R/O Vascular Dementia

"Once a man, twice a child."

Now that my week of Geriatric Medicine is almost to a close, I can admit that I've enjoyed the exposure to the field of Geriatric Medicine. 

Due to the proximity of the Geriatric Hospital to the Psychiatric Hospital in Nassau, The Bahamas our Psychiatry rotation is diverse in what we're exposed to during our time in Psychiatry as it encompasses acute presentations of psychiatric disorders as well as those with chronic mental illnesses. Beginning next week I will be exposed to the Community aspect of Psychiatry as we will be stationed at the Community Counseling and Assessment Centre that works with out-patients and anyone in the community who may be experiencing any form of psychiatric illness. 

Today was a special day mainly because it was Clinic Day at one of the local clinic's that happened to be located in my neighborhood. Geriatric patients throughout Nassau can attend these clinics when they are scheduled. We had the privilege of seeing an 87 year old female who presented with a recent history of strange behavior who was referred from the local hospital to the Geriatric Clinic for examination. 

As the history was taken and the physical examination completed (Fundoscopy included), it was a rewarding experience to present to an enthusiastic and caring Consultant our Assessment and Plan for this patient. 

Overall, the patient was assessed with possible Vascular Dementia due to her history of lacunar infarcts and history of hypertension and non-compliance with medications. It's interesting to discuss with a Consultant one's plan and thought process because although we commented on her visual impairment when we presented her history, we failed to mention this in our assessment. Our consultant was able to provide us with tips on how to assess Geriatric patients appropriately and to consider all possible diagnoses in light of what is given in the history. 

It's always easy to remember a patient when they present with symptomatology that can be referenced in a textbook and despite our history and exam taking 2 hours, it was a learning experience that I will not forget and a diagnosis I will be sure to recall. 

As we age, our bodies undergo a series of changes both internally and externally. As a medical student, I'll admit that I didn't light up whenever our census consisted of 90% of geriatric patients mainly because it meant that there were be more comorbidities and issues that would require more time at each bedside, but after this week of geriatric medicine, I've realized that I did myself a disservice during my internal medicine rotation because rather than seeing that as a time to learn medicine and learn it well, I ran away from a rewarding challenge. 

Be sure to enjoy your time during your Geriatric Medicine rotation if you're afforded the opportunity as you will be rewarded simply by the fact that you're making someone feel special simply because you're taking your time to converse with them and your mere extension of care of their well-being will unlock a superb learning experience for you.