Tuesday, March 9, 2010

Internal Medicine - 2 Days In

Well, I'm two days in on my internal med inpatient rotation. Life is already 100 times better. I start later and get home earlier. The doctor that I'm with this week is amazing. She is young, super smart, and very personable. I can't believe how much I've already learned. I feel very fortunate for this rotation. My days starts with getting our census, deciding which patients I'm going to see, go see my patients and prepare my note, find the dr and finish rounding with her, present my patients and go see them together. She told me today that I did a good job, so hopefully all will continue to go well.

And of course my stories.

Patient 1- she's elderly and in the ICU and on a ventilator. She's been there a few weeks and her family decided yesterday to withdraw care. While I rounded on her, I realized that it was probably the last day she'd be alive. I just patted her hand, knowing that her name will most likely not be on my list tomorrow. It's sad, really sad, but she's been miserable and she keeps waking up, feeling her vent and gagging. It really is no condition to live in.

Patient 2- brought into the ER because of coffee ground vomiting and hypotensive. Turns out, she has hepatitis C, alcoholic cirrhosis, and esophageal varices from both her alcohol disease and her eating ibuprofen like candy. She really has to give up alcohol, and she seemed like she was ready to make that move. But she refused a social worker to discuss AA. It's really hard especially since her husband drinks every night. In my discussion today, we talked about her hepatitis C and where it came from. She admits to using drugs and sharing needles in her past. "Well, it's what everyone was doing." Looking at her, you would never ever guess that she was an IV drug user back in the day. I mean, she could have been yours or my aunt. She told me that I will make a really great doctor. It's good to hear that even though I had that type of conversation with her today she was willing to look past my "lecturing" and see that I really care.

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