The Veteran Clockmaker

Here we go again with more patient and Dietetic Internship adventures at the Memphis VAMC!(Previous week's blog posts can be found to the left under the navigation by date headings.)

DIETETIC INTERNSHIP: Weeks 6 & 7  (of 41)

Weeks 6 & 7 - Home-Based Primary Care

Nationwide, the VA has a great program called, Home Based Primary Care(HBPC), which sends medical practitioners to a patient’s home if travel for an appointment would prove extremely difficult.  The HBPC team includes doctors, nurse practitioners, nurses, dietitians, social workers, etc…  The frequency of specialty visits is dictated by the patient needs, but he or she is usually visited by at least one practitioner every other week.

Entry into one’s home can be a very private and privileged experience.  A person’s home is very personal and unique, and entering such a dwelling offers a glimpse of a his or her life.  This week, I entered >15 different homes (with another RD), and each presented exceptionally different experiences.  Some were in quite insalubrious neighborhoods, while others were more nourishing.

• I counseled my first HIV positive patient.  He offered his hand as a welcome and departure greeting, but instead of a handshake, he gave me a fist-bump.  I was a fan!

• In one independent senior living facility, each apartment is about 450 sq ft.  One man, whom we’ll affectionately refer to as The Clockmaker, had thoroughly built and decorated his walls with clocks.  We were present at the top of an hour as the chimes began… I was both mesmerized and terrified when the top of the hour began its onslaught.  I counted clocks as I stupendously marveled the sounds and sight: 70.  Yes, 70 clocks in view – which were counted in only the living room and dining room (about 200 sq ft).  I didn’t see the bedroom or bathroom, but I’m willing to guess at least another 20 were hiding in there.

• During these home visits, many of the patients have full-time caretakers.  In one particular visit, the patient was suffering from advanced Alzheimer’s.  What I encountered: the most patient, kind, and gentle daughter taking full-time care of her severely demented father.  Her demeanor was a product of genetics, as I noticed how tenderly he smiled and conducted his limited movements while sitting up in his wheelchair.  He required handfeeding, but could independently sip liquids through a straw.  After she placed the straw in his mouth, I watched him easily down a handful of pills with a cup of coffee, half a cup of milk, and a cup of water with breakfast.  That visit warmed my heart up so much I nearly developed fever.
• Before leaving the hospital each morning, practitioners look up a patient’s electronic chart, record medications, notes from other medical team visits, etc…  Upon accessing a patient’s chart one morning, I encountered a great big warning label,”Caution: VIOLENT,” and he also was afflicted with mild dementia.  Needless to say, I was apprehensive to conduct an interview with this patient.  I ended up interviewing his full-time caregiver, who was also his sister, as the patient was in his bedroom watching TV and stomping around the back of the house.  My feelings were not slighted in the minutest!