After a few more weeks of rotations, I may be ready to sign voluntarily...😀
Actually, it's been a blast, seeing lots of interesting stuff, learning tons and working with several great docs. After the Step 1 push, at this point I'm ecstatic to be doing anything other than sitting around on my a$$ and studying for 15 hours a day. I'm sure that after a few more weeks of getting up at 4am I'll be wishing I could just sit around and read...
I love the hospital life on inpatient IM. I get to the hospital at 7, punch in the code and pull into the Physician's parking lot. Go through the physician's private entrance into the physician's lounge, where they give me a newspaper and a wonderful breakfast buffet. After that, I sit in a big physician's chair and watch the news on the physician's big screen TV for a while. Then I head into the physician's dictation office and get a copy of my patient census. That's when the life of luxury ends for a while....
I see previous patients, check their progress and write notes most of the morning, then it's back to the physician's lounge for a wonderful buffet and more patients. Usually, I get admits in the afternoon to do. So there's lot of H&P's on them. Then you start getting medical management consults from surgeries that day. Hopefully, you can fit in the rest of your patients around that. If you have call you could admit 10 or more patients overnight.
Between all that I'm constantly reading-- especially on UptoDate-- about whatever pathology my current patients have and how to manage them. After I leave I'm constantly reading about the cases I've seen for the day because there are soooooooo many different patients on the medicine service. It seems to come in cycles. One day was all bugs and drugs day. Had multiple cellulitis cases, sepsis, several hep C's with complications, etc. Even went to a drug dinner on antibiotics that night (wonderful food and wine, btw). Every one had a different disease and I'm constantly pimped on what the most likely bug is and what you treat it with. Yesterday seemed like neuro day-- all day long. Saw my first Parkinson's case. He was "classic" with all the symptoms. Feeling the "cogwheel rigidity" finally after reading about it for so long was amazing. I'll never forget that. I've had an alcoholic cirrhosis day where everyone had ascites and developed SBP. It's just amazing.
Plus, most of my patients are old, with multiple comorbidities. I'm more likely to ask what is NOT wrong with them. The whole time, though, I've been treated really well. I'm having to get used to being called "sir" all the time and having someone start to run to get something for me when I accidently mumble out loud.
I've found that most patients are more than willing to tell me their whole life story. If they did drugs and chopped the heads off of squirrels when they were ten, they'll tell me about it. The hardest thing is examining some of the people who just can't move or are in too much pain to move a whole lot. You still have to hear their lungs somehow. I'm getting a lot better at hearing heart sounds....but I could use a lot of practice with breath sounds. Most of the people have a history of illness, though, so when you tell them that spoty on their lung is just another cancer, they pretty much take it in stride. It will be really interesting to see what working with a more healthy population will be like.
I absolutely LOVE inpatient IM, though, because the amount of pathology is really amazing. I feel like an idiot mot of the time, though, so I'm spending a lot of time reading. One of my attendings told me a story that he pulled his attending aside after the first week of his IM rotation, starting crying and begged him not to flunk him because he was trying really hard. The attendig told him not to worry because you've probably only read about this disease 4 or 5 times in med school. By the time you're finished rotations you'll have seen it 30 times. By the time you finish residency you'll have seen it 300. Medicine is really learning by repetition. I can very clearly see that now because we have only come across a few things that I haven't heard of before-- but I certainly don't remember them all that well. I certainly didn't remember all the brain nuclei yesterday-- but my attending did. So, here I am reading neuro stuff all over again that I thought I was just about through with. No, it's not all that importnat in the treatment of the patient, but understanding the process is so much more helpful.
Anyway, enough of my ranting and raving. I've got studying to do. Or maybe I should rephrasee that and call it "learning". I've got learning to do, and that's much more fun that just studying
🙂