Learning by living

Age-old insights: UNECOM student experiences life inside a nursing home

Matthew E. Sharbaugh, OMS II, hopped in his truck and set off to sign into a nursing home.

At about 6:30 a.m. last June 28, Matthew E. Sharbaugh, OMS II—all of 24 years old and in perfect health—hopped in his 2003 Jeep Cherokee and set off to sign into a nursing home.

He traveled lightly, with just an extra pair of jeans, sweatshirt and pants, socks and underwear. But shortly into the 180-mile trip from Biddeford, Maine, to the Chelsea (Mass.) Soldiers’ Home, Sharbaugh realized he had additional, unwelcome, baggage—a growing chorus of doubts: “What am I doing? This is my summer vacation, and I’m going to spend it sitting and sleeping in a wheelchair, in a corner of a nursing home, bored? I’ll be miserable.”

In another’s shoes

Sharbaugh’s nursing home venture stemmed from a discussion four months earlier. As student at the University of New England College of Osteopathic Medicine (UNECOM) in Biddeford, Maine, Sharbaugh went to dinner the previous February with other members of the school’s geriatrics club. He listened as Marilyn R. Gugliucci, PhD, UNECOM’s director of geriatrics education and research, discussed her “Learning by Living” project.

Begun five years ago, the program aims to help future physicians better understand—and eventually better treat—elderly patients by letting students live the life of a nursing home resident. “The project’s purpose is not for the students to critique the nursing home,” Dr. Gugliucci says. “The whole point is for them to answer the question, ‘What is it like for me to live in this environment.’ ”

As part of the program, each student admitted to a nursing home receives a bogus diagnosis and treatment regimen. For two weeks a student with, say, paralysis of his legs due to a stroke would be expected to stay in a wheelchair and attend the requisite physical therapy, as well as other nursing home activities.

Sharbaugh learned that students who had participated in the project often lauded it for heightening their compassion for elderly patients. The nursing home residents’ humor and kindness also shattered many students’ preconceptions of the facilities as cold, lonely institutions.

Sharbaugh quickly took an interest in the program. “It was just what I was looking for,” he says. “I figured it would be a great way for me to learn patient skills that I couldn’t acquire during the first year in the classroom.”

Foreboding sight

But by the time Sharbaugh pulled into the Chelsea Soldiers’ Home parking lot, much of that enthusiasm had dissipated. He looked up at the four-story building atop Chelsea’s Powderhorn Hill and thought, “Well, it’s got windows, but there’s a whole lot of red brick. I’m going to be locked in there for the next 12 days.”

Yet he pushed himself.

Nursing home staff, well-aware of Sharbaugh’s medical school project, agreed to treat him as a stroke victim with right-side paralysis and assigned him a wheelchair. But unlike the staff, residents weren’t informed of Sharbaugh’s real reason for being in the home.

Upon admission, a nurse wheeled Sharbaugh to the 16-bed wing where he’d be staying, quickly introduced him to his 11 ward mates and left. “I knew that living with 11 roommates could be tough, so I decided to go back and meet them all again,” says Sharbaugh. Among the first he spoke to was a man Sharbaugh calls Mr. E.

Tan, thin and in his early 80s, Mr. E always wore a floppy brown hat. Sharbaugh wheeled over, introduced himself and explained he’d be in the ward for the next 12 days.

“He just mumbled something,” says Sharbaugh, who reintroduced himself and received the same response. “I could see that he might have been a stroke patient. But I was pretty nervous; everything was still very new to me. So I laughed awkwardly and moved on.

“During the next three days or so, Mr. E and I would cross paths several times, but I avoided him because we had such a hard time communicating.”

Despite the age differences, the men on the ward accepted Sharbaugh as one of their own, someone who shared their challenges and fun. Sharbaugh recalls, “One of the hardest things about the nursing home was waiting—waiting your turn to sign off the floor, waiting for the elevator, waiting to be helped out of bed. And you lose your dignity. The first time I was taken to the bathroom, I was standing there naked in front of someone I met an hour earlier. For people who live there, that happens three or four times a day.”

A few days into his stay, Sharbaugh realized that his fears of loneliness and boredom had been worn away by the daily round of meals, therapy, TV and bingo.

More than food

Initially considered a flight risk and thus required to eat in the dorm, Sharbaugh after several days could join his roommates for meals in the 1st floor dining room. Mealtime ranked as a social highlight.

Sharbaugh kept his tablemates abreast of news about his family in Connecticut, and they filled him in about their pasts. The foursome at the table included Mr. E. Sharbaugh saw that though Mr. E seldom tried to talk, he seemed good natured and a sharp observer. Still, recalling their initial encounter, Sharbaugh remained reluctant to initiate conversation.

“Those of us who ate together also watched the World Cup soccer finals on TV,” Sharbaugh says. “We had a lot of fun cheering for the teams and players. I know I was very lively, and I think it was exciting for all of us.”

Generous gesture

One day, Mr. E failed to show for lunch. “Now that made me nervous,” Sharbaugh recalls. “One time someone had been taken from the ward and never came back.” After lunch, Sharbaugh went to the TV room and about mid-afternoon wheeled back to his ward.

“I was rolling toward my bed and saw a Wendy’s fast food bag on my tray table,” Sharbaugh says. “I thought, ‘Okay, someone left his garbage here.’ I looked inside the bag and saw it was full of french fries. Right then, I saw someone rolling toward me and it was Mr. E. I listened closely and heard him say, ‘I saved these for you.’ His son had been there and taken him out to lunch. Here was someone I tried to avoid a few days earlier because I couldn’t understand him. Yet he overlooked our earlier inability to talk, and that meant a lot to me.”

Mr. E’s generous gesture made Sharbaugh try harder to communicate with him. “I’d have to lean in toward him and listen very closely,” Sharbaugh says. “If I didn’t understand him the first time, I’d ask him to repeat himself and try harder to listen, and that always worked.”

The two often sat together on the home’s front porch “catching sun,” Sharbaugh says. He learned that Mr. E had made his living as a landlord in east Boston, still owned several apartment buildings there, and had two sons. And Mr. E took a keen interest in Sharbaugh’s background and career plans.

“One morning Mr. E rolled over to me holding his broken electric razor,” Sharbaugh recalls. “The head had fallen off, and he handed it all to me. When we didn’t say anything as I fixed it, I knew we had become good friends.”

During his return trip to Biddeford, Sharbaugh thought back to the events and conversations of the previous 12 days. But his takeaway from the experience, the lesson in responsibility he now regards as key to his future as a physician, didn’t occur to him until weeks later.

“I was reviewing my journal notes from my stay at Soldiers’ Home and began to enter my final thoughts about the project,” he says. “I starting thinking about Mr. E and how there was so much more to him than the stroke patient I saw on Days One, Two and Three.

“A lot of times health care professionals view patients as merely a diagnosis. But there’s a whole life behind that condition. Providing good patient care involves a lot more than knowing the correct medicine to provide. It means making the effort to connect with every patient. If you have a stroke patient and all you see is the diagnosis, well, you might be missing the fact that this guy used to be a runner. And now, not being able to walk is about the worst thing that can happen to him. As that person’s physician, you need to be aware of that.”

3 comments

  1. While I am very familiar with this extraordinary program created by Dr. Gugliucci, I must congratulate Mr. McCann for his very insightful and well written article.

  2. We need more programs like this! My father spent the last five years of his life in a “good” private nursing home. He suffered from dementia and severe osteoporosis of the spine. He lost everything–dignity and freedom–when he landed the memory-impairment ward of the home.

    He lived in another state, and my infrequent visits meant the world to him. There were always various health and cognitive issues for him, and I was often alarmed by veiled “threats” that he would be moved to a psychiatric nursing home as a result of afew occasions when he “misbehaved.” I had visited such places. I was frightened. So I became cooperative more than proactive for my Dad. Staff has a lot of power…

    In one sense, he was fortunate to get a bed in this “home;” in another sense, it was five years of purgatory. I never encountered a doctor who seemed to care about his quality of life. Sometimes I would surprise the staff with a visit, and then I saw the neglect. Of course, the excuse what always the same: Dad would not cooperate, and he could be very bad-tempered. Yet, when staff knew I was coming, he was generally cleaned up,presentable and happy. In between, he was sometimes treated with affection, and sometimes physically abused. Offending staff was fired before I was even contacted, but still, the humiliation and suffering ocurred.

    Fortunately, as death approached, I was able to transfer him to a beautiful, free hospice. He arrived with a stage-three bedsore that was discovered by the hospice nurses. Until he passed, I stayed with him and we were treated as if we mattered.

    God willing, I will retire in 2 years and I will volunteer in nursing homes and hospices. In the meantime, I will thank God for Dr Gugliucci, the wonderful students in this program, and pray that they multiply like rabbits!

    I have no easy answers, but I do know this: geriatric care, especially in nursing homes, is a vocation, not a job.

  3. Very well written, wonderful experience, great program for students ( and practicing physicians as well, if there was an opportunity). As our population ages, we need to be more aggresive in our awareness of the needs of our seniors. I am one of them, at 61, fully engaged in my ostepathic medical practice in Upstate New York. Luckily, right now I am in very good health and humor. Who knows if and when that could all change so swiftly.
    Will there be compassionate care for me if and when I need a nursing home or continuous home care?

Leave a comment Please see our comment policy