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Since it’s been a few days since I’ve had to be in the hospital, a lot of new patients, but I had to just jump right back in. I got assigned my usual URI picture kind of patients. They seemed somewhat straightforward at first, but were a little more complicated when we started digging a little deeper. One of them had these mysterious hives and constellation of symptoms that weren’t super consistent with anything in particular, but were suggestive of a few different things, so it was hard to say whether what they were experiencing was just a reaction to viral illness or something a little more serious underlying.

Later that day I saw my first in-patient constipation case and I realized how little I know about management of serious constipation. The kid was really plugged up. This was the first time I really felt an abdomen that distended. Also, part of the discharge plan is to make the family watch a video called “The Poop In You.”

My last day of my last full week on in-patient. It’s gone by pretty fast. I’m partially relieved, but also a little sad because I really like my team and I honestly do like spending time in the hospital (when there are things to do). Today pretty much all the patients I was assigned were planned to be discharge later that afternoon including my osteomyelitis kid who was there for a while. It’s going to be whole new patient list when next time I come in. New folks to meet, hopefully some new pathology. We had a couple medical mysteries come in the past couple days and it’s been really interesting seeing the residents and attendings trying to piece together diagnoses for them, it’s very House-esque.

It’s really crazy to think how much experience my senior residents and especially my attending have. Sometimes when we are standing around in the hallway and they are having conversations about what antibiotics to use for what bacteria and the mechanisms of why they should use this one and not that one, but what about this one, is just kinda wild when I take a step back. It’s all pretty standard stuff that you learn in med school (not that I am anywhere close to mastering it), but when I see them actually applying it to feed real people real pills or shoot a medication into someone’s vein, I am just in awe.

At the same time, I see how overworked they all are, and despite seeing deep down how lovely the medical team I’m work with is, I can also see the cracks in the armor. It’s sad because most of the time I see how much they love their work, but the burnout is pretty apparent sometimes. I like to think I’m a pretty resilient person, but I’m sure there have been people stronger than me who have been worked to the ends of their wits. I guess the only thing I can do is be cognizant of it and, when possible, incorporate wellness practices into my daily routines.

Today was a long day, and I did my first solo in-patient admission H&P. My seniors historically have been really nice and done them themselves or done them with me (I think also because they want to make sure it gets done properly the first time). H&P are the one thing though that I feel pretty confident in, is the assessment and plan parts that I need to develop more. Luckily this was another bronchiolitis vs reactive airway disease (baby asthma) patient which I’m pretty comfortable with doing assessments and plans at this point, so it felt nice to kind of be able to run the whole thing for this patient (as much as I am legally allowed to).

Definitely feeling more confident and also like an actual part useful of the team these days. Hope that only increases as I start my last week there.

It was a longer day today, but there was some good learning that happened. Something tells me the attending hasn’t been impressed with me thus far. Maybe not disappointed, but not impressed, and she communicated that with the residents. I only say that because today one of the residents worked especially close with me on my presentations for rounds today. It was undeniably super helpful, and I think I did an ok job. Sometimes when I get praise, I can’t tell if it’s genuine for if people are just trying to be nice. Regardless, like I said yesterday, being in the hospital motivates me to study more, but also it just takes so much out of me that it’s hard to come afterwards and study. I think I need to avoid coming home right after work and just try to get work done outside of the house.

Back to the weekdays and rounds did normalize a little bit, but the vibe was still different. Today I got pimped by the attending on what a “left shift” was, which I surprisingly answered correctly, as well as the follow up question of what the differential looks like in a true left shift (it shouldn’t have been a hard question, I just get super nervous and freeze whenever they look directly into the bowels of my soul as ask if I know the answer). So that felt good. There was definitely a lot of learning today, as there was yesterday which I appreciated. More and more I’m getting comfortable apply things I learned in the first two years to actual real-world problems which is satisfying. Getting put on the spot to present my assessment and plan for my patients is nerve-racking right now, but it’s also super helpful, and if it’s even halfway decent the team does a good job at supporting the things I said that were “correct” and then addending to it in a way that doesn’t make me feel too dumb. Definitely it’s motivating me to learn more.

Today was my first weekend at the hospital and my first day with the new (t0 me) attending. It was a very different vibe. Not sure if it was mostly because it was a weekend shift or because of the attending herself, but definitely feels like it was a mix. She was a little younger and had a more comraderous(?) relationship with the residents. There was talk about personal lives, food, debaucherous activity, but at the same time she was very much into teaching and honestly pimped me more than the other attending leading to me embarrassing myself on several occasions.

She bought us lunch which was super kind of her. It was like these Texan breakfast tacos. Very good. I never know what to do in situations like that though. Like clearly, she plans on paying for the meal, but I don’t want to be presumptive. But is it insulting to asking if I can pay someone back or suggest that she may want compensation? I don’t want to take her generosity for granted (it was never mentioned upfront), but also, I don’t want to be this lowly medical student putting myself on an “equal playing field” with my attending by offering to pay. I’m definitely probably overthinking it, but you all know that’s just the way I am.

We’ll see how things go tomorrow during the weekday, though it sounds like she want to kinda keep it similar to how we did it today throughout the week. The residents seem onboard with it.

I feel like I get in trouble a lot for being “introverted”/ an overthinker/ very much in my own head. When I’m with people sometimes I can have whole conversations with myself without saying a word only to realize I’ve just been staring at someone or off into space for an uncomfortable amount of time. I don’t really feel like it’s anything I need to or want to change except maybe for the sake of people around me, so it’s just something I need to be more aware of.

I had to say goodbye to my first patient who I was working with from admission. One of the bronchi-boys. He still had a little squeak in his right lung, but nothing that was super concerning. If I decide to do hospital work this is probably going to be one of the hardest things for me; coming to terms with the fact that I’m probably never going to see most of my patients again once they leave the hospital. Having those long-term physician-patient relationships is a big reason I went into medicine. When I was little, I remember when patients would come up to my dad in the grocery store or in Costco and just be so happy to see him. Those memories are part of why I decided to consider going into medicine after actively avoiding it through most of my college career.

In-patient is rewarding because you play an active role in helping patients get better and you have real-time evidence that what you are doing is (hopefully) effective. In primary care, there’s a lot of trust, a lot of making plans, a lot of follow-up. That’s part of the difficulty and challenge of it, and also what I kinda like about it. I can see how it can be frustrating, but helping patients figure out lifestyles and plans that work for them and give them more control and autonomy over their lives is something I feel like I would find rewarding, and I think I could be kinda good at it.

Some of the tired is starting to creep in, but also ’cause I’m not heading to bed in time. I’m still enjoying my time at the hospital though. I enjoy having a case to manage and then having to figure out what I’m going to do. Of course it’s not really up to me, if I decide to do the wrong thing I get immediately overrided by my resident who can get overrided by the attending, but that makes it feel like a safe place to make mistakes. It’s also been nice going to the conferences and sometimes knowing the answer to questions they ask, even if I don’t say it outloud.

I think I’m going to get my first non-bronchiolitis patient so I’m excited to be working on something different. The hospital has certain protocols for different conditions. I looked up the protocol for osteomyelitis and it looks relatively straight forward, but it feels good to be able to suggest things and be told that they agree, even if I don’t 100% have a good reason other than “the flow chart told me to.”