Week #2 of Internal Medicine

Well, today started off the 2nd week of IM. My first week was okay. Started off a little slow because its a new rotation and we are getting to know our residents and what is expected, and of course they are getting to know us! The first day of IM was also my first call night which involved me doing alot of sitting around in the ED and reading. So far, alot of internal medicine, at least for us students, is sitting around. Occasionally there is a blood draw, or ekg, or IV line to put in and of course we get volunteered for that. I really don't mind because it gives me something to do. But a vast majority of the time, I am either searching endlessly on Uptodate.com for diseases and treatments, or I am sitting in a corner of Tower 3E reading in my medicine book. After the hectic schedule of surgery, I was looking forward to more time to learn and comprehend. However, I have a feeling that by week 6, this will all be very boring.

Our call schedule is q4 with no weekends, which meant that I was also on call Friday as well. That night was a little more interesting. I did many blood draws, an ABG, and an ekg. I also saw a male patient with liver cirrhosis, hep c, external hemorrhoids, and 2 very large and in charge scrotal hernias. He has had these for over 20 years and currently it looks like 2 medium sized soccer balls dangling between his legs. He says it is painful and uncomfortable to walk.....ya think?? Unfortunately, he can't have surgery because his liver is so bad.

The last patient before I left on friday came in with a severe asthma attack. She had a superimposed upper respiratory infection. We tried several courses of albuterol and solumedrol with no relief so she had to be intubated. She told us she has had this happen in the past, 3 times, and she also said her last one was very painful so she requested to be "put out" for this one. Unfortunately, it didn't go as planned. Ativan and propofol was pushed IV and the intubation was very difficult. Turns out, the IV was infiltrated and most of the medication ended up in her arm. They re-established an IV (2 of them) and was able to get her sedated enough to put the endotracheal tube in. However, she started fighting and trying to remove it, so they had to restrain her. I felt bad because she was in obvious pain and distress. I left around 9pm to come home, but I found out today that she did manage to self extubate herself around 11 pm which didn't make the anesthesiologist too pleased.

Today was a rather mundane day, or better yet, an average IM day. I get to the hospital around 7am. I proceed to check the vitals, labs, and radiology reports of our assigned patients. Then we (my 2 residents, a fellow student and myself) do a mini round on all of the patients. At 8:30, the attending shows up and they again go over and round on all the patients. At 10am, we have morning report where we hear of some of the admits from the night before. I have come to find out that IM doctors love to hear themselves talk!! They will debate tiny details for 20 minutes, or at least until they have exhausted every possibility and then they move on. At noon, we have lecture which is good and bad. Good because it gets lecture over with at a decent hour. Bad because it is during lunch and I find myself dozing off. Today was especially bad....the topic was Anion Gap. Very boring.......and easy to fall asleep to!!

The afternoon was really slow until family members of one of our patients showed up and started screaming at the doctors. They were upset, but for good reason. Their father had been in the hospital for 3 days and his condition was worsening. They were also questioning why he was being treated for alcohol detox (for DTs) when he doesn't drink. The daughter was yelling questions and yet none of the doctors were giving her any answers, or if they were, they were not explaining themselves very well at all. Then they walked out of the room with no explanation and she became even more upset. I really couldn't bite my tongue any longer, so I did something I probably shouldn't have, but I answered all of her questions. I explained to her that her father was brought into the hospital by the police department who found him wandering around on a highway very confused and agitated. He could not give us a proper history of what had happened and he showed signs of altered mental status. Because of this, the initial treatment was to rule out the life threatening things that cause altered mental status.....trauma, bleed in the brain, alcohol withdrawal, etc. They started to treat him for DTs and he was responding to the treatment. The doctors were unaware that he had early onset dementia/alzheimers due to boxing injuries sustained for over 30 years and also did not know that he only spoke spanish. I was able to get some more history from the daughter as well as her father's normal baseline which I then passed on to my senior resident. The doctors then began to suspect a possible infectious cause and started the workup for that. I spent 2 hours with the daughter answering all of her questions and helping her to understand. She was very grateful and at one point said "How come you are spending your time to explain this to us when we can't get straight answers out of any of the other doctors". I told her it was because I was a medical student who had more time to devote to answering her questions. She thanked me for helping her and told me that she was sure I would make a great doctor which was a very nice complement.

Of course, it then got me thinking. She was right. All of the other doctors present took no time in explaining anything to her. They just said "Well, we are going to start antibiotics and get a repeat CT and we will go from there." But nothing was explained as to why or even what they were looking for. It made me wonder if being in medicine had caused them to be this careless in dealing with the patient/family or if this is just how they normally deal with things. Up until the point i started to talk to this woman, she was screaming that she was going to sue the hospital for malpractice and have the tv cameras down there. But once I talked with her and explained, she was fine...no threats....she just wanted the best care for her father and she felt like she wasn't getting it or any explanations as to what was being done to treat her father. As a doctor, you can be sure that if it was your family member, you would want the same thing....and in fact demand it. But I feel that many doctors don't step back to see this. And it becomes very costly in the end, because then you are not only dealing with a sick patient but a a very agitated, upset, and angry family whose only option, they feel, is a lawsuit. I can only hope that through my training and beyond I am able to keep my ability to communicate with patients and family members. And to recognize that I may not know all of the answers to every question, but I can do my very best to help find the answers.

I hope everyone has a good night. Take care.