Category: Medical

Today I got to pick-up some patients today. It’s always hard to try present and round on a patient who is new to me. Overall it just had different vibes to my last rotation. Family medicine and internal medicine definitely have different energies, but maybe it’s more the hospital itself vs the residency culture. Still having a good time for what it is, but also I still don’t really have any actual responsibility. I can’t imagine when the time comes where I actually have to make real decisions for patients in a way that impacts their health. The thought is also motivating for me to be the best I can for their sake.

This is going to be my first time working in the Kaiser system. I’m curious how it’s going to be after spending so much time in county systems. Today was pretty low key because it was orientation day, so they didn’t even have us follow any patients. It’s also the first week on wards for the interns on our team so that will also make thing interesting. I came and joined them in the middle of rounds, the presentations were pretty formal which I feel like hasn’t been the case in my recent rotations, but maybe that was just my perception. There were some interesting patients on the list who I was hoping to follow if they are still there tomorrow.

The last day of a rotation is always the worst; having to say goodbye to the people who you’ve come to know over the past few weeks or so. Fittingly all the patients I was following from yesterday were being set up for discharge today and I was able to do my part in making it happen. We had some good discussion on pragmatic ethics and also in celebrating the good in patient for whom we can’t give a neat answer for their symptoms.

I still have.a lot of thinking to do, if anything doing this rotation made my decision harder, not easier, but I’m not sure what I expected. It would have been easy if I hated the program, but (1) I have never hated any rotation so why would I start now and (2) I loved the program. I did get a chance to talk with a doctor who made some salient points to help balance out my thinking so I guess I’m just going to need to do some more soul searching.

Big shout out to all the residents who made my experience so awesome and to all the faculty who put up with me.

The more I think about it, the more I can imagine myself at a program like this. There is so much opportunity to really do everything. There’s no competing with residents from other specialties to be involved in various activities whether it be trauma, surgery, ICU, etc. On the other hand, this program is in a unique area. If I want my practice to reflect this full spectrum training, I may end up needing to either stay or go somewhere more rural. Which may not necessarily be a bad thing, it’s just something I will need to consider for myself.

What I do know, is that if I did train here I would be more prepared than at any other program to just be dropped in a random area and be able to practice medicine (if that sentence makes sense). And this idea of being prepared for anything is something that has always been a part of my philosophy in life.

But yea the theme of the day was really imagining a future in which I was a resident here, and surprising to myself I kinda liked what I saw.

Today was long-call. I was actually out sick yesterday, feeling a lot better today. I had not patients who I was previously following on the list, and the list was short as it was (only 4 patients), so I just waited for new admissions given were were on call.

I first got a alcohol withdrawal patient who was agitated and pulling out his IV with his teeth, then a code stroke who was clinically completely normal by the time of exam, and then a cellulitis vs DVT complicated by psychiatric issues. Overall they were pretty straight forward, but good learning and review cases.

It ended up being an extra long day though because right as our shift was ending we had to consecutive trauma calls that we had to go down to (that’s how it works at this hospital). For the second one I was at head of bed. My job was basically to make sure patient was protecting his airway and to stabilize his neck. I also had to perform the physical exam on his head and get some history from him. The whole process is pretty chaotic cause their are like 5 other people all doing their own things on him. With these relatively minor traumas I kinda feel bad because the patient is fully alert and aware that they are kinda just being tossed around (safely) and man-handled and getting their clothes cut off with scissors.

Then after the trauma there was a code rapid response on one of our patients, so we had to run up and make sure that was all ok. Turned out to be nothing too serious, but in a high risk patient so important to rule-out. Then finally almost an hour after we were supposed to sign-out to the night team, we were able to sign-out. It was a long day, but exciting, especially near the end, and definitely got some good experience in.

Overall, it was a pretty smooth day and a new attending. Today we talked a bit about surrogate decision making. This was in regard to our Creutzfeldt-Jakob patient. The new attending told us about the “empty chair” technique; inviting a potential surrogate decision maker to imagine the person as they once were sitting in a chair at the table and then to further imagine what they would want if they could see themselves as they are in the present. This was a kinda moving exercise for me just imagining myself in the shoes of the family of this patient. The idea of putting aside our own selfish wishes and desires to deeply empathize with the memory of a loved one is heart-breaking.

As far as the rest of the day, some of my patients who I thought were definitely going home over the weekend were still on the list today. It’s interesting how quickly things can change in medicine in a short amount of time. Or in some cases it’s a slight difference in assessment by different doctors.

Regardless, I picked up my old patient and picked up 2 new ones and they were all pretty much on the path home, or at least I thought so. In a couple cases, my senior thought they should stay overnight and so I went along with that plan, but when I presented to the attending that they stay overnight, he suggested that they could probably go home. I felt a bit vindicated in that, but also I still have a long way to go in terms of clinical judgement because there have been plenty of times where I have been wrong.

We have some pretty complex patient on our list. It’s interesting though that we actually don’t have that many cirrhotics, alcohol, or heart failure patients unlike at County. We have a lupus flare patient, a likely Creutzfeldt-Jakob patient, new multiple sclerosis diagnosis, and just some other curious cases. It’s been fun to think about these cases and it’s been good learning. It’s kinda hard to believe it’s only day 2.

I was a bit concerned transitioning back to the inpatient side. I thought I would not have my chops or that I would get a bit under-stimulated after the constant fluctuation I had gotten used to in the ED. While I wouldn’t say I necessarily shined today in terms of performance, I definitely have come a long way from when I was on Internal Medicine almost a year ago, and I enjoyed working/ thinking though long problem lists and wide differentials. I do think that I maybe prefer walking rounds compared to table rounds. We have a few interesting patients and I feel like I’m missing out when I don’t get to at least briefly see or examine the other patients. But I get it, it takes a bit more time and you can’t simultaneously work as much while table rounding. As I continue to become more competent and further develop my clinical reasoning this all just becomes more fun (the main barrier is still just the anxiety of presenting/ failing/ saying something dumb to an attending who doesn’t explore why you think what you think).

Today was my last day in the ED. I got to learn to use a slit lamp to look at people’s eyes and I had a return patient for some good “continuity of care.” I also had a bad leg infection from a guy who had his wound surgically debrided a few weeks ago and then left AMA without completing his course of antibiotics and just happened to come back because he got picked up by the police for a stolen bike. Then there was a lady that was screaming at everyone while getting medically cleared for jailed because she was destroying the flower arrangements at the grocery store. So overall it was a very ED day.

I’m going to miss being here because of the variety of stuff I got to see and the different stuff I got to do. It was definitely a good learning experience for me as a student. A lot of medical school condensed into a short amount of time. Hope this isn’t my last time doing a lot of this stuff.

I was in clinic this morning. Putting primary care clinic right next to emergency medicine, I can see why people like EM. There more variety, not so much routine health maintenance, less chart review, less time writing notes, etc. That said I think my experience is slightly skewed because every time I’m going into these clinics I’m talking to these patients for the first time and don’t have a prior relationship with them. That doesn’t matter so much in EM. I do enjoy talking to patients, my concern is that I do too much conversation/ go overboard with details in both. I also feel like as a medical student I’ve felt more judged in some of my interactions with family medicine preceptors than by ED ones, in general. Of course there have been exception, and not that it’s necessarily a bad thing, just an observation. Today I had a patient with a genital rash and another who I had to do a digital rectal exam on. Tomorrow is my last day in the ED, sure going to miss it.