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Physician Trainee Spends 10 Days in Veterans Home, Part 2 - Depression Sets In
07/22/2013   Reported By: Patty B. Wight

It was nearly a week ago that 25-year-old Anthony Pastore checked himself into a nursing home as part of his medical training at the University of New England. Pastore will spend a total of 10 days at the Maine Veterans Home in Scarborough, where he is treated by staff as if he were an 85-year-old resident. Patty Wight brings us the second in a three-part series about Pastore's experience. In Part Two: After the initial adjustment, depression sets in.

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Anthony Pastore (left), and Norwood Grant

Anthony Pastore visits with nursing home resident Norwood Grant.

Follow Anthony Pastore as he rolls his wheelchair through the halls of the Maine Vets Home, and you feel like you're with the town mayor. Pastore seems to know everyone here.

Anthony Pastore: "How's it going Everett?"

Phil: "How are you sir?"

Anthony Pastore: "Oh, very good Phil, how are you?

Phil: "Fine."

Anthony Pastore: "Excellent. How's it going Bob? Wearing the orange again - I like it!"

"At first I was really nervous about meeting people - expecially older people - who might not be able to hear as well," Pastore says. "I have a good friend who is pretty close to non-verbal. He mumbles a lot. A lot of the time I can't understand him, but you start to really start pick up emotions and people's facial expressions and their eyes."

At this moment, it's day four of Pastore's stay, and he's at a high point. He's made friends, he enjoys the food - Pastore's gained five pounds. But he's also experienced plenty of lows. The first was when his professor - Dr. Marilyn Gugliucci - said 'goodbye' on his first day. Pastore keeps track of his observations in a daily journal.

"This excerpt is from my first day here," he says, "the admission day on July 16: 'When Dr. G left, after four hours, I felt nervous, scared, abandoned, unprepared and alone. Multiply these emotions by 500, and that's probably what some of my buddies here felt like when they were admitted indefinitely.'"

Pastore's days begin humbly. When he wakes up, he presses a call button so someone can help him get dressed and ready for the day. Pastore is treated as if he's had a stroke on his dominant side and is recovering from pneumonia. He says the staff here are exceedingly nice, but small differences in their approach have a huge impact on his state of mind.

"One day I was handed the deoderant stick, and I was actually pretty proud of myself that I could reach around, kinda like a chimp, and with one arm apply to both armpits."

The next day, a different staffer swiped Pastore's underarms herself.

"You know, I'm sure that a lot of residents need it or prefer it. But in my case it was a little - maybe frustrating, or a little demoralizing that it was thought that I couldn't do something, or wouldn't want to."

Pastore's professor, Dr. Marilyn Gugliucci, says this can lead to something called "learned helplessness."

"You start doing for people to the point where they either no longer can, or no longer will, do that activity," she says. "And so that is something that is very prevalent in nursing homes, and often times adult children do that with their parents that are perfectly fine. And it's just a form of infantilizing, or a compassionate ageism. They want to help, but it really isn't helpful."

Before he came to the nursing home, Pastore led an active lifestyle, so to stave off idleness, he relies on the countless activities offered, from cards to bingo to concerts.

"I like moving around. I like going to some different wings," he says. "I try to go to all the activities, even if some of them are a little - a little, maybe, mundane. But it's definitely better than not being there."

But going to activities isn't enough to stop the depression that sinks in just a day later. Pastore says he remembers the moment he hit rock bottom. He had parked his wheelchair in front of a giant bird cage in one of the nursing home hallways.

"There was one bird who I really kind of related to - he was kind of sitting by himself, not really interacting with the other birds, on his own branch," he says. "I kind of felt like he was giving up a little, or he was succumbing to his environment, and I was as well."

Pastore says he stopped going to activities and trying to engage others in conversation.

"I kind of wanted to exercise what little control I had, because I'm kind of losing control in a lot of aspects, whether it's what I having for lunch, or what time I get dressed, or what kind of activities I'm allowed to do. And I think I wanted kind of to remove myself just because I could, and exercise a little control."

A visit from his sister pulled Pastore out of his slump. But he still hasn't embraced activities like he used to. On day seven, he declines a golf outing he was excited about just a few days before.

Staffer: "You coming with us today?"

Anthony Pastore: "I don't think so."

Staffer: "No?"

It's shower day, Pastore says. It only comes once a week, so this will be Pastore's first. He wants to savor every minute, even though he will need assistance. These physical challenges lead to the mental ones, Pastore says. "As tough as it was for this weekend, I can't imagine what that would be like for an actual permanent situation."

Marilyn Gugliucci says Pastore's experience is a condensed version of what happens to residents. She says it typically takes them three to four months to fully adapt. The hope is that over the next few days, Pastore will as well, to both inform - and transform - him as a future physician.

We will have the third and final installment of Anthony Pastore's experience in a nursing home later this week.

Photo:  Patty Wight

Related Stories
Physician Trainee Spends 10 Days in Veterans Home - Part 1
Nursing Home 'Patient' Checks Out, Part 3

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