Saturday, September 4, 2010

My Internal Medicine Rotation

I wanted to make sure that I wrote this out before my vacation ends, and my surgery rotation starts, and I forget it all. So, here goes!

In July, I started my first rotation as a 3rd year medical student. I began a 2 month rotation on "Internal Medicine", which for all you non-medical peeps, is basically adult medicine (versus surgery). There are many subspecialties within internal medicine, including cardiology, nephrology, oncology, gastroenterology, and so on. During the month of July, I was on cardiology.

I could not have asked for a better first team. The resident of the team was amazing, in that he was very approachable and helpful, always answered questions, gave the students enough responsibility but not too much. It was so awesome to be able to see real patients! For the first two weeks, I was on the "Acute Coronary Service", which is basically where all the patients with heart attacks go. It was very straightforward (cuz basically everyone had the same problem!) and thus a great environment to get my feet wet. I learned SO MUCH from that rotation.

I definitely learned that the nurses know EVERYTHING. And even if one nurse doesn't know, they have a secret phone system to all the other nurses and they'll just call the nurse who DOES know, and find out for you. DO NOT MAKE THE NURSES MAD.

At the end of my first week, I learned a lot of lessons from a 39 year old woman who had a heart attack in bed with her husband. He immediately started CPR, but it was a massive heart attack, they flew her to our hospital and we opened up her arteries right away, but she coded twice. I was really touched by all her family members that showed up, crying, saying "She's a fighter", praying on their knees in the conference room we set up for them. That night, I went home and I made sure to spend time with my family, because that's what's so important: if I had a heart attack, would my family care that much? Anyway, I was sure she was dead, but just over a week later she walked out of the hospital! I talked with them as they were leaving, and the husband remembered that I had put my hand on his shoulder in the elevator on Day 1, she herself said she was quitting smoking, and they were all so incredibly grateful for everyone's help.

Later in the month, I had a guy who was pretty sick. His arteries were so clogged that he needed open heart surgery, but his blood counts were pretty low, and we kept working him up to assess his lung function, the source of his bleeding, etc. Every time I went to check in on him, though, he was smiling, and said he was doing "Alright!"

I had a patient who kept passing out, and she'd been told before what the cause of it all was, but it had clearly not been explained to her very well, because she kept coming to the ER for it. I took the time to look up patient information sheets on it for her, and explained the process of how it happens, and I (like to) think that it actually sank in.

I noticed a patient one morning, as I was getting vitals on my patients (at 6am), who was sitting in her wheelchair in her doorway, seeming to glare at the nurses' station. I tried to smile at her, but she just glared back at me. Later, I saw a handwritten note taped on her door, "I can't shut my door, so PLEASE PLEASE keep it down so I can sleep!" I inquired, and apparently she was on a medication that required her door to be kept open, in case her IV alarm went off, and that also made it so she had to be right by the nurses' station, so they could hear if it went off. I heard so many times during my rotations, "This isn't a hotel, and the patient's will just have to learn to live with all the noise." Well, yes, some of that is true, but we (doctors, nurses, other staff) can also learn to try to provide an environment that is conducive to healing.

I had a very negative experience during my 2 week oncology rotation, in the beginning of August. It was a big change from cardiology: the patients were a LOT sicker, and we had more patients per doctor, so everyone was busier. The new resident in charge ran things differently than in cardiology, and I found that I had a LOT more "busy work" to do, and a lot less time to spend with patients. To my shame, I acted very resentfully during this rotation, and didn't make the most of the situation. I did learn a lot of things,though (even though many of them were what NOT to do in the future!!)

We did have one patient that came in because his nursing home had not been treating him well (he had throat cancer and couldn't speak, eat or drink through his mouth). They had not been giving him enough liquids at his nursing home, and his electrolytes were all out of balance. Tragically, somehow it got mixed up that we did not actually order fluids for him for over 8 hours after admission...thankfully when we realized this, we were able to get it under control. But, TWO DAYS LATER, we discovered that no one had ever ordered FOOD for him, either! (He needed food to drip through a tube through his skin into his stomach). We got that under control as well, and he did end up stabilizing enough to be discharged. I faced an ethical dilemma here, though, because the doctors in the team said we didn't need to report that as an "incident". I wasn't so sure, and talked with some of the medical school leadership, who advised me to fill out an Event Report, myself. I felt kind of like I was tattling on my team, but I did end up filling out an event report, because it was absolutely unacceptable to have a patient on our service not eat for 3 days because of our negligence. If we can study this occurrences when they happen, we can hopefully learn how to prevent them from happening again.

The 2 weeks I spent on the infectious disease consult service was a lot of fun. Whenever someone in the hospital had a patient with a difficult infection, they would "consult" us, and we would go see them, and give our recommendations on antibiotic choice, duration, etc. So, every day I was assigned one or two of these consults, and I got to spend a few hours learning everything about their case, talking with them, doing a thorough physical exam, and then reporting back to the team. It was here that I really got to develop my exam skills, because I had the time to do so! I did get to see a lot of interesting patients, too. A lot of nasty, nasty infections!!

Well, this is already hugely long, so I'll cut it short here. I saw many patients and families who touched me, and I've kept a little journal about their stories, so I can always remember them. I think it's very important to learn not just the science, but also the art, the human side, of medicine.

(I also confirmed that I DON'T want to go into internal medicine...I had a lot of good experiences, but adults are terrible patients!)