In the House of God

Greetings EDC,

We are approaching the Merriest time of the year and I am so happy it is finally here! The Xmas tree is up, the stockings are going to come together eventually, and this weekend we will hang Christmas lights outside! On a side note, I have also gained an appropriate amount of Christmas cheer in the form of a chubby gut and slightly thickened double chin. ‘Tis the season.

Today marks the completion of 4 weeks of Inpatient Internal Medicine and it was pretty awesome. I have many comments to make about this rotation as it was easily one of the best ones I’ve gone through. In an effort to hold your attention, I will employ Benjamin Franklin or Abraham Lincoln’s tactic of splitting this into Good and Less Good parts of my experience.

Good:

  • My Residents. I got really lucky and wound up with the nicest set of residents one can imagine. Seriously. They were all DOs, very supportive, eager to help me out, and I learned a lot from them. Some of them even encouraged me to apply to their residency program, and their confidence in my ability to even be taken seriously by residency programs was really heart-warming and reassuring.
  • Practicing putting together a solid H&P, doing patient presentations and learning how to defend my evaluation and treatment plan, and getting feedback (PIMPED). On my last week the Attending grilled me non-stop on everything. On my last day we sat down and he made me walk him through how to read EKGs, interp all the AV blocks vs. Afib, diagnose hemolytic anemia, diagnose AKI and nephrotic syndrome… the list goes on. I learned a lot.
  • Learning more about what Intern year looks like. Intern year is notorious for being the hardest year of a doctor’s career. In the House of God by Samuel Shem he portrays the Intern year as being marked by trauma, failures, and coming to the realization that learning the art of medicine is a messy affair. After seeing it in the flesh, I’m less fearful of what it holds, in fact I’m excited to be in their shoes one day and look forward to when I can be closer to a competent physician.
  • The Complex Pathology. Very few patients come into the hospital with less than 10 medications. Each of these medications needs to be accounted for and understanding their impact on disease patho-physiology & pharmacology is clearly essential to their clinical improvement. Understanding their chronic conditions and overlaying their acute conditions is a challenge and makes you appreciate the intricacies within each body system.
  • And, finally, My Patients. Inpatient med does not permit a ton of time to sit and hang with patients in the morning, but after Rounding is complete, the notes are in, and your stomach has finally been satisfied, you get a chance to revisit your patients and see how their day is going. Sometimes it was great to just walk down the hall and peak in on your favorite patient with Dementia and see if she remembered you that day. Other times it was less fun to see your chronically ill, not improving since Day 1, patient get wheeled down to X-ray once again looking less than pleased.
  • Almost failed to mention my favorite part of the day: watching the sunrise while eating a veggie breakfast burrito:

BEST TG view

Less good, but still okay:

  • Checks and Balances: CHARTING. It’s the worst, but…you get used to it? Every single thought that crosses your mind about the patient and how you’re going to manage them has to be documented. The EPIC people will find you and call you if there is a mistake found. Luckily, being a 3rd year med student, I put the title “MED STDT” on each of my notes and EPIC will never glance at me. I will not have this luxury forever.
  • Of course, the hours:
    • Sign Out starts at 6 am
    • Pre-Rounding goes from 6:45-9:30 am (typically)
    • Rounding starts at 9:30 am and goes until either 11:30 or noon – depending on your Attending
    • Didactics run from 11:30 am-12:30 pm
    • THEN LUNCH!!!!!!!! happy happy happy
    • From after lunch until 6 pm (or 4:30 if you’re lucky and none of your residents are on-call) you take admits, visit your patients, and grab more coffee.

There are 2 more weeks left for my Internal Med rotation and they will be spent in an Outpatient setting. I will keep you all posted.

Until then, Happy Holidays from me and Wesley (who lives). wes xmas cat

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