Well, I finally finished medicine. I can't help but shout a good and proper WOOHOO!! because I really was getting pretty tired of it, after so long. Don't get me wrong, internal medicine is important, and of course I have to know how to manage a heart attack or a stroke or blah blah blah. But honestly, so much of medicine is simple paper pushing, or dealing with "soft admissions" (someone who really didn't need to be admitted but we did it anyways to cover our asses), or patients trying to get out of work, or whining about pain. I exclude the ICU from this criticism, because I feel like I learned so much from my two weeks on ICU. Those patients are actually sick, and because there are less of them but with more problems, you can really dig into the physiology aspects of all of the disease processes and get a bigger picture of sepsis, end stage renal disease, end stage cancer and post-operative management. I have two more weeks on ICU coming up that I am really looking forward to, but I just wish that my surgical program required us to do two months of ICU, instead of forcing us into a month of medicine.
My last day of medicine included a 24 hour call. In our hospital, the night shift manages the patients for 6 nights a week, which means that their night off must be covered by a 24 hour call. It's not so bad, but they only put two interns to cover a fully functional hospital, which includes things like discharges, transfers, writing daily progress notes and taking in lots of new admissions. Our census was especially full this weekend, and my co-intern and I could see that things were going to be somewhat nasty. I agreed to take step-down / telemetry (boo!) so that I could also get the ICU, gambling on not too much drama happening in the ICU, allowing me to focus on the extra-packed telemetry unit.
Boy, was that a stupid mistake. The previous night, a young guy came in after not being able to breathe for a long time. Because he was young and healthy, his heart came back after several rounds of cardiopulmonary resuscitation, but the damage was already done and his brain had suffered from lack of oxygen. It was a very sad case, made worse by the fact that his family was so calm and quiet through the whole thing. I spent the whole day fighting back tears and thinking of my parents, and how awful it must be to suddenly lose someone so precious to you. (This was made worse by the fact that this patient was SMOKING HOT, which I know shouldn't matter, but it was like God gave a gift to women and then selfishly took it away. Just wrong.) So I spent the morning accompanying him to the CT machine so that we could evaluate the extent of damage, then talking to the family about options for transfer.
 | |
| The sanitized version of putting in a chest tube. |
I had not yet been able to write a single progress note on a patient when E, one of my favorite surgical residents, mentioned a patient of mine on telemetry who seemed to have fluid building up in the space around her lung. This patient had just undergone a very minor and routine surgical procedure the day before, and her chest x-rays were getting progressively worse. E paged me to say that it looked bad, and since her oxygen saturation was dropping and she looked pale, we would have to place a chest tube and try to drain whatever was accumulating. We were all hoping it would be pus or some other fluid, and not blood, but the odds didn't look so hot. E generously offered me the chance to put the chest tube in, which I jumped at, because I had never done one myself and I knew I would have to when I rotated at an outside hospital.
There are times where the human aspect of medicine collides with the surgical aspect of medicine, and it's frustrating because it's so easy to just dismiss the human part. This patient spoke very little English, and she and her husband were both frail elderly people. We explained multiple times, with a translator, the emergent need for the tube, why we needed fresh blood samples, and why it would be better if everyone stepped out of the room for the procedure. But it was hard to stay patient with them as they struggled to understand - all they could see was that we kept sticking her with needles for blood, and why weren't those samples good enough? And why can't our daughter come in, and our son-in-law, since they all speak English? And why is this so serious? And where is the attending who did the procedure yesterday?
