THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Monday, April 3, 1995 TAG: 9504010039
SECTION: DAILY BREAK PAGE: E1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
LENGTH: Long : 286 lines
Feb. 24
Perceptions
Dependency.
That's what bothers Kevin Baiko most about old people. That they are so dependent on others.
And sick. And, well, old.
It is a week before Baiko, 25, a fourth-year medical student at Eastern Virginia Medical School, immerses himself for two weeks in the problems and illnesses of the elderly.
The mandatory clerkship is supposed to sensitize him to the many physical, mental and social issues that affect an aging population.
For by the time Baiko and his classmates begin their practices, they will be treating the largest population bulge this country has ever seen - the aging baby boomers. Within the next 35 years, the number of people 65 and older will more than double, to 65 million. This means that for a doctor like Baiko, who is planning a career in primary care medicine, half his practice will be made up of older patients.
And yet, four years in medical school have exposed this California transplant to very little about geriatrics.
The few encounters he's had with older people - volunteering in nursing homes, seeing patients at the Veterans Administration in Hampton - have convinced him they are among the most challenging of patients.
``It makes me deal with my own vulnerability and potential to be dependent on someone, and that's hard for me,'' he said. ``Particularly someone with Alzheimers. The idea of losing it is scary.''
With his ponytail, Elvis-like sideburns and gaunt, pale face, Baiko looks more like a burned-out guitar player than a medical student. In fact, Baiko is a musician. Next year, while his classmates are starting internships, he'll be back in California, seeing if he can make a go at his music before returning to medicine.
But he's looking forward to this gerontology rotation - mandatory for all fourth-year students.
In addition to basic classroom lectures, he'll visit area nursing homes, homes for adults, a hospice, meet with caregivers and attend a panel discussion at Westminster-Canterbury retirement community in Virginia Beach.
``At the very least,'' he says, ``it will be a check of where I stand inside with working with the elderly population.''
At the most, he says, ``It will challenge me and open me up to areas I've not tended to look.''
March 6
Empathy
Here at the Med Emporium in Norfolk, among the wheelchairs, the aluminum walkers, portable toilet seats and bedpans, Baiko is learning what it means to be old.
To have fingers so stiff with arthritis that you can't curl them around a pen to pay your monthly bills. Vision so cloudy from cataracts that you can't read the instructions on your prescriptions. Joints so achy from Parkinson's disease that a walk down the aisle to fetch a bag of Depends takes 10 minutes.
This is the aging simulation segment of the gerontology clerkship. For the next three hours, 13 students will wear adult diapers and Vaseline-smeared goggles. Have pureed baby food spooned into their mouths. Sit in a wheelchair facing a blank wall for half an hour - as residents often do at nursing homes.
The most important thing, says Dr. Bruce S. Britton, a Portsmouth family practitioner who is leading the simulation, is that the students learn to empathize with their geriatric patients.
There are giggles and embarrassed looks as the students file out of the changing area, walking awkwardly to accommodate the diapers they are wearing under their clothes.
``Whether you are going into general medicine or surgery,'' Britton says, ``you need to understand how older adults feel wearing them.
``They chafe. They rub. They're hot. And just imagine if you're wet. So you can understand now why your incontinent patient doesn't want to leave the house, or even tell you she's having a problem.''
Assistant professor Viki Lorraine pairs Baiko with Christine Pohlmann, 26, who is going into family practice. ``You are the elderly sister,'' Lorraine says, taping Pohlmann's fingers together to simulate arthritis. She slips a pair of Vaseline-smeared goggles over her eyes, duplicating the fuzzy outlines seen by cataract patients.
``And this is your demented brother,'' she says, pushing Baiko into a wheelchair. He wears gloves to simulate peripheral neuropathy, a nerve disorder that lessens feeling in the hands and feet. Lorraine wraps a brace around his neck - mimicking the stiffness of Parkinson's disease - then assigns Pohlmann to pull on her ``brother's'' jobst stockings - thick, tight support stockings that prevent the feet from swelling.
Pohlmann struggles to get Baiko's shoes off, scrabbling at the laces and socks with her taped fingers. Pulling the resistant stocking on is harder, and her face reddens.
``This is worse than a girdle,'' she says. But the joking stops when she realizes that if she really were 81 years old, with arthritis, she wouldn't be sitting on the floor tugging and pulling like this. And then how would she care for her brother?
Lesson learned, says Lorraine. ``Doctors blithely prescribe these without realizing how difficult they are for older people to pull on,'' she says.
For Baiko, the reality of aging is slowly sinking in. ``This would be really hard if I couldn't do it myself,'' he says. After pausing, his voice softens as he says: ``I don't like being that dependent. It's a very humbling experience to not be able to do that for myself.''
Next stop is the feeding station. A nurse wraps a bib around Baiko's neck and spoons pureed green beans into his mouth, interspersed with sips of vanilla Ensure, a liquid dietary supplement.
And Baiko learns about loss of choice and control. If he could have had some butter on the beans, a straw for his drink and the Ensure chilled, he says, it would have been better.
``These are the kind of small things that can make a world of difference when a patient has so little control.''
March 7: Revelation
Bryce Fisher, 77, is lying in bed, clutching a stuffed teddy bear as his home health aide empties his catheter bag and pulls on his pajama bottoms.
On the twin bed next to Fisher sit Baiko and Aimee Kokotakis, 27, another student, spending the morning with Bryce and his wife, Ruth. The couple has been married 52 years. Six years ago, Bryce was diagnosed with Alzheimer's disease.
Today, Baiko and Kokotakis will see what it is like to care for a loved one through years of a debilitating illness.
It is the first time in their medical training, Baiko says, that they have seen how a caregiver copes with sickness.
Ruth Fisher, by her own admission, is one of the lucky ones. She can pay the $6 an hour to have certified nursing assistants from 9 a.m. to 5 p.m. seven days a week.
Without them, Ruth, 75, would have had to put her husband in a nursing home. She is too weak to lift and turn him, to provide the unrelenting hours of care his condition demands. But, and this is a point she is careful to make to the medical students, her health insurance doesn't cover in-home care. It all comes out of her own pocket.
``Do you want your face washed, doll?'' Ruth croons to Bryce. ``Does that feel good?'' she says, gently wiping the remnants of breakfast oatmeal from her husband's face.
She agreed to participate in the clerkship because ``all these things I've been learning so hard for six years I'd like to give to someone. I just want to make compassionate doctors out of you.''
By the end of the three hours with the Fishers, Baiko has begun to see another side to illness - the family's side. The hours spent trapped in the house. The financial hardship. The physical and emotional drain of watching a loved one waste away.
Teaching this in medical school, he says, would make for a more holistic way of approaching medicine.
And there is something else he is beginning to understand as he watches Ruth put tiny bits of banana in her husband's mouth.
That maybe this dependency thing isn't so bad after all.
March 9: Comprehension
This is the part of the clerkship Baiko has been most looking forward to: Discussions with volunteers and cancer survivors at Lee's Friends, an organization that provides one-on-one support to cancer patients and their families.
Baiko is fascinated with death. He's read books about it, participated in weekend seminars exploring it. And now he's going to hear from people who - like many of his future patients - have pressed their noses against it and then turned away.
Says Emily Filer, who founded Lee's Friends after her teenage daughter died of cancer: ``If you want to be a wonderful doctor, take the time to listen to your patients. Your being able to listen and hear what that patient and family is saying is real, real important.''
Baiko knows. It's one of the problems he has with modern medicine. ``Not only do doctors have difficulty crossing that barrier, but the system is set up that way - you're taught how to tackle the diagnosis, not provide comfort.''
And comfort is needed.
For instance, says Brooks Harris, 63, who was diagnosed four years ago with rectal cancer, cancer patients like to be touched.
He learned that through his own volunteer work with Lee's Friends, through the long hours he has spent caring for dying patients like Earl, who is paralyzed from the waist down with spinal cancer, holding his hand and praying.
And how does it affect you when they die? Baiko asks.
``You cry a lot,'' Brooks says. ``Crying is some of the best therapy in the world.''
Gary Nance, 61, who recovered from what doctors thought would be terminal lung cancer in 1984, tells how the experience changed his outlook on life.
``You have a special appreciation for life you're never able to grasp before,'' he says. ``When you're young, you just rule out death, and that's natural and good. But in the last 10 years or so, I've been associated with it and facing death and figured out that we're all suffering from a terminal disease called life.''
But for doctors, Baiko reminds them, death is the enemy.
And for patients, they shoot back, especially those in terrible pain, it is often a gift.
March 10: Enlightenment
Together, the five Westminster-Canterbury residents have more than 350 years of wisdom, knowledge and living.
And now, facing the mostly twentysomething medical students, they draw on that experience to describe what it is like to grow old.
``Getting older is not something you decide; it just happens to you,'' says Jane Lawrence, 73.
This is the final day of the clerkship: a tour of the luxury retirement community, followed by a frank discussion with five of its residents in this penthouse meeting room overlooking the Chesapeake Bay.
The residents, all in their 70s, are here not to speak of aches and pains but of new chapters, of changing expectations and of acceptance.
Acceptance when you can no longer live - or no longer want to live - in your own home.
It came to Eleanor, 75, and Euell Barberousse, 77, two years ago, when they went to their daughter one day and said, ``We want to talk about the rest of our lives.'' They chose Westminster-Canterbury not for the stunning water views or the elegant lobby but for the continuum of care it provides - from independent living to skilled nursing care.
Moving to a place like Westminster-Canterbury doesn't restrict your independence, Lawrence notes. It only enhances it. ``You can be more independent here than at home, because there's no trash to take out, no yard to take care of, no groceries to shop for. So you have time and energy left to commit to whatever you wish.''
For Lawrence, the transition to Westminster-Canterbury didn't work out exactly as she'd planned. Soon after she and her husband moved there two years ago, he was diagnosed with Parkinson's disease. In November, he moved to the facility's on-site nursing home, where she visits him twice a day.
``It's strange when you're over there so much,'' she told the medical students. ``These people become more real to you than we are, and you start relating to them. You talk to them, and you don't know what they're saying but you talk, and it's not bad. It makes me less afraid in the event of going over there.''
Throughout the residents' comments is interwoven one theme: the sense of community and safety Westminster-Canterbury provides.
Where a buzzer in every bathroom brings emergency medical help. Where the men have their own ``club'' complete with pool tables and smoking room. And where someone always knows your name, and cares whether or not you make it downstairs for breakfast.
A place where dependency is respected.
March 20: Closure
The old man in the nursing home who held his hand and cried for an hour and a half because it was longest anyone had interacted with him in months.
The one-on-one friendship and caring the Lee's Friends volunteer brought to a dying patient - which a doctor couldn't.
The enormity of providing 24-hour care for your husband of 52 years.
These are among the images Baiko is left with at the end of his two-week immersion in gerontology.
But he's undergone a much deeper, more profound transformation.
He no longer fears dependency.
In fact, he says, the biggest lesson he learned is that people need to depend on each other. And that ``independence'' in early and middle adulthood is an illusion.
``That whole illusion starts breaking down when our bodies start breaking down and we start dying, and that happens in old age,'' he said. ``Maybe people would be a lot healthier if they were open to the idea that we are interdependent and we do need each other.''
He's now more comfortable around older people, around dying people. It's an experience more health professionals need, he says.
And he's learned how important it is to focus on the positives of aging. Like the aging simulation. It was frustrating, Baiko said. ``It limited my range of motion, my ability to use my senses. . . . There were a couple of times I just wanted to say to hell with it, to sit down and say, screw it all.''
But it also showed him that a physician can help an older person influence his own environment. ``When they were feeding me food that tasted so bland, giving me food without a choice, I found I wanted to go and get the chocolate vs. vanilla Ensure, to have a choice between beet mush or green bean mush,'' Baiko said. ``That gives a person an influence over their environment, particularly when so many of these things are happening beyond their control.''
He's learned that it's OK to be frail, to be needy. ``And because of that, it's not so threatening to work with people who are needy, who will remind me of my own potential frailty and interdependence. And because it's not so threatening, I'll be less likely to treat my elderly patients in a way that's standoffish. To ignore them.''
Personally, he said, the experience has made him want to become more connected with people, particularly as he ages.
``I think the more I realized that people are interdependent on one another, the more it seemed OK to reach out for help when you need it. And if I get sick as I age and my body starts aging and changing, I guess that's not such a threatening thing.''
Lesson learned. ILLUSTRATION: BETH BERGMAN, Staff color photos
Wearing fogged lenses to replicate the experience of elderly people
with cataracts, medical student Kevin Baiko struggles to read
instructions on medications.
Baiko, with a neck brace to mimic stiffness caused by disease, feeds
pureed food to fellow med student Christine Pohlmann.
Beth Bergman, Staff photos With legs tied and glasses fogged,
medical student Kevin Baiko struggles with the handicaps of
restricted movement and vision.
Lung cancer survivor Gary Nance tells Baiko how his experience with
a life-threatening disease changed his outlook on life.
KEYWORDS: DOCTOR MEDICAL SCHOOL GERIATRICS by CNB