Sheila Rustgi: Working with Patients & Teachers BACK

Published by AFAR

Today was a busy day for the MSTAR students at Mt. Sinai. In addition to time dedicated to our research projects, the nine of us come together weekly for a research seminar and didactic sessions as well as to practice our clinical skills in Mt. Sinai’s Geriatric Outpatient clinic, the Martha Stewart Center for Living. Having only recently learned history taking and physical exam skills, I am excited about the opportunity to keep practicing over the summer.

First we heard from Dr. Helen Fernandez, a geriatrician who also runs the Geriatrics Fellowship program at Mt. Sinai, about how and when to perform a geriatric assessment. She taught us some straightforward tests, such as the mini mental state exam and the clock drawing tests, and also provided us with evidence from the literature of their specificity and sensitivity. The session was interactive and we discussed a recent case of Dr. Fernandez. Even though the patient lived alone, Dr. Fernandez had done a very thorough history and found a number of potential issues in the patient’s life. In just a few visits, she was able to create a long-term plan of action as well.

After the seminar, I met with Dr. Melissa Carlson, my project mentor, for our weekly one-on-one meeting. My project is an analysis of inappropriately short and long stays in hospice by cancer patients. I’m using the SEER-Medicare dataset, a registry of deceased Medicare beneficiaries diagnosed with cancer. Dr. Carlson answered some of my questions about SAS and we reviewed the table I had made. After identifying some variables of interest, we created a work plan for the next week.

Following this meeting, I grabbed a quick lunch and reported to the geriatric outpatient clinic. Last week I had shadowed the Chief Fellow, but this week was a bit different. I reported to the Special Medical Office Assistant, Willy, who takes the patients’ vitals and draws blood. As I watched him chat and joke with patients, I was impressed by how quickly he put them at ease. The second patient we saw was a former nurse. She was very talkative and asked me about myself and medical school. She also remarked that Willy is a good teacher as he showed me what he was doing as he drew her blood. After watching Willy draw blood from a few more patients, he took me into a room and announced that I was now going to draw his blood. Having done this only once before, my pulse began to quicken. I asked which arm I should use and he just shrugged. Despite my anxiety, I successfully stuck a vein and Willy didn’t even (visibly) flinch. Then he told me that once he found an appropriate patient with “big juicy veins,” I would draw blood from that patient as well. If I wasn’t sweating before, I certainly was then.

The patient he chose was a very nice man. He sat quietly while I gathered the gloves, gauze and alcohol prep pad. His vein was so large that Willy said he wasn’t even going to stand over me. Although I did have some difficulty, the patient never complained and was kind enough to tell me it didn’t hurt. That was when Willy told me why I should go into geriatrics. The geriatrics patients, he said, were the nicest. Many of them love to chat, like the nurse I had met earlier. Even when he had difficulty drawing blood, the patients just told him to try again without complaining. As I continue to practice and refine my history-taking and physical exam skills, it is encouraging to work with both patients and teachers who are kind, patient and have faith in you.

Sheila Rustgi
Mount Sinai School of Medicine

 

"Diary of an MSTAR Student" follows scholars in the 2011 Medical Student Training in Aging Research (MSTAR) Program, highlighting their summer experiences. As they continue their path of research, training and clinical practice, read their daily thoughts at www.afar.org/mstarblog. New diary entries are posted every day, so check back soon.