Today our team revisited the community of Yabucoa to make good on the promises of the first week. We started the day by meeting with community leaders from Parroquia Santos Angeles Custodios, who had already planned for our team to be divided into two groups and visit the more elderly, home-bound members of the community. One team was led by Dr. Haack and the other was led by Emory anesthesiologist Dr. Mark Caridi-Schieble, who has joined us for the second week of activities. The medical students on each team performed vital signs, physical exams, blood glucose checks, and wound care as necessary for each patient while the attending physician interviewed the patient and family regarding their current medical problems, treatments received, and ongoing medical needs. Overall, our team made 26 patient visits for the day and began to function like a well-oiled NASCAR pit crew team as the day went on.
We were, in the literal sense, making house calls. My first observation was that the doctor-patient interaction takes on an entirely different dynamic when the encounter occurs within the patient’s own home. In the office, you can’t see a bed-bound patient’s daughter waking her up with a shower of kisses. You can’t see the hole drilled through a wall of the family’s home for the oxygen tubing. You can’t see the positioning schedule posted on the bedroom wall to prevent bed sores.
In these home visits, I gained a new appreciation the people who become caregivers at home--the sons and daughters, the cousins, the neighbors, the social workers. They care for patients long after the visit to the doctor's office is complete, and they do so from a place of deep respect and love; I noticed how the simplest of praises, such as a “good job” for preventing bed sores or following a strict diet, had a marked effect on these caregivers' morale. In discussing this with Dr. Haack on the car ride back from Yabucoa, she told me “Never underestimate the power of just showing up. Showing up lets these people know that their work is not forgotten.”
Seeing these small details brought me to another realization – this type of home care, with multiple children and grandchildren living in the same household and caring for the elderly of the family – seems less common, or is at least less visible, on the mainland, where most of the patients we visited today might have been placed in nursing home or assisted living facility. In fact, there are entire books dedicated to the subject of the different ways in which diverse cultures treat and care for the elderly and bed-bound (see Atul Gawande’s Being Mortal for some excellent examples), so I will refrain from rehashing the subject in this blog post. Truly, the devotion and love of the patients’ family members, many of whom had either stopped working or cut back on working to care for their elders, is something that I will not soon forget. Here, in a rural area of Puerto Rico, I saw a segment of American culture that treats aging as a natural, inevitable process that we will all experience, hopefully with grace and dignity, surrounded by the people we love.
Our team had a great day today. As a medical student, we crave the feeling of putting in an honest day’s work in the craft in which we are training. The obligations of book-learning sometimes obscure the joy that comes from having a positive impact on a patient’s day--the "soulcraft" of simply working without expectations of results. Today, was one of those days. Our team was smiling on the drive home, with the tired satisfaction that comes from a day spent serving the people of Yabucoa.