nANIMOv

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.

It feels good to be told you’re wanted. It’s validating to hear from the residents that I wasn’t the only one who thought I fit in. Whether or not it’s truly genuine is another story, but I like to believe it was. At this point I feel like I’ve beat to death talking about how much I felt like this kind of practice and these kinds of people align with my philosophies and values in medicine, so I just want to express my gratitude to everyone I worked with these past weeks. Even if I don’t end up back here, I’m glad to know there are doctors out there doing much of the work that I aspire to.

It’s kinda hard to believe I was spent 12ish hours a day 5 days a week for 4 weeks in this clinic (as of tomorrow), and was pretty much actively doing something the entire time. Surprisingly I don’t feel super burnt out and I think a big part of that is variety of things I get to see. Certainly there were days where I would be thankful for breaks and breathers throughout the day, but I’m a bit sad this rotation is coming to an end. I feel like I could very easily see myself as a resident here (should I be so lucky), but that’s all still a bit aways to see if MedPeds is even the path I want to go down. This isn’t the first time I’ve been a bit sad to leave rotation, but it may be the one where I felt the most validated and understood.

All that said I am also pretty excited to start pediatric cardiology next week. I love CHLA and I can’t want to be traipsing through her beautiful colorful halls once more.

I’m really starting to feel like this is where I belong. A lot of the residents and I have shared interests or if not interests similar perspectives on different things, especially with respect to medicine and patient care. Again it’s hard to tell if its actually getting along, or they are just super nice and easy going people at baseline. It’s weird ’cause I keep thinking about all the future med students who are going to go through the clinic after me getting kinda jealous wondering if they will be liked better than me. All silly stuff, but I can’t help it. In any case it’s too late now for me to try to change anybody’s mind for the better, just gotta keep pushing forward.

Today was a much-needed slow day. There was a lot of no-shows in the morning and a lot of babies in the afternoon. Of course it’s not great when there are no-shows because that means someone is missing care. One of the patient who I did see was from juvenile hall which was interesting. I’m not sure what I was expecting when I met her, but she just seemed like a pretty normal, pleasant kid with some additional psychosocial aspects. I’ve been really enjoying the continuity and the transitional care aspect of this rotation. Also we should not restrict trans-healthcare or gender affirming care to adolescents. I agree extensive conversations should be had with patients and family. But there is a lot of good data to support that having access to these kinds of services is safe and saves lives.