leading to a revoked license. The answers to these issues differed from province to province, reminding me how privileged I truly was to have the opportunity to work through such issues with medical students from schools across Canada. Every student was passionate about learning, and it was evident to me that I was networking with future medical leaders.

However, the Geriatrics Summer Institute was certainly not all about hospital visits and academic discussions. Over the course of the week, I went on an afternoon jog through the gorgeous university campus to enjoy the ocean breeze, shopped along Robson St., went on a boat ride to Yaletown, explored Aberdeen Mall in Richmond, walked through the Dr. Sun Yat-sen Classical Chinese Garden in Chinatown, ate at numerous delicious ethnic restaurants, explored Stanley Park, took photos at Kitsilano Beach, rode the ferry to Bowen Island, and hiked up Grouse Mountain just before sunset, among much more. Sightseeing with my medical student colleagues, future physicians sharing an appreciation for working with the mature adults, may have been the most rewarding adventure of all. I hope that we will keep in touch throughout our careers.

Furthermore, the memories of a week of learning will stay with me as I embark upon my medical career. No matter what field I ultimately endeavour towards, I will undoubtedly maintain utmost respect and appreciation for the elderly population. Considering the plain fact that most fields of medicine involve interaction with older adults, the Geriatrics Summer Institute will very likely positively influence my future practice.