Internal Medicine – Day 16

I feel like I’m breaking out a bit more for the first time in a while. Not sure what it is. If it’s the long days. The lack of sleep (though I’m not sleeping thaaaat much less that usual). The 10+ hours a day in a mask. The internal medicine diet. The stress. Part of me thinks it might be as simple as this new sunscreen I’ve been using that is very oily, but I only put it on when I’m driving home. Maybe it’s a combination. I will say it’s nothing like it was before, but definitely surfaces bad memories (though my scars are already a constant reminder and source of insecurity).

I have an actual weekend coming up, so hopefully that will help clear things up. Or if nothing else help narrow down the etiology.

Definitely been thinking a lot about what I want my future in medicine to look like these past 3 weeks and I feel like I’m getting closer to an answer, but still probably not anywhere close to a definitive answer. Yesterday I ran into the clerkship director of my Ob/Gyn rotation while getting pho and he had a lot of interesting insight.

Internal Medicine – Day 15

Last few shifts have been pretty quiet. My patients have been pretty stable, but aren’t quite at the point where they can be discharged. Plus we haven’t really gotten many new ones. Of course though, close to the end of my day a new admit came in from the ED and I was overdue for a new one so I volunteered. Based on the sign-out we got it sound like a pretty straightforward case of angina secondary to coronary artery disease. After taking our own history, it sounded like things may be a little more serious than we thought, but perhaps only slightly and with marginally higher suspicion of something more insidious happening.

Over all, it sounds like a pretty “bread-and-butter” cases as I hear people say so so often, so I’m glad I’m able to take this one on from the very beginning.

Internal Medicine – Day 14

I finally got to see a paracentesis. It’s one of those procedures that makes you think of old crude, medieval medicine. There’s fluid in a place where it shouldn’t be. How are we going to treat it? We’re gonna suck that shit out with a big ass needle and drain it into a giant milk bottle. Simple, yet effective (of course this doesn’t address the underlying issue, but we’ll put that aside for now). As much as we like to think of medicine as a strict science, a lot of it is intuitive/ common sense, as long as you know the science.

How do you treat an infection likely cause by this organism? Put something in the body that kills via a mechanism specific to that organism.

At the end of the day, doctors are just people who are out here making decisions based on the evidence available to them, especially with inpatient medicine. In outpatient the script is flipped. Patient’s have more say if the direction of their care, which on one hand is a good thing and navigating that is an art of its own, I’m not sure which I prefer. Inpatient feels more like science which I think is really fun. Outpatient feels more like life coaching and habit-shaping, which I think is also fun in its own way, but not in a science way, but it also aligns better with my philosophically. aowegawehgawiaejgoaehgueah

TTITF
(1) People who are willing to be vulnerable, (2) stranger smiles, (3) made up phrases.

Internal Medicine – Day 13

It was the last day with one of the interns and with our senior resident, and the first day with a new attending. I really enjoyed the team we had. With it being his last day with us, our senior took us all aside for feedback. I never know what to make of these feedback session. I can never tell if they are saying nice things because they don’t want to hurt my feelings or because it’s easier to say someone did a good job than to actually work with them through some of their deficits. I mean I think I’ve done a decent job, but I also don’t think I’m among the best-of-the-best that have walked these pathogen-ridden halls. At the same time, I don’t mean to suggest that my preceptors care enough about me or care so little about “the future of medicine” as to compromise their integrity. Idk, I want someone to make me cry, or feel like crying. Not because they are being insensitive, but because they make me reckon with my own shortcomings. Third party verification let’s call it. Or maybe it is better this way. And I should just continue forward the best way I know how.

Internal Medicine – Day 12

It was a long day today. I feel like our weekend shifts are supposed to be shorter, but for some reason it was exceptionally long. I feel especially bad for the interns who really bore the brunt of the business and kept getting calls. We added like 5 new patients to our list today. Our cap, which we haven’t reached is 16 I think. Not sure how close we got to that today.

But even in the morning I could feel it. I turned off my alarm and closed my eyes for a little, woke up and it was already 5:30 AM and time to go.

When I got home I took a shower and took a 2 hour nap and then it was 8:00 PM.

Tomorrow is my day off 🙂

TTITF
Packed party food, quad-colored pens, cheap basketball shorts

Internal Medicine – Day 11

So yesterday I took on a patient who seemed to have pretty severe altered mental status and concern for dementia. We had difficulty communicating with her so it was hard to tell if she was actually impaired or it was just that she was mostly deaf + language barrier. We erred mostly on the side of dementia given her age.

The this morning I was able to have a somewhat coherent conversation with her in my broken Spanish. She asked for my name, and I told her. She was no smiling and very pleasant. I was hoping that this was an indication that she was more with it than we thought. I went back and report the news to my team and we went about our day.

Later on I found out that she had been asking for me by throughout the day. I went to visit her, and she seemed to remember who I was, though maybe was a bit confused about me role. But still that made me feel good.

I need it to because I feel like I’ve been really flubbing on my presentation and my clinical decision making. My assessment have been all over the place and my plans overridden. It’s part of the learning processes, but also chances are, based on how evaluations are structured, these mistakes will effect my grade, ultimately playing a role in whether I match or not. This is something I historically have not been taking as seriously as I should, and it’s hard for me to take it seriously based on my philosophy towards learning, which is maybe a lame excuse, but that’s not something that it so easily changed (I know because I used to be on the opposite end of the spectrum).

TTITF:
Happy memories, friends who are as uncool as I am, popcorn chicken

Internal Medicine – Day 10

Up to this point, there are certain cases that for me only lived in board exam practice questions and lectures. Elder abuse was one of them. When the admission came in we were told there was some concern for neglect, but I really didn’t anticipate the extent to which it turned out to be and the potentially malicious nature of what may be going on. When I was actually able to get a seemingly reliable account of what was going on, it was heartbreaking. It almost didn’t feel real as I was asking question to the witness and hearing their account.

People can be scary.

TTITF:
(1) My supportive IM team, (2) comfort food (Taco Bell specifically), (3) language interpreters

Internal Medicine – Day 9

Trying to figure out if I’m enjoying inpatient medicine because I’m working with people who are closer in age to me or if I actually enjoy it. Because of my schedule I’ve had to cut out a lot of things I used to do in my free time, video games and watching anime being big on that list. I actually don’t miss it at all. I mean I miss talking to my gaming friends who I only really am able to engage with on a regular bases through gaming, but I don’t crave playing which is assuring to me that my propensity towards these things was more a convenience behavior. And with the little free time I do I have, I really have to be more intentional about what I spend it on.

I feel like I’ve already learned and relearned so much on the 1.5 weeks I’ve been on this rotation. I’ve seen pretty good variety of things, while also getting a good amount of repeat pathologies to reinforce management of common presentations. I like the pace of the work. I don’t like that compared than outpatient, the vast majority of my time is spent in front of a computer. Inpatient medicine is definitely a different way of thinking, which I feel like I’ve been able to appreciate more with adult inpatient than kids, maybe. Or I just notice the difference more having spent so long in the outpatient, primary care setting. Not sure yet which I prefer.

TTITF:

(1) crushed/ crumbly ice (why are hospitals the only place you can reliably find good ice), (2) bandaids, (3) thin blankets that feel kinda cool when you put them on

Internal Medicine – Day 8

I will say that I very much enjoy some of the patient encounters on internal medicine. Compared to primary care or some of the other populations I’ve worked with so far, with in-patient medicine some of the patients are reckoning with their mortality in real-time which I find to be a fascinating and special experience. Being able to sit with people in their most vulnerable moments and having the opportunity to listen to their reflections in the face of acute illness is part of what brought me to medicine in the first place.

I some of the conversations I had with patients today were good examples of that, the contents of which I would like to keep suspended in the time at which they occurred. And even if I don’t remember what those conversations were far enough into the future I’d like to think they played a role somehow in my future development.

Another thought I had is that almost none of these experiences are taken to account in our evaluations. Most of our encounters with patient go completely unseen by our residents and attendings. And all they see are our awkward presentations as we fumble over our words.

TTITF:
Melty cheese, clear expectations, exceptionally large bunches of kale

Family Medicine – Day 22

Another one down. These rotations have been going by so fast (at least it feels like that when they are over). As always, it was bittersweet having to say goodbye to this place that was my home for the past 22 days. The connections and relationships over these past few weeks were about to become a thing of the past. Was it a waste? I felt like I was emotionally invested here, but I really was just a blip in the day-to-day hustle-and-bustle of this clinic. Did I make an impact at all? Remember, if not it’s ok, you’re here to learn, not necessarily change lives or be remembered. Though I am sad I didn’t get to give a proper goodbye to all my attendings.

Overall thoughts on family medicine:

These rotations have kind of felt like a game show. We have all these doors in front of us, behind each is glimpse into in a life that we previously had little to no conception of. From what I saw of family medicine, this is definitely the work I envisioned myself doing when I decided I wanted to become a doctor. Sitting down with patients, listening to their stories, being invited to a have a peak into their lives, their worldview, their lived experiences, and leveraging that to provide the best, compassionate, patient-centered care that I can so they can go out and live their best lives, on their terms.

I saw a lot of that while I was here. But I also saw a lot of barriers to being able to do that properly or in the way I envisioned it. The paperwork. The bureaucracy. The scheduling. The missed communications (vs miscommunication). The redundancy. I can see how even with the best of intentions and the strongest of passions for this specialty (yes specialty, I will fight anyone who thinks otherwise), it can be easy to get lost and discouraged by all the red tape, but I also think thats where the art of medicine can really come in to play. We can’t necessarily change the circumstances in which we practice (at least usually not all at once), but we can change how we operate within those circumstances, just like in life. How we navigate our challenges and obstacles is what separates people for whom medicine is a profession vs an art. It’s a fine line I think, and easy to flip from one side to the other based on something as fickle as what side of the bed you woke up on that morning. We can’t expect to always have the good days. The days where we feel motivated. Where we feel the fire in our hearts. Where we feel our souls being fed. That’s just not the way life works. It may even be a bit much to expect more good than bad. 50/50 is acceptable (such is life in a world where rules are often made by people who are not personally invested in the communities they make the rules for), but every once in a while if you have those moments that remind what you’re here for; the stubborn old man who finally lets loose a hearty laugh. The little girl whose face lights up when you pull a dinosaur sticker out of her ear. The lady who came to you on the verge of losing everything, celebrating 2 years of sobriety. Those moments can make it all work it, and these are just some of the things I have seen in primary care and in having long-term relationship with patients and what draws me so strongly to this field.

That said, who’s to say I can’t have that if I choose to go down a different path. Maybe it will look a little different, but the feeling would be the same. Or maybe I can find a place where I can find work that sustains me, but also give me the financial stability and the time to do the work I think is important on my own terms. There’s still a lot to think about, and so much in medicine I still want/ need to see, but I’m thankful for this opportunity to experience life behind door number 1.

TTITF:
My gimpy, but resilient colocasia that I grew from a taro root from the grocery store instead of turning it into sinigang; unexpected moments of laughter; friends who are like family who still reach out even after long periods of not seeing or hearing from each other.