The story of Damaris de Kruijf - AIOS geriatric medicine
Cognitive neurorehabilitation: an elective internship with impact!
Written by Damaris de Kruijf, resident geriatric medicine, Thebe
It was the first time that I treated a patient in the nursing home who had just turned 20 years old. A ride on a scooter, as she did so often every day. Unfortunately now with a dramatic end. 'NAH after accident HET, scooter vs. truck', it says briefly and powerfully in the otherwise blank history. The course afterwards is by no means short and sweet, but what do you expect: non-congenital brain injury after a high-energy trauma. Already during admission to the ICU, her consciousness appears to be insufficiently restored. After the hospital, she first ends up on the VIN, then the LIN. Consciousness recovers to a PALOC-8, but it cannot function independently at all. I met her in our ward, where her parents fought like lions for her with the courage of despair, hoping that one day she could do more than sit in a wheelchair with her head bowed.
Her neighbor, a formerly fit man in his fifties, had figuratively speaking turned the tent upside down after a brain hemorrhage in the hospital in such a way that he was put in a tent bed. Despite his half-sided paralysis, far-reaching fixation and large amounts of medication were necessary to protect him from further injury. After a few weeks of rehabilitation, he got back on his feet, free of psychotropic drugs. Despite his remaining aphasia, he made it clear that he was happy to pick up his life at home in a new form.
An internship in cognitive neurorehabilitation (CNR), what do you imagine? I thought of brain injury, post-comatose patients, but I didn't have an idea of that, let alone an idea about the impact that ABI can have on patients and their environment. Nor did I know exactly what I, as a geriatric specialist in training, could do in such a department, except that I knew that patients with such serious injuries often end up in the nursing home. I therefore seized the opportunity to be able to work in such a unique department for a few months,
It does require sturdy shoes, such an internship. As a resident in geriatric medicine, I was mainly used to treating older patients who already had a whole life behind them. Together with patients, we are looking for a way to give a quality interpretation to life, despite physical or mental limitations. And, often also looking together for a good completion of a completed life. CNR is at first sight the odd one out. Rehabilitation, but with a completely different population than the GRZ, where the common denominator of the patients is severe ABI. Brain injury is so serious that recovery at home, in a medical specialist or geriatric rehabilitation is not (yet) feasible. And here too the search for a quality interpretation of life, where everything has changed in a short time.
Hope and despair alternate, sometimes at a rapid pace. It is fantastic when patients make such progress that they can go home with discharge (with or without help), even though their life with acquired brain injury will forever be different than it was. Sometimes, however, reality turned out to be harsh. Young patients, in the prime of their lives, who had suffered serious brain damage due to an accident and did not recover. Family members who, against their better judgment, clung to every potential straw, and who (very understandably) could not accept that more rehabilitation was not useful.
A few months of CNR have taught me a lot, in various areas. Obvious: medical content, working together in a multidisciplinary team, communicative... I have never had so many types of bad news conversations in this internship, even though none of the patients were in a terminal situation. In addition, I have gained a lot of knowledge about acquired brain injury and the search for appropriate care: what are good forms of treatment for this small group of patients with highly complex problems? Sometimes that is also pioneering, because guidelines are not available or do not appear to be appropriate. This internship also offered me the opportunity to contribute to scientific evidence; In my case, this meant empirical research into patient population and medication prescribing behavior. All in all, a versatile elective internship!