Monday, May 27, 2019

Research Subject

Image result for research subjectWhen I was on staff at a large medical center, the CEO established four core values for the institution which he arranged in a diamond pattern, safety at the apex, think of yourself as a patient at the bottom corner.  While it seems hard to assess how seriously this mission statement was taken, or if anyone really remembered which value went in which corner, the institution expanded and he got to retire shortly after my departure to a different institution.  Thinking of yourself as a patient usually includes not wanting to be one.  Fortunately, medical care is not all rescue from misfortune.  Research abounds.  If American health care underperforms markers of access and outcome of other countries, our laboratories sparkle like no other.  We have assigned once dreaded diseases to the medical history books, made pneumoencephalography obsolete, and have transformed our biochemistry courses from understanding metabolic pathways to understanding the molecular basis of diseases.

Having watched patients on Medicare assign their too frequent doctors' visits to their prime social outings, I resolved on retirement that I would find other reasons to venture out of my house.  The Osher Lifelong Learning Institute became a valued destination.  While the ties to the state university are generally loose and subordinate, they are not absent.  As our health varies from unimpeded to not entirely independent, we make for a good pool of research subjects to enroll in several ongoing projects at the university's expanding health institute, which does not yet have a medical school but promotes allied health professions training in a big way.  Seeing a project on mental acuity, my son's neurology fellowship pursuit, I opted to sign onto one of the research protocols.  Since I can drive my car safely in all but highly flooded weather and never have to hit the alarm option on the key to find it in the parking lot, they designated me a Control.

While I've done mental status assessments as part of history taking for my entire career, I was not prepared for the sophistication of the battery that came my way.  Lists of words, unrelated, floundering at first but able to put the unrelated single words into a few categories.  My memory is mediocre, attention span so-so, ability to learn verbally very good.  They showed me shapes and had me place them back in order.  I named each shape, then put each back on the screen.  Right sided spacial reasoning did not go as well.  I had to find an object but could not relate fixed landmarks that would enable me to find it when hidden.  I was also not allowed to move the joystick backwards.  What I did instead with limited success is the fishing technique of fanning.  Having no idea where the fish are in the pre-electronic age, we would cast repeatedly in a semicircular pattern from our starting point.  It got me to the target about a third of the time.  I'm just not right-brained but my spacial orientation is adequate to drive safely, though I still struggle to parallel park.

Finally the uncontrasted MRI.  An hour's relaxation with a supine posture, slightly itchy nose that had to wait, noises that reminded me of a confined contraption at an amusement park and an occasional instruction from the technician as there were some dynamic elements.  At the end, I read my scan.  An empty sella, I think, More cerebral atrophy than I might have predicted from my still pretty decent intellect, and no masses or asymmetry.

In another month we get to part 2, an exercise test for which I am self-training on my treadmill with decent compliance and another battery of psychometrics.

Medicare folks whose office visit is their periodic home escape often make a day of it.  I thought about doing that too, especially since I still had 40 more minutes before the next parking surcharge.  Looked for lunch on campus.  Too expensive.  Went into their 5&10, a dying breed, dominated by University logo items.  More than I wanted to spend.  Paid the parking fee and went home.

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