One Week Last October

Anthony Fiorini, Consultant Geriatrician and Senior Lecturer, Clinical Chairperson of the Department of Geriatrics, Malta tells us about his week.

Monday:

I am an early riser by nature, not because of advancing age! Household chores are finalised, then a quick swim in a nearby indoor pool. By 7.30 am I am on the road, crawling to work.

The 8 km car journey takes half an hour. Malta is the EU’s most densely populated country and it feels like everybody is driving to work at this time!

The morning is dedicated to a ward round at St Vincent de Paule Residence, an 1100 bedded long-stay institution. Medical students are in attendance and I get them to listen to an aortic murmur, note chorea movements, palpate a distended bladder. Fewer lectures, more hands on practice are what they always seem to need!

In the afternoon I lecture on ‘delirium’ at University to students enrolled in a Gerontology Masters programme. My trusted laptop takes 5 minutes to warm up. I refuse to switch to a younger version and be accused of ageism! In the meantime I am teased about the weekend loss suffered by my favourite football team. I adopt a nonchalance attitude, quoting Kipling, something about treating triumph and disaster just the same, but in truth I am annoyed!

Tuesday

I participate in a seminar on ‘Improving medication use in older persons’. The keynote speaker, Denis O’Mahony, pops over from Dublin in spite of the European inclement weather and competently tackles ‘the quiet epidemic of adverse drug reactions’. I present, ‘tales of the not so unexpected’, describing vignettes with drug induced complications. Ministers attend ensuring the event’s messages are reported in the mass media.

Wednesday

I spend the day at the Rehabilitation Hospital Karin Grech, a 269 bedded institution. I first attend the doctors’ handover meeting at 8.00 am. I enjoy this opportunity to meet the junior staff and hear about the admissions and medical complications dealt with by the team on call. Then off to my day hospital clinic which spills over into the afternoon with a multidisciplinary conference. The medical students again attend and they are able to observe patients with a lesser degree of frailty compared to those seen at St Vincent de Paule Residence. Patients are wheeled in with a variety of syndromes. I take the opportunity to conduct a tutorial on falls. I also assess a number of applicants seeking entry into state run care homes. Although I emphasise to the students that comprehensive assessments improve problems and postpone such admissions, deep down I remain concerned about a culture surreptitiously developing in Malta, tipping towards institutionalisation rather than community living. The state nurtures such an attitude by creating more long-stay beds in private public partnerships whilst community services stagnate.

Thursday

Back to St Vincent de Paule Residence and a visit to the Admission Ward where new residents undergo detailed assessments. Nearly all the patients I discuss today suffer from dementia, a diagnosis fast becoming the main precipitant towards long-term institutionalisation. Later, I don my clinical chairperson’s hat and attend a hospital management meeting. Talk, talk, talk, detailed minutes, the usual frustrations, few resources, little progress!

Friday

My grand ward round day at the rehabilitation hospital. I do it the good old fashioned way, ambling from one bed site to the next, reminiscent of Mussorgsky’s pictures at an exhibition, pushing the files trolley, trailed by team members and students. Most of the 26 patients seen have been transferred from the acute hospital. There is a wide spectrum of clinical problems and co-morbidities to whet my appetite and I feel like a real geriatrician. I meet relatives and alleviate some of their concerns. I then lead the afternoon’s interdisciplinary conference and try to instil some humour. The added bonus of a generous slice of baci cake complements my mug of coffee, courtesy of the foundation doctor who rotates to another firm next week. Added swimming laps will be required tomorrow!

Saturday

Yes, I work! It is the only time in the week all 11 consultants can meet. We first participate in the CME presentation, on Vitamin D deficiency. We then gather for our management meeting, the main topic being the need for a geriatric ward at the acute hospital, a longstanding bone of contention. But Malta has a new minister of health sympathetic to our cause. Who knows, 2014 might be a good year for the Department of Geriatrics!

Sunday

Is dedicated to family matters. After church, my sisters and brother-in-law pop in for a chat and a drink. Then my married children arrive for lunch. Whilst my wife is creating a scrumptious meal out of what seems like total chaos in the kitchen, I dote over my grandchild and crawl around with him. Later the males sit in front of television ready to watch our favourite football team’s next game. Now will I be teased again tomorrow?

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