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

Internal Medicine – Day 4-7

It’s been hard to keep up with these, but to be honest, in terms of experience, a lot of these days are more or less the same. I go in, rush to not be late even though I’m already waking up at 4:30 AM, starting looking at what happened to my patients overnight, start reviewing the charts of the new patients so I can decide which one I want to take, go get sign-out from the overnight docs, come back, do more chart review, go see my patients, start some charting, go on rounds, do more charting… wait I am just now realizing I went through all of this in the last post I think. It is interesting to see the different pathologies though, and to think about some of the more difficult etiologies of refractory problems. Also so far I feel like I’ve gotten pretty lucky with patients being pretty open to talking to me. I also feel like my Spanish is improving… slowly. Definitely been helpful to be hearing a lot of medical Spanish on a daily basis. I’m also learning a lot of other stuffy too.

We also got a new attending today. She’s little more formal, but also seems like we are going to have very clear expectations of us for this coming week. Wish me luck.

TTITF:
(1) Friends who talk to you about new things and make me think about things in different ways, (2) lasagna, (3) finding something you thought you lost forever.

Iced vs Hot

I recently came across this “life hack,” or rather this (quite elegant) rant from a disgruntled individual who took to the internet to promulgate about why he thinks iced coffee is a scam. He makes several well-reasoned arguments as to why, including value (with iced coffee you are getting less coffee volume per unit money because of the ice), science (some research found that ingesting hot beverages actually makes you cool down more under certain conditions), and respect for the art of coffee making (you “taste the qualities of the coffee” better when it’s hot). My initial instinct was to agree with him because from an objective standpoint, yes you are getting less volume of the thing your are “paying for” for just as much if not more than you would be getting sans ice; I like science and primary literature-based arguments (even though technically he cited a secondary source and not the journal article itself); and I myself can be a bit snobbish when it comes to wanting to enjoy things in their more “pure” form.

The more I thought about it though the sillier it seemed to me that this man was so fired up about this. Despite his good arguments, the one thing he doesn’t satisfactorily address is that some people may just enjoy iced coffee more. He uses the aforementioned study to argue against the point that people find ice coffee “refreshing” and “helps regulate body temperature.” But even if objectively it may not do that (though also it’s just a single study from 2012), if people believe it does and if they feel good drinking it who are we to deny them that. If people are willing to pay for something they enjoy they should have that right, even if it’s not good deal from a good-per-money standpoint, because the value is in more than the good itself. Also, something tells me not all baristas are toiling over the idea that customers aren’t savoring the hidden notes to be found in the giant vat of coffee they brewed in bulk at the start of their shift in anticipation of the morning rush (though of course those that do should be respected if it means that much to them).

And yes I am also being a bit dramatic, he is not advocating for denying anyone their right to iced coffee. I’m just saying that sometimes I think it’s ok to let people make their own potentially questionable decisions in life if it makes them even just a little bit happier for a trivial personal cost.

Internal Medicine – Day 3

We had a substitute attending. Both the attendings I’ve worked with so far have been pretty young. Like late 20’s early 30’s looking. He was a super friendly guy with a very amicable and loose way of talking, as if we were his buddies and we were hanging at the bar. Except instead of beers we all had black coffee. And instead of sports, we were talking about anion gaps and how to spot right bundle branch block on an EKG. He put a lot of pressure on me when I was up to present my patient. He wanted me to read an x-ray and give a full assessment and plan for a patient, who I honestly had no idea what was going on. As we went through the presentation I maybe started to piece somethings together as processes were running in the background while I was speaking, trying not to repeat myself too much. When he actually asked for my assessment, I paused for a while, and stammered a bit, but eventually pulled a diagnosis out my ass, and he actually agreed. At first I thought he was doing one of those things where they just humor you at first as a teaching point and make you defend your case and describe your thought process even if you’re wrong. It felt good, and even for all the stress I had throughout the process I appreciate that he made me go through it and also didn’t make me feel too stupid when I said dumb things. Overall I’d say it was a good day for learning.

Internal Medicine – Day 2

I got my first patient today. History of pretty severe brain damage coming in for some generalize weakness. He was also in a pretty well-guarded and kinda hidden ward. I got lost trying to find it when I left the workroom to pre-round on him. And when I did I kinda followed some people who looked like they knew what they were doing, and then had to ask around cause the patient was not where our list said he would be. When I finally did find him, I wasn’t able to get much info between the language barrier (even with an interpreter) and the cognitive impairment. Fortunately he did understand enough (I think) to let me do some physical exam so I wouldn’t come back completely empty handed, though also just watching him move (he was feeding himself at the time) did also give some good general exam findings that I could report on. After that the day pretty much business as usual. Rounding then charting. My guy was pretty stable so after a quick consult, we were able to discharge him. My note was in and I was done. First patient, in-and-out.

It’s definitely a lot different here compared to family medicine. A lot of people talk about how crazy IM is, but to me, even in peds, it kind of feels like there is a lot of downtime compared to family medicine, at least from a student perspective. In FM, I was constantly doing something. Constantly alternating between seeing patients, to charting, to seeing the next patient when they were ready. No time to catch a breath in between. That said it is still early, and I don’t have the patient load of an intern (or even a sub-I) so that def part of it (but similarly in FM I didn’t have a full load). Yet why does it feel like there so much less time in the day?