Alicia Arbaje, 35

Geriatrician, Johns Hopkins Bayview Alicia Arbaje isn't afraid to talk about death -- and to use that word, not the sweeter euphemisms some prefer. People die. Making them and their families comfortable with it is Arbaje's life's work. As she was growing up the daughter of first-generation immigrants in Osawatomie, Kan., life centered on Arbaje's unwell grandmother, who lived with the family. When Arbaje went to college, she drove home every weekend to help care for her. She'll never forget her grandmother lying in a hospital near the end of her life, on a breathing machine, and a doctor coming to the family and saying, "Next time do you want to hook her up?" "We really didn't understand the choice," Arbaje says. "That's now a decision I help families make all the time." In medical school, even as her colleagues balked at treating older patients, Arbaje was realizing that caring for the elderly, with their often complex, multi-faceted health problems that could weigh on entire families, was precisely where she wanted to be. "I felt like we had a band-aid approach," she explains. "You have an 80-year-old in a nursing home, not eating, weak, with pneumonia. She goes into the hospital, is treated for pneumonia and is sent back, still not eating, still weak. The hospital didn't address the real problems. It just dealt with the one thing that pushed the patient over the edge. What about the family? What about the nursing home? What about the 20 different medications she's on? "Is that a reasonable way for an older person to be living? I didn't feel like we were dealing with the big picture┬ů. Maybe they would be back in another week, we never found out what actually made difference for that person. Arbaje spends part of her time caring for patients, but most of it researching ways to improve the health-care system for the elderly. When she isn't working, Arbaje, who's single and lives in Baltimore, goes salsa dancing and is training for the Baltimore marathon relay. "People ask me why is a young person interested in an older person?" she says. "We live in a youth-oriented society, but older people are really integral to families, and there's going to be more and more of them."
Doug Kapustin, Special to The Baltimore Sun
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