In the Life of a Fickle Intern

September 28, 2010

Anesthesiology

Filed under: Daily Lowdown — dailymedicine @ 21:55

This week I am on Anesthesiology. It’s only appropriate that I am not going into this field because I cannot spell the word “Anesthesiology” without having to look it up (I just googled it!). Sad, but true.

There is no Anesthesiology residency at my school so there are no residents for us to follow. Instead, we hang out with the CRNAs – the nurse anesthetists. If this rotation was a few months earlier and I had residents to learn from, I might be vaguely interested in learning more about the field, but since that is not the case and I am on total cruise control for the rest of the year, my fellow students and I show up, see a case or two, and are out of the hospital by lunchtime. It’s pretty fabulous.

I feel guilty about my current apathy for learning because I know that this is a great opportunity, but honestly, there are no pulls for us to hang around. There are only two attendings to every eight CRNAs so we don’t get much time with the Anesthesiologists. Moreover, because it is a CRNA training program, they get all the procedures and intubations. I will learn in residency…right?

However, it has been fun being in the operating room again, especially now without the pressure of being graded! Today I got to watch my friend, the Oral Maxillary Surgeon with whom I did my surgery rotation with, wire a guy’s mouth shut after a mandibular fracture. It was pretty cool! Unfortunately, it was not cool enough to hold my attention for more than thirty minutes. I hope this lack of enthusiasm for learning is only temporary!

September 24, 2010

Misconceptions

Filed under: Daily Lowdown — dailymedicine @ 22:13

This was a forwarded email that was read to us during rounds this week. It’s cute (but don’t take it seriously!)

Q: Doctor, I’ve heard that cardiovascular exercise can prolong life. Is that true?
A: Your heart is only good for so many beats, and that’s it…don’t waste it on exercise. Everything wears out eventually. Speeding up the heart does not make you live longer. It’s like saying you extend the life of a car by driving faster. Want to live longer? Take a nap.

Q: Should I cut down on meat and eat more fruits and vegetables?
A: You must grasp logistical efficiency. What do cows eat?  Hay and corn. And what are these? Vegetables. So steak is nothing more than an efficient mechanism of delivering vegetables to your system. Need grain? Eat chicken. And beef is also a good source of field grass, which means that you’re getting your green, leafy vegetables.

Q: Should I reduce my alcohol intake?
A: No, not at all. Wine is made from grapes. Grapes are fruits. Brandy is distilled wine, which means that they take the water out of the fruity bits so you get even more concentrated fruit goodness. Beer is made from grain. So point is, bottom up.

Q: Aren’t fried food bad for you?
A: No! Food is friend in vegetable oil. In fact, the oil permeates the food. How could getting more vegetable be bad for you?

Q: Is swimming good for your figure?
A: If swimming is good for your figure, explain whale to me.

Q: Is getting in shape important for my health?
A: Hey! “Round” is a shape.

So remember, life should not be a journey to the grave with the intention of arriving safely in an attractive and well-preserved body, but rather to skid in sideways with a Chardonnay in one hand, a hamburger in the other, with the body thoroughly used up.

And for those who do watch what you eat, here’s a final word on nutrition and health.

1. The Japanese eat very little fat and suffer fewer heart attacks than us.

2. The Mexican eat a lot of fat and suffer fewer heart attacks than us.

3. The Chinese drink very little red wine and suffer fewer heart attacks than us.

4. The Italians drink a lot of red wine and suffer fewer heart attacks than us.

5. The Germans drink a whole lot of beer and eat a lot of sausages and fats and suffer fewer heart attacks than us.

Conclusion: Eat and drink what you like. Speaking English is apparently what kills you.

September 22, 2010

Comfort Care

Filed under: Daily Lowdown — dailymedicine @ 22:25

So this week is pretty light. Instead of my normal 12-13 hour days, I’ve been working maybe 4-5 hours a day. In the mornings, I go to the multi-interdisciplinary team meetings where social workers, chaplain, bereavement coaches, nurses, pharmacists, and the attending doctor meet to discuss patients. Instead of addressing medical problems, these people present and discuss emotions, feelings, etc. It’s neat. Actually, there is no mention of the medical problems at all other than the primary diagnosis, but everyone in the room knows how many siblings the patient has, who he/she lives with, who the caregivers are, if he/she have pets, what his/her religious outlooks are, etc., all of which is important in comfort care. The meetings always start with a prayer and end with a debriefing session in which team members can share their own life issues and problems for support and comfort. It’s interesting.

After that, I round with the attending. Again, instead of addressing their medical problems, we assess their pain and comfort. This is very different from what I’m used to, especially since I just finished a month of Internal Medicine where every little medical issue was noted. It’s definitely an experience. I don’t even examine the patients anymore! There is not much medicine involved.

Unfortunately, being that it is Palliative Care, two of my five patients had passed away over night. I just had them assigned to me yesterday. It was depressing this morning when the notice “This patient is deceased” popped up on the screen when I opened their medical records. 😦

After rounds, I’m dismissed for the day.

September 20, 2010

Palliative Care

Filed under: Daily Lowdown — dailymedicine @ 22:55

After a long weekend of fruit picking, pie making, cookie baking, rest and relaxation, I started my month of medicine specialties today. This month I will be rotating through four different specialty fields, starting with Palliative Care this week.

Palliative Care is a special field in which doctors focus on comfort care for chronically ill patients or terminally ill patients. They use a lot of different means to ensure that patients are comfortable and painless. It amazes me how certain people choose to do this as their career. It’s so sad. During orientation today, we watched this incredibly depressing video about this lady’s last 203 days of life before she passed away. It was kind of horrific. Then I spent the rest of the afternoon rounding on dying patients. That was not fun. Though it will be emotionally challenging, I think I’m going to learn a lot. This week will give me a whole new perspective of medicine and what it means to care for the patient as a whole. I am really glad that I have this opportunity, but I wish that I could have started off with something happier.

September 15, 2010

Cruise Control

Filed under: Daily Lowdown — dailymedicine @ 23:09

Today was my last day of my Internal Medicine JI, which also means that I am pretty much done with my last year of medical school. I still have some electives left, but from this point on, no more weekends, no more calls, no more tests, no more real assignments, and no more grades. All the electives are pass/fail. I’m so pumped about having a life again! For the last 3.5 years, everything has revolved around school. I can’t even describe how excited I am!

Even though it was my last day, I finally lost it and yelled (spoke loudly) to my very annoying intern during rounds. It was the same old situation – him trying to show me up by presenting something about MY patients to the attending. Unfortunately for him, it just made him look bad in front of the team. It’s poor form to try to manage other people’s patients. I called him out on his inaccurate information in my very annoyed “please get your facts straight” tone. He did apologize for “stepping on my toes” and I apologized for snapping at him, and I clarified for the hundredth time that he has no role as an intern in taking care of the JI’s patients because it’s our learning experience. I’m just saying.

He totally messed up my streak of undeniable admiration and love for all the residents that I’ve worked with. He is the first resident whom I have not liked/loved.

I spent the rest of the day tying up loose ends on my existing patients so that whoever picks them up tomorrow will know what’s going on. Most of the work I had to do revolved around social work, calling families and primary care physicians and whatnot, but I didn’t mind. Sometimes that is all that patients need.

Cruise control in full effect. Sweet.

September 14, 2010

Noncompliance

Filed under: Daily Lowdown — dailymedicine @ 22:47

Bounce back patients are patients who return to the hospital after getting discharged from inpatient care within a short period of time. It can be relatively common with frequent fliers, or patients who are non-compliant with their medical treatment so they end up in the ER again and again. I was just bragging the other day to a friend how I had not had any bounce backs this whole month, and the very next day, a bounce back patient.

This older gentleman has an extensive list of chronic problems who comes to the ER almost every other day for the same complaint – shortness of breath. He has all the equipments he needs to control his problems at home: hospital bed, electrical wheelchair, home O2, etc., yet he still likes to come to the ER. When I asked him why he came back, he replied, “Oh, you know, I had trouble breathing.” I asked him if he used his oxygen when he had this shortness of breath, and he replied, “oh, I don’t use my oxygen at home.” Later, when I was talking to his brother, his brother told me, “he gets bored at home so he calls the ambulance.” REALLY? I mean, he is a nice person, but there is nothing medically that we are doing for him. We just put him on oxygen in the hospital and he feels better. There is a reason he has home oxygen available. Now he is just hanging out in the hospital waiting for social work to find a nursing home for him since he decided within the last two days that he does not want to live with his wife anymore. Really!?

Last night, one of my friends who is doing her JI in Internal Medicine at another hospital told me that my other gentleman with Aspergillous is now on their team without his meds. I checked his record at my hospital and he has been back to the ER three times already. I had his medicine sent to his home, for goodness sake! This is so disheartening. When he was hospitalized for 10 days, I literally spent hours on the phone working on getting him the appropriate care and supplies. He has an extensive history of coming into the ER for nonmedical problems, but I gave him the benefit of the doubt that he used the ER since he did not understand his situation because of the language barrier. I put so much time and effort into his care. I made all these arrangements and explained everything about his health to him. I thought that I had really made a difference by going that extra mile for him. Now I’m not so sure. I was really discouraged after I found out about these recent ER visits. I don’t care about being acknowledged or thanked, but I do care that people care about themselves. How is it that a perfect stranger like me can care more about his health than he does? How does that work? Am I wasting my time? All he has to do is take his dang medicine. Is it really that hard? It is so frustrating.

Neither one of these patients have anything to do with being insured or not. They both have Medicare, and they are both actively abusing the health care system by being non-complaint. They don’t follow up in clinics; they smoke and drink; they don’t take their medicines or use their available resources; and they just don’t care. I don’t know what else I can do.

No wonder doctors get burned out.

September 12, 2010

Working on Weekends

Filed under: Daily Lowdown — dailymedicine @ 22:06

Even though working on weekends suck, there are some benefits to it. The hospital is much quieter, and everyone is working at a much slower pace. There is no required morning turnover or report, and rounds are informal. With time to spare, I really get to talk to my patients. I talk to them every day. I’m the first person to see them in the morning, apart from the nurses, and I am often the last person to stick my head in to say hi before I leave for the afternoon. I know all there vitals, their electrolytes, their past medical history, their medicines, and everything about them medically, but it’s only on weekends do I have time to just chat.

One of the my patients was an ICU (intensive care unit) transfer because of severe, uncontrolled high blood pressure. Medically, she is a morbidly obese lady with uncontrolled asthma and high blood pressure; personally, she is this young lady full of life who has made a few wrong turns. We ended up talking for over 45 minutes  today about her life and all the stresses that she encounters daily, and ways that she can make small changes to improve her health.

Another patient has uncontrolled diabetes now with a diabetic foot ulcer that may require toe amputation. Every morning for the past few days, he has a string of doctors and surgeons coming in to tell him that he needs an amputation. Every aspect of that specific problem has been addressed and answered, yet he had a string of basic questions about diabetes that has not been approached. So this morning we talked about diabetes, its complications, it control, etc. This doesn’t mean that we, broadly speaking of all health care providers, don’t explain everything to patients. We do. But sometimes, with the time restraint, we end up using medical terminology instead of regular vocab in our explanations. It happens, but that’s why we have weekends and medical students. 🙂

September 8, 2010

New Team

Filed under: Daily Lowdown — dailymedicine @ 20:44

The residents and interns rotate based on the monthly schedule while we, the medical students, rotate on a four week schedule. We got a whole new team last week. I really like my new resident and one of my new interns. As for the other intern, I might end up killing him by the end of my rotation. He’s really nice, but he is very interesting, for lack of a better word. I think he means well, but he is invading my JI’ing! He keeps on trying to micromanage my patients when he isn’t even taking care of them. As a junior intern, I don’t work with the interns at all. They have nothing to do with my patients. However, this one intern has taken it upon himself to write orders for my patients and “update” me on them. After a few of these events, I finally brought it up to him this morning, asking him to please let me take care of my patients since it is my learning opportunity. I was cordial. I’m sure he just hasn’t worked with JIs before. I’ll give him the benefit of the doubt, and he was really receptive. I think it’ll be ok from now on. Hopefully.

September 6, 2010

Application

Filed under: Personal Ramble — dailymedicine @ 21:30

I just submitted my residency application!! It’s quite a process. The application opened up on July 1st for completion and editing; it opened up for submission on September 1st. I’ve been working on my application since July, but I was not ready to submit last week because I wanted to confirm with one of my attendings about writing my last letter of recommendation. He was on vacation so I did not hear back from him till two days ago. Then, I was too nervous about pressing the “Submit” button because once you submit it, you can’t make changes to it anymore. I finally sucked it up and submitted it today. I’m applying to 28 programs! It sounds like a lot, and it is a lot, but it’s just what you have to do. I don’t want to take any chances of not having a place to go next year!

The application consists of a personal statement, three letters of recommendations, a curriculum vitae, board scores, grade transcript, and a Dean’s Letter. I was so nervous clicking the submit button, though I am glad that I’m done with it and I don’t have to fret over it anymore. Now I sit and wait with my fingers crossed.

Anywho, wish me luck and hope that I get a lot of interview invitations and that I match into a program of choice!!!

September 4, 2010

Sick Patients

Filed under: Daily Lowdown — dailymedicine @ 21:10

I am not ready to be an intern. I carry an average of four patients at a time, and yet I am at the hospital for about eleven to twelve hours everyday. What am I going to do next year when I have to take care of more patients?!

The patients assigned to me are all really interesting, but they’re all really complicated and sick! I picked up a new patient the other day. She sounded pretty straight forward – a young lady who came in after a suicide attempt needing psychiatric inpatient placement. My job was to medically clear her for psych treatment and find a place for her to go (again, social worker!). Anywho, when I went to see her, she was having trouble breathing and complaining of chest pain and cough. On exam, her lungs sounded pretty junky. I got a chest xray and she had pneumonia. Ok, treatable. Not a big deal.

My resident went to see her later and she had an acute abdomen, meaning that she was very, very tender to palpation, usually a bad sign. We got a CAT scan, and she was found to have constrictive pericarditis from calcification of the pericardium, the sac that holds the heart. This was a big deal.

This was all yesterday. I go see her this morning and she’s tachycardic (fast heart rate), tachypnic (breathing fast), and her blood pressure is really low – all signs of impending badness. Anywho, we stabilized her and got some more studies. Her lungs are horrible, totally messed up! She’s ok now, hopefully, but my “easy” social placement patient has turned into my sickest patient.

I would to remind these patients that I am ONLY a fourth year medical student so they should STOP threatening me with their life. Not cool. I’ve always known that I will be responsible for people’s lives one day, but I don’t think it really hit until this rotation. I mean, these are my patients who are crashing on me. I have seem so many people die right in front of me, but I have yet to have one of my own patients pass away. I would like to keep it that way, please.

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