In the Life of a Fickle Intern

August 31, 2010

Social Work

Filed under: Daily Lowdown — dailymedicine @ 21:23

Medicine is 40% medical care and 60% social work, at least on Internal Medicine in this city. I have been playing social worker for the last few patients that I have been taking care of. One lady had to stay in the hospital an extra three days because we could not arrange for her to go home with oxygen because she was not insured. Not only that, it was over the weekend and apparently, normal people don’t work on weekends and I could not get in contact with anyone. It really sucked because she wanted to go home, I wanted her to go home, and society wanted her to go home (since it cost approximately $1000 a night to stay in the hospital and she was uninsured). Either way, it was a frustrating situation. There was no medical reason for those extra three days! I finally got her out yesterday after many, many phone calls to social workers, case workers, etc.

Another one of my patients has Aspergillus, a fungus, growing in his lungs. It is yet another relatively uncommon problem in patients with normal immune system, and his presentation of the disease is very atypical. This patient has been a social case since the start. He has some history of tuberculous but there is no record in our system of it so I’ve been on the phone with the health department daily for the last week trying to gather his medical records. Now with this new diagnosis, he has to take this really expensive drug (voriconazole) daily for 6 months. For a 30 day supply of this medicine, it costs around $2600!!! Isn’t that ridiculous!?

Well, being an older, unemployed gentleman who doesn’t speak much English, there is no way that he’ll be able to afford this or find ways to get it. After talking to the social worker, the case manager, and the Pharmacist, I ended up calling the Pharmaceutical Company and asking them if they had any patient assistant programs available. After an hour on the phone, as my patient’s advocate, he is now qualified for a free month of this medicine! I am not going to lie, I felt pretty great afterwards. I’m just thrilled that from a medical perspective, I provided the best care possible. I still have to do a lot of paperwork to get him the other 5 months of meds, but as for now, I’m happy with my small step in helping someone today.

Though all this extra work is not medically related and it takes up so much of my time during the day, I am still glad that I’m actually getting something done for these people. However, every day, I gain more and more appreciation for the social workers!!

August 29, 2010

Code

Filed under: Daily Lowdown — dailymedicine @ 22:56

Last Friday, one of my patients coded on me! He had a procedure done in the morning where they stick a long, thin camera down your larynx to look at the lungs and take some tissue samples to analysis. I visited him right after he got back from the procedure, and he was doing fine. He was a little shaky, but apart from that, he was his normal self. Fifteen minutes later, his nurse called me and stated that he had become tachycardic (heart rate > 100 beats per minute) and that his O2 saturation was dropping to the 80s. As I ran to his room, I called my senior resident and told him the situation. When we got to his room, he was completely out of it. He was hypoxic (not getting O2 to his tissues), delirious, and his vital signs were out of whack. Poor fellow!

Because my resident was there, we did not call a code. A code is when a patient crashes and you announce it over the intercom to get the senior residents to the room to resuscitate the patient. Though I’ve seen and been to a bunch of codes in the past, this was my first one in which it was MY patient who was coding! After stabilizing him and getting all the appropriate tests and whatnot to rule out all the bad stuff that can kill you right away (heart attack, collapsed lungs, etc), I had to call the ICU fellow to come evaluate my patient. He was going to have to be transferred to the Intensive Critical Care for monitoring.

Strangely enough, after an hour of being unresponsive, and even before we gave him any medication apart from O2, he recovered and got back to his baseline. He woke up, started talking, etc. It was the strangest thing! I am still trying to figure out what happened! He was fine when I checked on him on Saturday, but I am a little worried. I took off Sunday to go to a wedding in St. Louis on Saturday night, and I don’t know what’s going on with my patients anymore. So much can happen in one day!

As the “intern” for my patient, I have gotten so attached to them. I don’t want anything to happen to them, especially when I’m not there! I might have to just work straight through and take my other two days off at the end of the month. Driving home from St. Louis today, I kept on thinking and worrying about my patients. I’m going in extra early tomorrow to make sure everyone is alright. I’m such a worry wart.

August 26, 2010

Zebras Cont’d

Filed under: Daily Lowdown — dailymedicine @ 22:41

In response to ZIP’s comment:

I don’t know much about the bacteria my patient has. I’ve never heard of it before, but my resident gave me a 50 page paper on the topic (atypical mycobacterium) which I just started reading. I’ll let you know when I finish the paper!

Some other zebras on the team:

We have a patient with Rocky Mountain Spotted Fever and/or Erlichiosis,  both of which are tick-borne diseases that are relatively rare. They both can be fatal if undiagnosed/untreated!! Still trying to figure out which one is it.

Another patient has Thrombotic Thrombocytopenic Purpura (TTP), a rare hematological disease in which your body destroys all your platelets and messes up your kidneys, brains, and blood cells. It’s a super emergency and you have to get plasmapheresis in which all your plasma is removed, treated/filtered, and then returned to your body. It’s a big deal! This is the first case my attending has ever seen. I’m glad that it was caught!

We have a lot of patients who have acute exacerbation of their chronic diseases like liver failure in a cirrhotic patient, kidney failure in chronic kidney patient, heart failure in chronic heart problems, etc.

All the patients are really interesting medically, but I feel so bad for them. I always feel so guilty being so interested and excited about getting these unique cases, but I justify it by reminding myself that I am a student who needs  to learn. That is the reason I am in school for all these years, right? Still, I wish my city was healthier for its own sake.

August 25, 2010

Zebras

Filed under: Daily Lowdown — dailymedicine @ 22:04

Our team is currently caring for 14 patients, and 8 out of the 14 have really cool diseases! That sounds awful, but it’s true – they all have zebras! In medicine, there is a reason common diseases are called common; you see them all the time. We call the common problems horses and the weird ones zebras. As a medical student, you wish and pray that you get something weird. And right now we have a list filled of zebras!! It’s so cool.

One of the patients I’m following has a weird strain of a bacteria (Mycobacterium absessus)  that I’ve never even heard of. When my attending told me the diagnosis, I had to wikipedia it for an overview (though I would not recommend that website as a real reference.) My poor patient will have to IV (intravenous) antibiotics for two months and then take oral antibiotics for two years!! How crazy is that? My resident is going to be a Pulmonary Critical Care fellow next year so he’s super excited about this patient. Where else but here will I get to see these diseases as a medical student!? I forgot how cool Internal Medicine can be! (No worries, I have no intentions of changing career plans now.)

August 24, 2010

Progress Notes

Filed under: Daily Lowdown — dailymedicine @ 23:22

I’m currently working in one hospital with a set schedule on the same team seeing the same patients day in and day out.  I’m so not on Emergency Medicine anymore!

This month, I’m doing my JI, my junior intern, rotation in Internal Medicine. It’s a ward month, meaning we take care of the patients who have to stay in the hospital. On our team, we have an attending, the big boss, a 3rd year resident who is finishing up his training, 2 interns who are brand new from medical school, 2 third year medical students, and me, the “acting intern.” My job is to function like an intern – I write notes, I write orders, I admit patients, I discharge patients, etc.

So some background information about writing progress notes, which are daily updates on the patients. Again, with the hierarchy, the medical student’s note has to be the first one in the chart, followed by the intern’s, then the resident’s and finally, the attending’s. Last year, when I was on this rotation, I would have to get to the hospital anywhere between 5 and 6 am to make sure that I beat the interns to see my patients first, depending on how many patients I was carrying. It was always an early morning!

As an acting intern, the only person I report to is the resident so as long as my note is in the chart before his, I’m golden and I can cruise, or so I thought. A whole year has gone by since my rotation and I had forgotten so much about everything! It took me four tries  and almost an hour yesterday to put together one decent note, mostly because I was being anal-retentive about my wording but also because I had to go through all her previous medical records to make sure I knew everything about my patient. As an acting intern, I can’t defer to my interns anymore! 😕

After two days, my bubble has been burst, and my hopes of cruising through this month has been shattered. Even though I don’t get a real grade on this rotation, I still don’t want to look like an idiot, hence, I’m back on work-hard mode. Maybe I can cruise after this month? I’m starting to think that either 1) I am not cruising material or 2) people lied when they said 4th year was easy!

August 22, 2010

Vacation

Filed under: Personal Ramble — dailymedicine @ 23:13

Even though it wasn’t a real vacation, my three day weekend was awesome! I caught up on sleep, got some stuff done, hung out with friends, helped my new roommate move in, and most importantly, got in some couch-sitting, movie watching, lazy time. I am so ready for tomorrow, sort of. I’m actually a bit nervous. It’s been exactly a year since I had my Internal Medicine rotation, and I hope that I still remember what to do. Nonetheless, ready or not, tomorrow is a brand new day in an old, familiar hospital with friendly faces. Best of all, I will be wearing real clothes instead of scrubs! Though it is really nice and convenient most of the time to not worry about what to wear or how I look since I have to wear scrubs, it is still nice to put on a little makeup and look cute for work once in a while. But only once in a while. 🙂

Alright, off to bed for an early morning. Sweet dreams.

August 19, 2010

Home!

Filed under: Daily Lowdown — dailymedicine @ 23:28

I’m back in the sweet comfort of home. It feels great, and I’m sure that I’m going to sleep amazingly well tonight, if not for anything else but the fact that I slept for 4 hours last night and had to drive over 5 hours today. Nonetheless, I am very grateful to be back! Doing away rotations is just another hurtle that we have to overcome and it’s just a nice feeling to be done with yet another thing on my “To-Do” list.

I was skimming through my last few posts and noticed a trend. Not only have I not been sharing any cool medical encounters, I’ve been slacking on keeping the blog updated at all. I do apologize! There are a few reasons for this lack of excitement. First off, I think that after a year in the hospital, things don’t seem as exciting to me as they did the first few times I see them. Don’t misunderstand, I am still loving it and I still think everything is interesting, but the initial shock is gone and I don’t have that urgency to tell everyone about everything.  But more importantly, after three high stress months back to back, I started focusing on counting down the days rather than anything else. I had so many loose ends to take care of that I didn’t really have much time or motivation to blog.

However, hopefully this will all change! Not only am I done with all my required Emergency Medicine stuff for application, at least for now, I’m starting my JI (junior internship) in Internal Medicine next. I’m super excited about it. I’m ready for a change of pace, if not for just a month. In this rotation, I’ll be an acting intern instead of a medical student, carrying more responsibilities and more decision making power over my patients. It prepares us for next year. I love Internal Medicine (not as much as EM) so I’m hoping this will be a really interesting month.

Oh, one new cool thing that I did last night was I popped in my first dislocated shoulder. It was pretty sweet!

August 17, 2010

Homeward Bound

Filed under: Daily Lowdown — dailymedicine @ 14:30

Last week in Chattanooga! Two more shifts, and I’ll be home free. Unfortunately, they’re all night shifts. It’s not as bad this time around, but I am so ready to be done. I have a horrible case of apathy. It’s very unlike me to be apathetic about anything, but I honestly can say right now that I just don’t care. I’m hoping that this will pass soon, but if not, I hope that I can get everything done before this sense of apathy kicks into full force. Oh my goodness, who I am?

Ok, two more days. Two more shifts. One personal statement. One presentation.  Home free?

August 13, 2010

Tow

Filed under: Daily Lowdown — dailymedicine @ 22:24

I’m done! After 5 hours of driving to and from Atlanta and 8 hours of testing, I’m officially done with all my boards for medical school. Even though I won’t get the result back until the end of October, I don’t have to think about it anymore until then. I did get really nervous walking into the building, but apart from one “patient” who almost made me laugh during the interview, I think it went pretty smoothly.

The apartment complex that I am staying at had sent out a notice earlier in the week saying that they were going to pave the parking lot. I skimmed it without much notice. Coming back at 2 am on Thursday, I did not think twice about where to park. Running a little late for lectures, I came out the next morning to find my car in the middle of the parking lot and a tow trunk backing up towards it. Being completely out of it, I waved and got in my car and drove away. It didn’t even hit me that my car was in the midst of getting towed until I got home and read the notice again. Oops. Total luck. I’m sure the tow guy thought I was a total idiot waving at him.

Either way, I’m done! My friends are coming up for the weekend. I’m so pumped! My first full weekend off this month!

August 10, 2010

Study Day

Filed under: Daily Lowdown — dailymedicine @ 20:51

I’m taking Step 2 Clinical Skills tomorrow, and I opened up the study guide book for the first time today. Don’t get me wrong, I literally have been carrying this book with me everywhere for the last 2 weeks, but unfortunately, I never mustered up any motivation to read it.

I took today  off to study, and it was definitely very challenging to focus for more than an hour at a time. The biggest challenge of all was to stay awake, and despite the multiple cups of coffee, I had to give in and take a nap. Dang it, naps. If I could, I would nap daily. That would be amazing.

I should be nervous about this test, mostly because it’s very expensive, but strangely enough, I am not nervous at all. I’m sure it’ll be a lot more nerve wrecking tomorrow. Luckily, instead of getting a number score, this test is a pass/fail. I hope I pass!

The way this test works, at least from what I understand, is that it’s set up to be like a clinic day where we have 12 back to back standardized patients, each one presenting with a problem. In addition to getting the history and doing a physical exam, we then write the patient up giving our differential diagnosis and labs and whatnot, all in a set amount of time. One year ago, this test would have thrown me into a frenzy. I would be shaking out of my pants with anxiety and nervousness. However, after hundreds of real patient encounters, I am surprisingly calm. Maybe it’s just apathy, but either way,  I’m not shaking! I won’t let this false sense of security affect my outlook too much, and I will try my best tomorrow because nonetheless, it is still a test and I still need to pass.

Wish me luck! Last board exam before I am a doctor….agh, what a scary, scary, scary thought.

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