Monday, March 19, 2007

I'm currently on Physical Medicine and Rehabilitation rotation. (My LAST ROTATION as a medical student! Good bye, short whitie!!! I am ready for a newer, more cute and flattering white coat. After all, it will be the most expensive accessory I own. And, not to be totally shallow, but there was definitely one program at which I interviewed for residency which I nixed based on the poor quality of their white coats. Like COME ON, I have worked FOUR YEARS to be a doctor, I am NOT wearing some stupid white coat that makes my ass look big. And...we're back.) I'm on the stroke service, which means we head the interdisciplinary teams that work to rehabilitate our stroke patients.

Rehab medicine isn't for me, but I actually think it's a pretty cool and rewarding specialty, which is totally unexpected. All through my internal medicine subI I bitched endlessly about how we saved people's lives even when those lives could no longer possibly be worth living, but I see that Rehab medicine is where people regain their quality of life. We had a very interesting ethics session on the first day of Rehab medicine where we each discussed what had to be taken away fron us in order to make our own lives no longer worth living. The top things on my list were not being able to enjoy the company of my friends and family and not having the independence to make choices for myself and do what I wanted. Therein lay the entire point of Rehab medicine: after people have suffered seemingly insurmountable trauma for whatever reason, they become rehabilitated to get their autonomy back. Many people of course won't be able to walk, or speak, or move one side of their body, or even control their bladder again, but the point of rehab medicine is to teach them a new way to live a full and independent life despite their disability. It's pretty cool. As my attending says, "We don't save lives; we save lifestyles." And honestly, one is just as important as the other.

Also, I've been incredibly inspired by how much these rehab docs are advocates for the disabled. It's refreshing to see doctors not only care about their patients, but about the system that makes it ridiculously difficult for their patients to lead autonomous lives. For instance, we had a lecture of "prejudicial politics," where we discussed why state's won't cover home health care but will cover nursing home stays, despite the fact that having an aide come to a patient's home for a few hours a day to help them with bathing, cleaning and cooking is cheaper than parking that patient in a nursing home and letting them rot. It's just always the way it's been done.

There have been some really hilarious moments on PM&R though. These are patients with brain injury, and...sometimes the cortex that's responsible for appropriate behavior and inhibition of inappropriate behavior gets knocked out. And that's why when I went to go examine a patient today I discovered him proudly offering me his own poop in his hand. (At least he didn't throw it at me.)

Also, some patients get confused in the middle of the night and try to climb out of bed, which is dangerous when patients aren't yet stable enough to stand or walk, so instead of getting restraints, which are dehumanizing and uncomfortable, they get these special beds which is like a zipped up canvas net in the manner of a huge tent around the bed. Patient's families don't like it because it kind of seems as though we're keeping their beloved sweet old grandpa in a gorilla cage, but patient's love it because their limbs are free and not restrained but they're still kept safe. Anywho, my patient found a way to escape his open-air restraint (he squeezed himself out under the mattress) and he was later discovered naked trying to use the bathroom in a female patient's bedroom. Rehab medicine!

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