Category: Medical

I started off the day pretty confused. I was accepted into this rotation pretty late, as in 2 weeks before it started and actually wasn’t even officially accepted until the Friday before with the last correspondence of whether or not I would be allowed in the hospital being equivocal. Fortunately, it all worked out and I was able to get my badge and everything, but didn’t have any instructions on where to go after that. So I wondered around and found the resident work-up. Meekly badged in and explained my situation with my saddest puppy dog eyes. They said they would try to help me out. I got some info about who the attend on service was. Eventually I went to the GME office once it opened and someone there was able to contact the ID attending. Lucky for me he turned out to be one of nicest guys ever. Very helpful, good teacher, super patient. It was overall a good introduction into ID and back into hospital medicine after my hiatus studying for Step 2.

At the end of the day I met the attending who will be taking over tomorrow and he tells me to go ahead and see all the patients in the morning and the text him when I’m done so we can round. It feels like a pretty intense return, but also not surprising at this point in my training, but also at the same time I’m excited to see patients on my own again.

The reason I chose to do this rotation this early on was so I could get a sense of whether or not there is any possibility of me wanting to pursue this in the future, thus informing what residencies I would apply to. I can confidently say that after these 4 weeks I have not ruled pediatric cardiology out of the equation. Between this rotation and last, I think one more definitive things that has come out is that I definitely want to have some component of working with kids. If I had to choose between only working with kids and only working with adults, I would drop adults in a heartbeat. I feel like there’s a path from my current trajectory that is pretty well defined to a possible future in congenital heart disease, but as I’ve mentioned I still have a lot of training to go through before I need to make that decision.

All in all, I’m just super glad I got to have this opportunity and I’m excited to see where things go.

The fellows were apologizing to me today because they thought I would be discourage from going into pediatric cardiology because they felt like they were always complaining, which was not my impression at all. They definitely have not been the most unhappy trainees I’ve worked with and they honestly were all pretty nice for the most part. I could tell they were at times a bit burnt out, but they seemed genuinely interested in their work. Also as I mentioned before, most of the attendings also seemed to love their work.

That said I went to a Family Medicine celebration dinner tonight for the 4th years who matched into FM this year. It was a super cute event with a lot of recognition being given out to preceptors and students, and just the whole community vibe was very inviting; something I likely would not get if I matched into Med-Peds, at least from KSOM since there was only 1 Med-Peds matchee this year. I also realized a lot of the doctors I really admire and look up to were there at the dinner which I thought was interesting. But yea just something to think about.

Today I got to sit-in on an electrophysiology (EP) study. Besides me embarrassing myself by asking dumb anatomy question, it was a pretty cool experience. The whole process from the control room seemed like an old video game, or like they were operating a machine from the original Star Wars trilogy. A lot of beeps and geometric shapes and colors and lines, and everyone was saying things in essentially a completely different language. It was a bit overwhelming to be honest, because not only was I trying to process all the things there were to pay attention to in the control room, but then I also had to try to correlate it to what was actually going on with the patient in on the other side of the observation window. It was all pretty hard to follow the details, but I think I got a could birds-eye understanding of things. Despite my feeling of being lost, I enjoyed the challenge of trying to figure out what was happening, I can imagine it being even more exciting to actually know what was going on because they were constantly problem solving in real-time base on the physiologic feedback they were getting throughout the study. Pretty cool.

There are a lot of personalities among the fellows and attendings I’ve worked with. Some attendings just completely ignore me when I’m in the room, others are super friendly an get me involved, and anywhere in between. I find the content of the work all super stimulating. I enjoy the variety of diagnoses and cool toys at the disposal of the cardiologist. I am worried though that if do go down this path, that it is a long road. At least three additional years of training (and three additional years of working under minimum wage), and in this climate at least one additional to subspecialize. Even if I don’t want it to be, it’s definitely a consideration for future me.

I was back in clinic this morning which was a nice change of pace from some of the heaviness of last week. The juxtaposition of seeing some really sick kids and then seeing those that made it out the other side was nice to see. I also got to see a patient on my own for the first time, both in the morning in clinic and in the afternoon back on the inpatient side. It felt good to be back to actually talking to patients and to use a lot of the things I’ve been learning over these past 4 weeks which have gone be super quick.

You get kinda attached to some of these kids after working with them day after day, and I was only on the transplant service for 3 days, I can only imagine how it must be for the fellows and attendings. Then again, at this point they are probably used to patients coming and going and are used to developing these relationship and then detaching when they are ready to leave. Also, the fact that they will likely eventually see them again in clinic probably helps.

I also spent some time in the simulation lab today, which I haven’t done since I was volunteering at the back home. This time though I was participating, thankfully not as a doctor, but I did have to perform CPR on a mannequin. The whole thing was pretty stressful, and I was with 2 first year residents who have never been in a real code and were pretty far removed from being involved in similar situations. Overall it was good practice and I’m glad we got to simulate these situations in a controlled environment. I feel like students and residents would benefit from doing more activities like this where we get to simulate real situations and then get real-time feedback on our performance.

There are a lot of things about inpatient medicine that I like. We always talk about continuity and longitudinal care as being major aspects of primary care, but during a hospitalization you get a lot of face time with patients. You see them every day for as long as they are in the hospital, and for a lot of these kids it’s been a pretty decent amount of time. The attendings and fellows have pretty strong relationships with some of them. Of course it would be better if they could get well and go home, but it is good to see that there are people who care a lot and have a lot of love in their hearts working to get them out of the hospital.

It was true, the heart function (formerly heart failure)/ transplant service was quite a bit more intense. The first patient we rounded on today still had an open chest from his most recent surgery and a few of them were having their blood pumped via a machine pumping their blood externally from their body (Berlin-Heart) and one was on dialysis. All of this is understandable they most of them were listed for possible or future heart transplant, but it doesn’t make it anymore heartbreaking.

What was encouraging to me though was the spirit of a lot of these kids, some of whom couldn’t even talk (some for development/ age reasons, some because they were on a ventilator). They were so cute and happy and interactive. It’s easy to forget that these are normal kids because as an outsider they are going through so much. It’s easy to pity them and treat them as “sick kids,” instead of just as a regular kids, and while they do need specialized care, they also need all the things another kid at their age needs. They should get to feel normal, even if just for a little bit each day.

We also had a really good discussion during journal club this morning about women and underrepresented minorities in medicine which sparked a pretty lengthy and provocative discussion involving the fellows and faculty (even I was called upon for comment being mistaken for a resident).

If the age of the oldest attendings is an indicator of the long-term physical and emotional sustainability of a specialty, pediatric cardiology would probably win among the rotations I’ve gone through. Jokes aside, as I mentioned before most of the cardiologist seem pretty balanced and happy. That said it does seem like it can get pretty intense and plus there’s call.

Overall, today was pretty good. I got to present my first patient and I thought I did a pretty good job for it being my first new consult presentation on the cardiology service. As stressful as it was, it was kinda nice to be back to actually feel like I was doing something/ able to show what I can do. Tomorrow I switch over the the heart failure service, which I anticipate will be a tiny bit more taxing that the acute service I was on these past couple days, but we’ll see.