Mrs. Giles, 88, a retired registered nurse, is an important part of the geriatric training that aspiring family practitioners take.
Third-year students interview Mrs. Giles or one of about a dozen other volunteers who live at Morningside Meadows, a residential community for senior citizens in San Antonio. Their work takes from three to 24 hours, and the final product is a written "life review." The review requires the student to learn about a patient's personal history and outlook on illness and death.
Mrs. Giles is the program champion. She has worked with 15 students in two years, more than any other volunteer.
"I have never encountered anything in my life that has given me the lift that those young people have. They are so young, so energetic, so alert, so articulate," Mrs. Giles said.
The "life review" exercise helps teach crucial lessons in dealing with elderly patients. The student examines advance directives with Mrs. Giles or another volunteer. Students ask sensitive questions, including whether the patient wants to refuse life-support systems.
"Everybody wants to talk about it, but nobody wants to bring it up," said Barbara Benz, RN, who coordinates the program.
Mrs. Giles and the students have plenty to talk about. She finished her nurse's training and worked at Santa Rosa Hospital in San Antonio during the Roaring Twenties. She lived in the lower Rio Grande Valley during the Depression. When World War II broke out, she underwent basic training, received her commission as a second lieutenant in the Army and served as a nurse-anesthetist. She treated casualties from the landing at Anzio in 1944 and other engagements in Italy. She says she administered the first dose of penicillin given to U.S. troops in the European theater.
As for advice to the aspiring physicians, Mrs. Giles said: "I tell the students to always remember their patient is another human being, not something you automatically diagnose and send on their way, especially the old people."
Students at the Health Science Center have other opportunities to learn about the elderly. Physical therapy students are offered a course in gerontology. The Dental School has had a required course in geriatrics since 1986, and dental hygiene students go on rotation at nursing homes.
First- and second-year medical students are offered the chance to work in geriatrics and gerontology with researchers during the summer. The eight-week program, which is funded by the National Institute on Aging, is designed to expose the students to biomedical research and encourage them to pursue a career in geriatrics or gerontology, said program director Arlan Richardson, PhD, of the department of medicine and the Geriatric Research, Education and Clinical Center at Audie L. Murphy Memorial Veterans Hospital.
A medical-dental fellowship program in geriatrics also is available at the post-doctoral level. The program, begun in 1988 and funded by the U.S. Public Health Service, is designed to promote understanding of clinical and research issues related to care of the elderly by physicians and dentists, said Michael S. Katz, MD, program director.