Rotation roundup: Internal medicine

Been a while – internal med can be a long, 8-week slog sometimes.  And summing it all up may be even more difficult.

This post has a bit of pathos infused in it.  After all, my classmates and I have been working year-round to be able to add that “4” to our signatures (already made that mistake 5 or 6 times today…).  I’ve only had a week off since Christmas and I’m really feeling the fatigue at this point.  Hell, it was a mental battle just to prep myself for writing this.  (Also I’m procrastinating – don’t really feel like memorizing toxin antidotes at the moment.)

But what kind of pseudo-blogger would I be without a little suffering?  A little (or a lot) of angst?  I’m even writing from an uncomfortable old wooden chair, sweating in the BC interior’s heat wave.

Irrelevant, I know.  The blog must go on.

The where: University of Alberta (8 weeks)

The good:  There’s really something to be said for being familiar with your surroundings.  To know where things are or where to find them (or who to ask to help you find them).  There’s something comforting about knowing most of the staff by name and being known by name.  Where you know the patients better than the incoming residents or staff.  Where you don’t panic when something bad happens on the ward because you know that patient back-to-front.  Familiarity is something I’ve missed a bit, where I may not know what every day entails, but I know the general flow of how things are done.

The spread of medicine, especially at the U of A, was pleasantly large.  Everything from leg clots to pneumonia to cancer (holy, so much cancer) to heart failure to gout to confusion to overdoses to kidney failure to hepatitis to electrolyte abnormalities… so much gets covered on internal, it’s no wonder we spend 8 weeks on it.  It’s another thing I’ve missed about family medicine, that exciting bit where you get to make the diagnosis and work up a problem.

The staff physicians on internal have been some of the most excellent I’ve met thus far, as a whole.  They tend to be great thinkers, who work through problems logically and treat based on best evidence.  Generally, they love teaching and all wish they could’ve had more time with the students and residents to just walk through an approach to X, Y, and Z.  I really strive to have the kind of intellectual prowess they exhibit on a daily basis.

The not-so-good:  I don’t know if I just had bad luck or whether that’s what internal is really like… but we had a lot of patients pass away.  Maybe it just felt that way.  Or maybe we just get a lot of sick people at the U.  Many we expected, but some we didn’t.  Some I was okay with (i.e. the expected ones, surrounded by family who lovingly guided them through the process) and some I absolutely was not.  I’ve never had so many emotional breaks in one rotation.  By the end, I’d just had it.  I was sick of these wonderful people dying despite my best efforts.  I was sick of watching helplessly as they slipped away.  Even now it’s really hard to talk about, there’s just so much emotion poured into that doctor-patient (and doctor-family) relationship.  So many people I got to know and laugh with and talk to in the days before they passed.  Easily one of the most emotionally difficult rotations.

On a similar note, I became fairly attached to some of my long-term patients.  The ones who I picked up the day I walked in, pretty much.  I’ve watched them and helped shape their treatment over two whole months, now I’m supposed to just write a long note and hand over their care?  It was hard enough after 8 weeks, I can only imagine how it feels for the staff after just 2.  We’ve invested so much and worked so hard, it’s almost like I didn’t trust anyone else with such a long course in hospital and complicated care plan.

I absolutely despise speaking poorly of my coworkers.  So I will simply say that I was somewhat unimpressed by the lack of professionalism and patient-centered care exhibited by some.

The internal medicine exams are ridiculous.  They’re easily some of the most difficult exams I’ve ever taken.  I can’t exactly explain the stations themselves, but needless to say, these are workups and physical exams that take far more than 6 minutes for you to talk your way through.  And the MCQ?  Good luck.  No amount of studying would have prepared me for it.  When time was called, most of us were silent and staring at the screens in disbelief.  (We get the results back this week – for God’s sake, pray for us.)

The verdict:  While dealing with very sick patients for 2 full months really added to my burnout (and I don’t think I could survive the residency!), I liked the overall generality of the work and feel far more comfortable dealing with ward emergencies.  Plus I’m awesome at doing EKGs now.

And done.  3rd year, all finished.  I’m currently on elective in BC for the next two weeks – I can’t wait to use this time to learn, relax, rest, and hopefully explore the interior!

 – Atalanta


1 Comment

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One response to “Rotation roundup: Internal medicine

  1. One book I really love as a reference for EKGs is “ECG Monitoring Made Incredibly Easy”. It’s part of the “Incredibly Easy” series that Lippincott publishes. It’s mostly intended for nurses (Lippincott also publishes a journal called “Nursing Made Incredibly Easy”) but there’s a lot of good information in it.

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