Internal Medicine: life lessons forged on the frontier of the Wards

Internal medicine. I wasn’t really sure what I was getting into with this new rotation. I was so sad to leave surgery because I loved it so much, so I was admittedly setting unrealistic expectations for my medicine rotation. (Oh, that’s another thing this clueless third year didn’t realize: it’s not “internal medicine.” The cool kids just call it “medicine” and you’re supposed to know what they mean.) Anyway, I started my ‘medicine’ rotation and was assigned a team. Orange team. If you know anything about my undergraduate experience, you know I hate all things orange- University of Oklahoma alums are trained to cringe at the sight of orange d/t (due to. medicine shorthand) Oklahoma State being bright halloween orange and University of Texas being burnt orange. So basically any shade I’m against.

So I started thinking it was a bad omen, that I was assigned orange team because it was bound to be horrible.

I walked into our little team room- that’s another thing, we are assigned teams made up of an Attending Physician, senior resident, 2 interns, 2 med students, and a pharmacist.

Breakdown:
*Attending Physician= GOD
*senior resident= in their 2nd or 3rd year of residency. Also godlike. They know everything it seems!
*interns= bright eyed and bushy tailed in their first year of residency. i.e. just graduated from med school in May. i.e. they are as clueless as me, but have way more at stake because they can prescribe medications and make orders
*med students= lost and confused but know just enough “boards relevant” stuff to be dangerous. Think they understand things. Often mistaken.
*pharmacist= drug lords. They know every cross reaction, side effect, dosage, and alternative to every drug and what conditions they work for. It’s a respectable and incredible amount of knowledge and expertise.

I am working at the Phoenix VA- Yes, THAT VA. As in the one making national headlines for being utterly horrible- only it isn’t. All of the ‘conflict’ is administrative- the docs are just doing their thang, not being bothered by the bad press. Which I love.

Being at the VA and on federal government property means a lot of things, but mainly that I can’t take any selfies or pics of anything on the property, and I can’t get on Facebook. Not too many restrictions.

So in the team room, we each have our own computer which is nice. The other med student and I get along surprisingly well- so much so that I believe we will stay friends after our short spat of time together is up! We are learning a lot from each other too! I’ve even been able to teach her some OMM! 🙂

The flow of the day is this: I get there at 6am. The other med student and I both have 2-3 patients each. I check my patients’ records for any lab results or updates from the night before, then I go see my patients. You’d think this was the fun part of medicine- and it is in so many ways! But it’s also 6 am. At the VA. These are old veterans who just want to sleep in. And I’m the first face nudging them every AM asking to listen to their heart, shine my penlight in their eyes, and interrogate them about their bowel movements (regular? loose? frequent? constipated?). It’s ridiculous. But luckily they are mostly polite and understanding that it is a teaching hospital so I have to poke and prod them to develop my physical exam skills.

So after I see my patients, I update the interns and senior resident and they check anything that I missed (even if I’m sure I did everything, there’s always some small detail I forget!). Then our Attending Physician/god comes in around 8am and we ‘present’ the patients to him. You basically sum up the entire history and physical (a good 15-20 minute interrogation of every detail of a person’s current and past medical conditions) in 2 minutes or less. It must be concise yet thorough, detailed but to the point. These presentations are the bread and butter of med school- if you can get good at presenting patients, you’ve learned a lot! So that’s what I’ve been working on polishing up. I think I’m on the right track because I passed what my Attending calls the “real test of presentation skills”: presenting in front of the patient. If you can do that and not have the patient correct you, you know you’ve made it! And apparently I have! Yippee!

Most of what I have learned can be detailed in one-liners. They’re better left to your own interpretation. Some are funny, some are tragic. Enjoy the list I’ve created below:
Vets love 2 things: their freedom. And their privacy.
If you’re nice, the prognosis is bad. (The mean ones have more of a fight in ’em).
Everyone steals your pens. Always carry crappy ones you don’t care about.
No one knows their antibiotics well… and that’s ok. (except the pharmacists!)
You just can’t make this stuff up.
There is not a single presentation that goes by where 5 pagers don’t go off.
GOMERs never die.
There is something called a Bed Czar. Look it up.
65 hour weeks are doable. Difficult, yes. But satisfying.
The patient is the one with the disease.
Everyone who smokes doesn’t inhale. Just ask them. It’s ok if you don’t inhale.
Meth addicts and HIV+ patients can surprise you. Not everyone is a stereotype.
Sometimes silence is best.
Sometimes they just don’t wake up.
Just because you know you can doesn’t mean you should.
CPR in an inpatient hospital setting only works 1/6 of the time.
Wording is everything- Do Not Resuscitate vs. Allow Natural Death.
Lastly, we are not here for our own health. We are providers. And that is a privilege.

I am so excited to learn more in my remaining short 2 weeks at the VA. It’s truly a wonderful experience. Don’t take one single minute with a patient for granted. In the words of my surgeon from last month, “See every patient. Listen to them. You can learn something from everyone, no matter the simplicity of the case.”

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One thought on “Internal Medicine: life lessons forged on the frontier of the Wards

  1. Stumbled upon your blog and enjoyed reading about your experience on the wards (and in radiology)…it brought back memories of being a student (I’m a senior medicine resident now). To keep you encouraged, I’ll just say that medicine does not get any less rewarding as you go further, and as long as you never lose the joy of taking care of people, you will become a fantastic physician. So good luck in your endeavors and on your rotations! 🙂 -phoebe

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