The elderly lady in Bed 20 had come in with abdominal and lower back pain and had been in hospital for several days. I was sent to assess her during ward round, which proved to be an interesting experience. She thought she was feeling OK ... wasn’t sure if she had abdominal pain ... couldn’t remember if she’d opened her bowels. I struggled through the history and presented it to the duty doctor, who immediately went and got a completely different but similarly confused story.
Later I was sent to do a mini mental exam on her. It’s basically just a series of questions to check if somebody is oriented to time and place and to assess their cognitive function and memory. We did really well for the first few questions – she knew exactly where she was and she even knew that it was a Thursday. But when we came to the date ... “I don’t know”. Month, season, year ... “I don’t know”.
And from then on she seemed to stop trying. “I’m going to say three words, and then ask you to repeat them back to me. Ok? Apple, penny, table. Can you repeat those?” She replied with, “Oh I don’t know who he is, I know he’s a doctor here but I don’t know his name.” We probably would have both liked to finish there, but we had to persist until she learned all three words, for recall later. This took some time.
Later on we came to the part where the patient has to follow a written instruction. On the paper was the phrase “CLOSE YOUR EYES”. I pointed it out, and asked if she could follow that instruction. She read it out loud several times with no troubles, but couldn’t register it as a command, just kept reading it out loud. And then when I asked her to write a sentence, anything of her choosing, she wrote “close your eyes”. I had to give her that point.
It was a genuine struggle to get through the examination, but of course you have to finish it or the result is meaningless. When we were done I thanked her for her time and hurried back to the haven of the nurses’ station to tally her score. It didn’t take long. She got seven out of thirty. When I told the doctor her score, all he asked was, “did you do it in English?”
Later I was sent to do a mini mental exam on her. It’s basically just a series of questions to check if somebody is oriented to time and place and to assess their cognitive function and memory. We did really well for the first few questions – she knew exactly where she was and she even knew that it was a Thursday. But when we came to the date ... “I don’t know”. Month, season, year ... “I don’t know”.
And from then on she seemed to stop trying. “I’m going to say three words, and then ask you to repeat them back to me. Ok? Apple, penny, table. Can you repeat those?” She replied with, “Oh I don’t know who he is, I know he’s a doctor here but I don’t know his name.” We probably would have both liked to finish there, but we had to persist until she learned all three words, for recall later. This took some time.
Later on we came to the part where the patient has to follow a written instruction. On the paper was the phrase “CLOSE YOUR EYES”. I pointed it out, and asked if she could follow that instruction. She read it out loud several times with no troubles, but couldn’t register it as a command, just kept reading it out loud. And then when I asked her to write a sentence, anything of her choosing, she wrote “close your eyes”. I had to give her that point.
It was a genuine struggle to get through the examination, but of course you have to finish it or the result is meaningless. When we were done I thanked her for her time and hurried back to the haven of the nurses’ station to tally her score. It didn’t take long. She got seven out of thirty. When I told the doctor her score, all he asked was, “did you do it in English?”
1 comment:
It's always the people you want to do well who don't, isn't it? Makes me feel a bit mean sometimes...
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