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to see if they could use a psychiatric consultant
who would come to their facility to see their
residents. To my surprise, each of the care centers
either had no consultant or was under-served, and
they readily accepted my offer to meet with their
administration.
What I began to see in these care centers was
entirely different from what I had remembered
from years earlier. There was no stench of urine.
The residents were clean and well cared for. I met
nurses and aids who really seemed to like their
work and residents who responded favorably to
the care they received. But these facilities are also
quite costly-$4,500 to $6,000 a month is the norm.
In my work with the elderly, I find that I come
face-to-face with disease, disability, aging, and
death. I come up against loneliness and regret.
Some residents have regular visits from family
and friends while some have no family left and
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F E A T U R E A R T I C L E
their friends have all died. I come across residents
who have lived full lives who are not depressed in
the usual clinical sense, but who tell me they are
ready to die. In fact, one woman in her early 90s,
on just meeting me, told me how the night before
she had been awakened by “twinges”-hoping and
expecting this would mean her death. One learns
to talk more easily about death-and at times to be
surprised.
Teaching opportunities abound in the nursing
home setting. Medical students and physician
assistant students are able to meet with the nursing
staff, see the residents by themselves, write notes,
and identify to me residents who may need to be
seen sooner than planned. The nursing homes
have as a whole been quite receptive to the extra
attention our students can give their residents,
and the residents benefit with extra visits and
opportunities to tell their life stories.
2 nd year DMU PA student Carolyn Duenwald wrote
about her own experience seeing nursing home
residents during a 4-week psychiatry rotation with
me; “My favorite part of the rotation was going to
see the elderly in the nursing homes. Wow, what
an eye opener! I enjoyed talking with them and
hearing their life stories. However, it was really
hard for me to witness the depression many of
them faced. I had mixed feelings about what was
going on. Being in a nursing home is not the ideal
situation for a lot of the residents, even though
medically it’s a good place for them to be. Most
of them were widowed, didn’t have many close
friends or family to talk to, and found it difficult to
find things they like to do there. Of course, they
are going to be depressed! And some are. I find
it equally important to work with involved family
members-to inquire about how they are dealing
with the decline and eventual death of their loved
one”.
All of the residents are my teachers. I learn from
them. I hope to face illness, aging, and dying myself
someday with the same integrity that I see on my
visits to nursing homes.