I will say, of the attending physicians I’ve met, none seem to genuinely enjoy what they do as much as some of the pediatric cardiologists I’ve worked with. Having had a chance to pretty much work with a new one every day, they also seem pretty happy and also it has been interesting seeing all the different practice styles. Some of them definitely do things that I could see myself doing in patient encounters. Others do things that work for them but personally would emulate (not necessarily because I think it’s bad, it’s just not me). One of the attendings did mention that is could be possible to still do some primary care/ general pediatrics as a specialists if you really pushed it, so that may be something I look more into further down the line.
There been a decent need for Spanish ability here, perhaps more than I expected, which has been good (maybe 30% depending on the day, compared to the 40-50% when I was on Med-Peds). My goal continues to be becoming more fluent.
Today I was assigned to the cardiac stress testing lab. You know those scenes of athletes hooked up to a bunch of wires and tubes riding a stationary bike or running on a treadmill while people in lab coats with clipboards watch from the side? Yea that was me today. One of the clipboard people. It was actually pretty cool. The patients who came in either had a known preexisting hard condition and we wanted to make sure their heart could keep up with some exercise or there was some kind of concern for an exercise-induced heart problem. Unfortunately we didn’t see anything super abnormal, but also fortunately for the kids’ sakes. Seeing all that exercise made me thinking how I really need to get back into doing more exercise, it is just pretty hard to find the time these days because of my commute. I know it sounds like an excuse, but if I could find time to go climbing during the week without compromising my other responsibilities I definitely would.
It was a pretty good day in pediatric cardiology. A couple surprisingly interesting cases. Surprising because they were supposed to be basic consults with normal workups and no cardiac relevance, but ended up being potentially cardiac-relevant. There was a good amount of talk about wearables today as well. One patient caught some interesting heart stuff (possible SVT) on his Garmin heart monitor belt/ strap thing. One patient’s dad developed an Apple Watch app that tracks and plots his daughters heart rates on a graph. All the patients and families were so lovely and now that I think about it I haven’t really encountered a “difficult” family during this whole rotation so far. While there are some stuff I’m still missing here in cardiology, there are also certain things I here that I like a lot that I definitely wouldn’t get in primary care.
It’s crazy meeting some of these kids after learning about their heart conditions and how differently their hearts developed and the procedures that were performed in order to give them a physiologically functional heart. And then to see them living, breathing, talking, laughing, walking in front of me is truly truly wild. We had some real characters today, and even for the ones who make a lot of trouble, it can be hard to get impatient with them because their troublemaking means they’re healthy, and that just makes me happy.
I’m definitely getting used to the process and routine of clinical cardiology. Check the chief complaint/ reason for visit (not different from primary care), review the echo and the ECG that they likely came in today for, review any other relevant details, go see the patient, get the history, tell them the plan. For a lot of these clinic patients, they are relatively stable which makes sense since we are seeing them in a outpatient setting, but that usually means we don’t have much for them by way of follow-up if everything looks good. The shortest follow-up is usually with the new patients (if there is any follow-up at all [there are a lot of referrals that end up not being cardiac related]) for a couple weeks just to go over the results of a simple work-up. A lot of the RTC (return-to-clinic) dates are set for a year or more. Still figuring out how I feel about this.
It’s been weird going from my last rotation to this one. In Med-Peds I was decently independent, able to see patients on my own, propose a plan, write notes, etc. Now I’m pretty much shadowing. It’s not like the encounters in cardiology are anything beyond my ability, they are actually pretty straightforward in terms of plans and history, I think it’s just difficult for the attendings to maybe trust a student when they are not used to having one. I think a big part of this rotation for me is taking initiative and asking for more responsibility if I want it and to essentially show what I can do, but also without being a burden to the attendings or anyone I’m working with (i.e. slowing them down).
Today I was working with the heart failure and transplant team. Heart transplant may be the most wild thing to think about of all the organ transplants. So much plumbing to deal with. I think also what makes it seem so crazy is the narrative around the heart. The heart is thought of as such an intimate part of ourselves. It in a sense has a life of its own both more figuratively and more literally. There isn’t as much fuss around a liver transplant or a kidney transplant even though they are arguably just as important for the patients who need them. I got to meet several kids today with transplanted hearts and seeing them alive and well and happy was quite amazing.
There are a few of niches even within cardiology which I thought was interesting. I do like the very structural and mechanical way of thinking that is involved with cardiology, but I also feel like I miss a lot of the more puzzle-solving way of thinking involved in internal medicine. I realize though whether or not I decide ultimate to pursue cardiology is a decision I won’t have to make for a long long time, so I probably shouldn’t stress much more about it a focus on the more immediate decisions that I’m going to have to make within the next several months.
Suspected arrhythmias was the theme of the day. We had no major structural defects or really any murmurs. A lot of stable, non-life-threatening or suspected-turned-out-negative hearts which is good of course, but also makes for a quieter day (literally). I did get to spend more time looking at ECGs and I spent a part of the morning with one of the echo techs which is always pretty cool to see them get done in real time. I was super impressed with how quickly she was able to get some really clear images and take measurements, of course likely due to her extensive experience doing these studies.
There has been a surprising amount of variety in what I’ve been seeing in clinic and add on top rotating through different services within cardiology, I can see this providing enough variety to keep things regularly fresh. I will say though is 100% the worst organized rotation I’ve been on.
Here are some of the things I’ve really enjoyed on my 2 days on this elective:
– Getting to look through the echocardiograms trying to spot the defects
– Trying to think through the physics of how these different diseases will progress
– Consistently positive physical exam findings
– Listening to murmurs and trying to figure out what is making the sound(s) (and what the sounds even are)
– Meeting these kids and their families and learning about their experience
– Trying to interpret ECGs
– No note writing for me, and the attendings’ and fellows’ notes seem minimal
Here are some of the things I’ve noticed don’t mesh as well with me:
– Physical exam and problems are limited to being relevant to cardiology, any other issue is deferred, at least in the clinical setting
– With the above, encounters feel abbreviated/ rushed
– The minimal note writing; I feel like I like being thorough and comprehensive when possible with my notes, but I’m sure this would likely be personal choice and one that may likely change as I progress in my career
I’ve been looking forward to starting this rotation because I think pediatric and congenital heart diseases are super interesting… and I like listening for murmurs. Today I got exactly what I was hoping for (mostly); truly amazing and awesome patients and their families, some really interesting cardiac pathology, plenty of echocardiograms, and lots and lots of murmurs. I wasn’t sure how my time during this rotation would be divided, but today was completely outpatient (despite being in the hospital) clinic work. To be honest I expected it to be 100% inpatient, but I’m glad its going to be a bit of everything. Having this rotation right after a very primary care heavy month I have several observations, but I think I’ll save that for after I have a few more specialty clinic days under my belt.
Also I think this commute just may kill me.