Internal Medicine: A Retrospective Analysis

Having just survived one of the toughest rotations of clerkship, I thought this might be an appropriate time for a little research and analysis....you know....some highly significant statistics, qualitative measures and general anecdotes to describe the last six weeks of my life. The following are official results census results (n=1).

The location: Concrete hell.
A modern marvel of ugly architecture. Every ward is set up differently to ensure that you can never find the chart, the vitals, the forms you need, or your patient. All teaching rooms and call rooms are as far away from the light of day as physically possible....I think this is so that we all lose the drive to escape or something!

The hours: Long.
At least twice over the course of the rotation I worked greater than 100 hours in a week. I have discovered that the human body can keep going long after the brain thinks it can't. And in fact that brain just packs up and leaves, giving up the hope that the body will be rational, leading to such shenanigans as 10km rollerblades and 2 hour bike rides after working a 10 hour day! Now if we refer to Grey's Anatomy (being a reliable source of TV information about medicine) we learn that greater than 80 hours is not safe for the health of the average person. Maybe Canadians are just tougher than wussie Seatle based fictional docs :P

The job: Scut worker.
This is a highly important job where you are responsible for everything and nothing all at the same time. It is your job to see the patient, write notes, write orders, talk to the nurses, call the lab and xray departments to schedule appointments or get results, and be the liason with other teams that are seeing the patient. But at the end of the day - you have no signing power. Kind of nice considering it would be scary as hell if I had the power to order anything I wanted, but unfortunate because it takes twice as long to get anything accomplished while you hunt for someone to cosign with you. A blessing and a curse I say.

On call: Inefficiency at its best!
Little does the puplic know why being seen in the emerg takes so long....first of all you see a triage nurse who decides how important you are. Then an ER nurse who takes your info. Then the ER doc who orders tests. Then the ER doc think you probably need to be admitted so he refers you to medicine. Then you are seen by the Clerk (the one shining spot in your day! hahaha) who writes a brilliant note detailing your entire life story, every mediciation you have ever taken, your mother's brother's second cousins medical history, and a detailed plan of action. (Please note: this plan of action always ends in - Will discuss case with staff....cause we don't know what the heck is going on.) Then your case is presented to the senior resident on call. Picture any movie/tv show you have seen where a crowd gathers at the bed and summarizes the patient in medical speak - this is pretty much exactly what happens. The resident does NOT write a brilliant note, they write something illegible along the lines of - please see excellent clinic clerk note, agree with above. Then the resident orders the right tests (curses the ER doc for being such a fool) and puts in orders to have the patient admitted. The house staff (aka. all use medical types) try to get some sleep but come back and forth checking on lab tests. If you are lucky you get a bed up on the floor instead of sleeping in emerg. And in the morning the whole case is repeated AGAIN to the attending physician. By now you have been poked and prodded by 14 nurses, 17 doctors, 8 xray techs, 4 lab people and probably the janitor, spent 15 hours in emerg and your entire case has become one great big game of telephone.

Karma: alive and kicking!
Karma is definitely something you have to watch out for the in hospital - especially while on call. I made the mistake of complaining one weekend that I had wasted my entire weekend by being in the hospital because I hadn't had a patient all day. Yup, you guessed it, I was up ALL NIGHT in emerg seeing patients. Never, ever, open your mouth to complain. It can and will get worse!

Honourable mentions:
1. Best patient - my palliative care man :)
2. Best resident - Mike. He paged me 15 minutes after I went in to talk to a difficult patient so that I would have a way to escape!
3. Best lecture - morning rounds where we got to see the magnetic stimulation machine they use to treat migraines
4. Best pearl of advice - "Don't order a test unless you know what you are going to do with the result. It's like ordering a serum rhubarb...if you don't know what the hell to do for a high rhubarb level then you shouldn't even find out what it is."
5. Best fight - evil ER nurse vs. my senior medical resident at 3am over who was going to follow who's orders. DRAMA!
6. Largest amount of blood seen - dude on the stretcher in emerg who puked blood EVERYWHERE leading me to run away so I could stop gagging.
7. Most dramatic case - an overdose we took straight to the ICU
8. Most common case - ruling out heart attacks
9. Most bizarre rare case - an enzyme deficiency where the man could not metabolize nitrogen (which is found in protein) so when he didn't follow his diet he would end up confused in emerg with a high ammonia level which makes your brain swell! (for lack of a less technical way to describe it!)
10. Most steps taken in a day - 15,000 in 24 hours. Although the honourable mention here should really go to Liza who manages to take 22,000 in only 8 hours working as a waitress.

End result - I kind of want to do internal medicine! I'm actually really on the fence here. I thought I would barely make it through these 6 weeks and there were actually only 3 days that I didn't feel like going to work. I woke up every morning with a smile on my face....this has thrown a complete wrench into my plans!

Thank you internal medicine for the amazing patients, the steep learning curve, the sleep deprived delirium and all the good times :)

Lots of love
Pamela

p.s. For all of you who got the mistaken impression from my last post that I have become mature....I jumped in puddles in my dress clothes on the way home from work this week, skinned my knee on my coffee table and then wore a skirt anyway (like a 5 year old proud of their wound!) and almost got asked to leave tutorial because I couldn't stop laughing after someone likened a patient's condition to a cat having a fur ball!