Still in IM...

I'm still doing my internal medicine rotation, and just wanted to check in quickly! I'm not loving the rotation, mostly because I'm pretty frustrated with the lack of care most patients actually receive, and I don't want to rant about it too much in case anyone from my school (or the doctor's office) could happen to find my blog somehow. But, essentially: the office I'm at sees a high volume of patients each day, and that means that the doctor spends about 2-3 minutes with each patient, and really glosses over some things that (in my opinion) should be given more consideration. So! It's up to the students to really talk to the patient and advocate for what they think the patients need, but the doctor can choose to ignore some really glaring things.

I'm honestly pretty disappointed in this rotation. As my preceptor's head nurse said to me today, "This is the rotation where you learn what not to do." My preceptor is a personable guy and pretty friendly, and his patients like him because of this, but they're really not receiving in-depth, quality care. I'm hoping my next rotations in Montana will be different!

A great day in IM!

This rotation is great. Not only are the hours incredibly sparse (this whole week, I will only be there for about 23 hours...), but my preceptor is really nice and a great teacher, and the patients are (mostly) nice and come in for relatively easy appointments. I think my favorite part, though, is just taking a few minutes to talk to people and help them beyond just refilling their medications.

Today, for example, we had a new patient come in who hadn't been to a doctor in over six years, because he "never felt bad." So, when I was asking him the typical questions that you ask a new patient, I inquired about his diet and found that it was awful (fast food, highly processed foods, no fruits/vegetables, lots of carbs, sugary drinks all day every day). He thought he was doing pretty well, and told me he never even thinks about eating more healthily. So...kindly and patiently, I suggested adding more fruits and vegetables in, and also suggested drinking something like a V8 Fusion that tastes pretty good but offers some of the benefits of fruits and vegetables. He said he hates fruits/veggies, so that sounded like a good option, and he was definitely excited to try it. Also, he was already trying to quit smoking, so I encouraged him with that and gave him some tips. We also set up a couple of referrals for problems that would require a specialist. It just felt really good to listen to the problems this patient was presenting with and help him to come up with a plan of action that he was really, truly going to follow. I felt good leaving that room because I knew that a person who had previously hated doctors and was only coming in for an acute complaint had been converted and would start getting preventive screenings and care. So, I was pretty proud of myself!

The rest of our patients today were pretty uneventful. This rotation is pretty relaxed, and we get free food a lot. Even though it's not as exciting as, say, the ER or surgery, I could see myself working in an office setting like this!

First day of internal medicine!

My first day at this rotation went much better than anticipated! I fell right back into the groove and did totally fine at talking to patients. It definitely helped that my preceptor is incredibly laid-back and funny. He's not pretentious or uptight at all, and he seems to treat students like people and not idiots, which is refreshing (even if I still feel like an idiot at times and still, obviously, have a lot to learn!).

He gives us a lot of autonomy, which is both awesome and terrifying. We (me and the two other students) bring patients back, take their vitals, and see them on our own. Then we jot down a brief SOAP note on the back of their intake sheet, and give it to the doctor (or present it briefly if we have time! He moves fast!). Then, he goes in to see them for about one minute, and basically just chats. Most patients are there for their three-month follow-up visits just for medication refills, but I did do one annual physical today. Then, he uses our opinion and our note to dictate the actual note! Seriously, I heard him doing one of mine and it was essentially exactly what I had written down. Even though it's scary to think that I'm essentially having the last word in terms of how a person is doing, it's also good because it makes you actually assume responsibility for the patients, instead of just relying on the fact that someone with more experience is going to go right in after you and double-check. So, it's closer to real life, and I like that.

Oh, and the content of the visits is very similar to family practice - medication refills and urgent care-type stuff like colds, joint or back pain, etc. Nothing I can't handle. :)

Back at it!

Well, after an amazing and much-needed winter break at home with family, I am back in Pittsburgh and ready for my sixth rotation - internal medicine. If I'm being honest, my heart's just not in it right now - I'd rather still be hanging out at home for a few more weeks! I'm hoping that getting back in the routine tomorrow will help.

This rotation should be relatively relaxing compared to my last couple rotations - this whole spring semester, in fact, is going to be much more laid back than the fall, just because of which rotations I have coming up. Internal medicine is really just general practice, but specifically for adults. So, it will be a lot of high blood pressure, high cholesterol, and diabetes, and managing all the medications that come with those. Personally, it's not fascinating to me, but my preceptor is supposed to be really nice and relaxed, so at least the rotation itself will be fun.

I'll actually only be at my rotation for the afternoon tomorrow, but I'll try to post an update about the first day anyway! Here's hoping it's either more exciting than I think it will be, or that my attitude changes with a good night's sleep. :)

Oops...an update!

Well, I've definitely fallen off updating in the past few weeks...maybe even a month! But there was Thanksgiving, the last two weeks of a hectic rotation, a giant summative exam (which I passed!), packing up and coming home for the holidays, and preparing for the holidays and celebrating numerous birthdays at home this week, so I've been busy!

The last few weeks of neurosurgery were great, though. I really liked all the PAs that I worked with! And I did get to go into the OR and see two more surgeries - a cranioplasty (putting pieces of skull back in that had been taken out previously, in this case for a patient who had been in an accident and who had had skull pieces taken out so his brain could swell and not get too cramped against the skull, which can cause damage) and a lumbar decompression (basically taking out bone spurs and arthritic changes in the lower spine to alleviate pressure on nerves and therefore back/leg pain). I got to scrub in (finally!!) on that last surgery, and even retract/suction/do staples at the end. So that was cool! Other than that, it was more of the same type of inpatient care that I've already talked about a lot.

So, I'm on break for about two more weeks, then it's back to Pittsburgh for a rotation in internal medicine! Sounds like it will be lots of management of chronic conditions, so nothing too exciting or fast-paced at all, but I'm sure I will learn a lot. I hope so, anyway!

Hope everyone has a very happy holiday season! :)

A better end to last week, followed by another crazy Monday

Last week ended really well - I was seeing my own patients and writing notes on them, and most people were easy post-ops who ended up going home. On Friday, I even got out over an hour early because everything was done! I can see how the job would be rewarding (and even fun) on those lighter days.

Mondays are another story. Traumas from the weekend are in, and weekend traumas are usually the worst traumas. Car accidents involving young drivers, falls down stairs caused by alcohol intoxication, drunken assaults...you get the idea. And, today we had another consult from the ER for a man who had been drinking and had seriously uncontrolled high blood pressure - a terrible combination. He hit his head on a shelf while drunk, and because his blood vessels in his brain were already stretched to the max from his hypertension, they ruptured and he had a huge bleed in his brain. We actually went down to the ER right when he came in to evaluate him, and we saw him get intubated and whisked away to the OR for an emergency shunt placement to redirect the extra spinal fluid and blood caused by the trauma and bleeding. He had a GCS (coma score) of only 9, where 15 is perfect and anything below 10 is basically not good. The worst part was that he was only middle-aged, and that we had to tell his wife and daughter (who was around the same age as me) what had happened and what was likely going to happen next. I don't know what his status was when I left, since he was likely still in the OR. I really, really hope he does well, even though I know deep down that he probably won't.

Another patient who probably won't do well is a teenage boy who was in a car accident over the weekend. He has some serious bleeding on the brain, too, and even after bilateral craniotomies his brain is very swollen. So...I'm not optimistic. But, he's young, so you never know!

Hopefully the rest of the week calms down like last week did!

Don't drink and drive...

One patient learned a good lesson the (very) hard way today. She's in her early twenties, and was driving home from a night on the town with a BAC of around 0.24. She ended up going the wrong way on the highway and hit four cars. She broke her odontoid process (part of the second vertebra in the neck), her collarbone, her wrist, and her leg. She woke up (still intoxicated) in the ICU this morning in what I can only assume to be crazy amounts of pain, and she was put in a halo this afternoon. Halos are these huge contraptions that literally screw into the skull and attach to a vest to keep the neck extra stabilized while the fracture heals. In her case, the bone fragment was too displaced for surgery to fixate it, so the halo was the only/best option. You have to wear the halo for 8-12 weeks, and as you can imagine, showering, getting dressed, and going out in public are pretty difficult with one of these things on. Not to mention the permanent scars in your forehead! She's lucky to be alive, and I obviously don't condone her actions at all, but I still feel bad for her. Hopefully she learned her lesson.

Another interesting/horrifying patient today was one who was trapped in a burning building last night and had to jump out from the third floor to survive. He ended up with a completely shattered pelvis, an L5 compression fracture, and a ruptured bladder. I'm not even sure how they fix the bladder...or his pelvis, really, since from what I saw on the images, it was completely destroyed. But hopefully they can! We are only involved for his L5 compression fracture, which is definitely the least of his worries right now. They won't even surgically repair it until his pelvis is taken care of, because without an intact pelvis there's nothing to fuse the lower spine to.

So! That was my Monday. I also saw a bunch of other (less awful) inpatients and took out some drains. I've started seeing people on my own and writing their notes, which is nice because I feel like I'm helping the PAs a little bit. Overall, I think I don't love this rotation, even though I'm learning a lot from it and I think brains are cool. The cases are interesting, but also sad. We spend way more time in the ICU than I would have thought, and the ICU is probably the saddest place on Earth. It's full of people who, for the most part, were doing just fine, and then something happened to land them in the ICU. For older people, it's usually a fall. For younger people, it's a car accident or some other sort of trauma. Either way, the patients (in most cases) were doing totally fine before the accident, and then, due almost completely to chance, they end up in the ICU and their lives are changed forever.