|
SubscriptionsSites I Read
|
|
|
|
| 3RD YEAR IN REVIEW - PART 9 - INTERNAL MEDICINE:
1. This will be a short post that probably won't do internal medicine justice, as I am already 3 weeks into putting 3rd year behind me for good.  Internal medicine is basically what the first 2 years of med school prepares you for, what you usually think of when you think of doctors and hospitals. Heart attacks and pneumonias and asthma and cancers and all that jazz. And because of that, I think the rotation felt particularly fulfilling and satisfying, to actually realized that you retained a thing or two from the past $80,000. It is also the best run 3rd year rotation in my opinion, because I felt like students had a well-defined role, were included in patient care and as a member of the team, and got a lot of good teaching.
2. ACES: This was my least favorite of the 3 months, although I think I got a lot of insight into the world of primary care/private practice/non-academic/non-hospital medicine. Maybe I didn't like it as much because it wasn't what we're used to and what we've really been taught. They don't really teach you which statin is more potent, or which is generic, or when to give patients free samples of what, or when someone is narc seeking. I'm also a little bitter that I had to drive an hour each way every day to O'Fallon, MO, although gas was relatively cheap at that time and my horrible singing voice got a good work-out. My preceptor also did not do a ton of teaching or really include me much. I think in some ways we wrote each other off, once I told him I wanted to be a surgeon and once he didn't make much of an effort to include me. But all of that aside, I do think primary care is very important and should be a patient's first point of contact. Chronic medical problems do not fare well in an inpatient or emergency room setting.
3. The VA: As one of my residents kept saying, "I forget, this is a fake hospital." Sadly kind of true. Things just do not get done how and when they're supposed to. Labs won't get drawn, orders will disappear from the system, stat EKG's will take 3 days, patients that should be in the ICU will code on the floor daily, nurses will be frying chicken in the lounge. But systemic problems aside, as much of a nightmare as it is for residents, I think it was a good rotation for a medical student because I got to take charge a little more and got a little more involved in patient care. It was my first inpatient medicine rotation and I learned a lot and common problems like COPD, acute pancreatitis, GI bleeding, MI's, and diabetes.
4. Barnes firm: Also a good rotation as far as learning and patient care. I had a good team of residents and attendings who made an effort to teach me a lot, gave me responsibilities, but also let me go home early when I was done. I must admit I was pretty checked out by then, being the last rotation of the year. But still one of my most enjoyable months of the year.
5. I think this is said about multiple fields, but to me, internal medicine is definitely a "hurry up and wait" sort of field. You order tests or start new meds or put in consults, then you wait until the results come back. Sometimes it's interesting when you get good diagnostic cases and you get to figure out what's going on. Other times you just get the consult and do what they say. Or it's a chronic medical problem that the patient has been neglecting and is really going to be an ongoing primary care problem.
6. It is unfortunate that I think I'm becoming more immune to bad news, poor prognoses, and the overall misery of being in the hospital. We had one guy with AML, which has a horrible survival rate. Gave a guy neostigmine so that he would have diarrhea, unfortunately his rectal tube was not well-placed, so it was quite a mess. Had to tell a guy he has newly diagnosed HIV when he just came in for a rash. Had to tell a 30-something year old guy with untreated HIV for 20 years that he had lung cancer with probable liver mets. Had to tell a guy he might need a hemipelvectomy but it might not be worth it if he dies from lung cancer anyway. Had to talk about end of life care for a 30-something year old guy who had a bad sickle cell crisis, global hypoxia, and is now basically braindead. Sigh.
7. I am indescribable glad that third year is over. I think it was the hardest year of my life (considering that the past 24 were pretty smooth sailing). But it was kind of nice ending on medicine, sort of coming full circle, realizing how much I've learned over the year. Now onward and upward...
| | |
| 3RD YEAR IN REVIEW - PART 8 - ORTHOPEDIC SURGERY:
1. The moment of truth, what we've all been waiting for. I've long had ortho in the back of my mind since my days of sports medicine at Cal (go bears!). But that being said, I've had limited exposure to the day to day life and patients besides athletes. And as 3rd year has progressed and I haven't found myself liking much else, I was scared of both liking and not liking ortho.
2. I spent the first 2 weeks on peds ortho with a handful of overall really nice and fun attendings. I was allowed to saw through bone and drill holes and put in screws on my first day. The majority of our patients were one of the following: cerebral palsy kids with muscle contractures and maybe foot deformities, limb length discrepancies, various foot abnormalities (in-toeing, clubfoot, etc), scoliosis corrections, fractures needing pins or rods, and wound or hardware infections (blech). I liked how we could do some pretty drastic things to a kid (take out huge chunks of bone, totally alter the alignment of their legs), and they almost always completely heal. My favorite were probably the big osteotomies (the major corrective surgeries), least favorite was spine because they're long and tedious. The hours weren't too shabby for a surgical specialty either, OR days about 7-4, clinic days 8-4. Although I had to do inpatient rounds with the resident and go to conferences, so I still had to be there at 5:30-ish. But attending lifestyle is not bad. Although that may also be partly due to the fact that we were supposed to take trauma call, but they let us go home and never called us.
3. My second 2 weeks were on sports surgery, with one of the docs that works with the St. Louis Rams (football) and the lesser known Blues (hockey). Unfortunately we didn't go to any games or meet any pro athletes (not that I would recognize them anyway). I did see a million ACL tears, meniscus tears, rotator cuffs, and osteoarthritis injections, but I still really enjoyed it. I think the patient population is fairly skewed, given the high number of young patients who are active and athletic and healthy, but I did see my share of old ladies with arthritis. I only spent a couple days in the OR, saw a couple ACL and meniscus recontructions, arthroscopies, and some total knee replacements, which I also thought were really fun. This guy's life is even nicer, almost all outpatient surgeries, no rounds, no emergencies, pretty short surgeries.
4. I also had to spend a few days on the hand service, which would probably be one of my least favorite sub-specialties of ortho (that and spine). I liked correcting wrist fractures and sort of the bigger operations, but the carpal tunnels and trigger fingers and cyst removals were bleh. The hand exam is also pretty hard to master, in my opinion, knowing all the wrist bones and each protrusion and each joint between them.
5. Another thing that made me excited about this rotation: I think I've found an international rotation for next year! One of the peds guys does a lot of clubfoot stuff, and he goes to other countries to teach them how to use casting and bracing to correct clubfoot instead of surgery (which was pretty unsuccessful anyway). He has contacts all over the place and if you know me, you know I've always wanted to go to Australia and New Zealand. Turns out he knows someone in Auckland, so I should be able to go there for a month next year!
6. Ortho is still a pretty male-dominant field, with about 1/6 new female residents each year. That in itself doesn't really bother me, but I think it works against someone like me who is more quiet and reserved. As much as I loved this rotation, it was also one of the most...emotionally trying, maybe because I wanted to like it and do so well in it. But I got a lot of criticism for not talking enough or not showing enough enthusiasm, which I don't dispute, but it's one of those personality things that is hard to change overnight. I also think I got pretty lucky as far as working with nice attendings. I've heard stories about some pretty rough ones. I guess it's inevitable to work with people like that, in any field, but more in surgery. I just keep telling myself that I'm not going to become like that. But anyway, that's the new plan for now, I'd say I'm 75% sure I want to do ortho. The other 25% is maybe plastics, which I'm going to try at the beginning of 4th year, general surgery is kind of a distant third. And I guess I shouldn't write off internal medicine, which I just started.
| | |
| 3RD YEAR IN REVIEW - PART 7 - ANESTHESIA:
1. Or should I say, anesthesiology, because anesthesia just means loss of sensation, but pretty much everyone calls it anesthesia. I initially wanted to do this rotation in order to get more experience with intubating, starting IV's, etc. and if I were to go into surgery, to see how the other half lives. And after trauma surgery, I was just looking forward to a month of relative vacation. And I must say, the rotation delivered on all counts. In addition, I learned more than I thought I would about all different types of anesthetics and techniques and other commonly used drugs. I was also painfully reminded how little I remember about respiratory, cardiac, and autonomic physiology.
2. There are a lot of appealing things about anesthesia, particularly the hours, lifestyle, and overall strenuousity of the work (most of the time). The hours were generally 6:30 - 3 or 4:00 or whenever the cases ended (sometimes noon). There are always people to relieve you in the OR, so you get all kinds of coffee breaks and lunch breaks, while the surgeons must suffer for hours on end. And not that it happens every day, but the stereotype about anesthesiologists sitting back there doing a crossword puzzle holds some truth. If I hadn't been there, I think a lot of the attendings (the ones who have everything down cold and are never phased) would have had a good chunk of leisurely time. Another plus and/or minus, depending on what you like, is that anesthesiologists don't really have to deal with people's medical problems. They have to at least keep them in mind with regards to the anesthesia, but before and after the surgery, their hypertension or COPD or diabetes are not your problem. But on the other hand, it kind of felt like too short a time of care, because you talk to the patient for 10 minutes before the surgery, then they're unconscious the rest of the time. And then you escape while they're still groggy in the recovery area and never see them again. You've basically made sure they didn't die from a potentially deadly situation which you induced to begin with. I don't know, some people might like that, some might not.
3. I would say about 80% of anesthesia is what you typically imagine in the OR's. There are a few other avenues which, overall, did not appeal to me at all. They would include:
- ECT: While you induce convulsions in psych patients, you kind of want them to be unconscious. Therefore you need someone to make sure people don't stop breathing or something in the meantime. I was not a fan of pysch patients to begin with (see previous entry), and this was just very rote with very little reward or meaningful patient interaction.
- Pain: Can you imagine anything more painful than having people complain to you all day about how much pain they are in and how nothing has ever been able to help their pain for years and years?
- ICU/Critical care: I'm not surprised that I tend to gravitate toward healthier patients and fields that deal mostly with healthier people (it was one of the few things I liked about ob/gyn and peds). So ICU care, not so much.
- OB: This was actually one of my favorite parts of the rotation. I didn't see or do any of the regular epidurals for patients in labor. The entire time I was there, we always had C-sections or tubals going on in the OR's, so the day was probably more exciting than the average OB day. One morning, we had 2 back-to-back stat C-sections for feet coming out of the vagina. I also liked seeing the babies again. And the surgeries were all relatively short (a couple of hours), so I wasn't bored with 6-hour long surgeries.
4. The bottom line for anesthesia is sometimes it's exciting and interesting, sometimes it's uber boring. A lot of the time, it's pretty chillax. But when something goes wrong, it can go really really wrong (to the point of death). And sometimes there are major emergency situations where you're basically the bottom line, whether it's in the OR or codes on the floor. (on a sidenote, see recent article about usher's wife, whose heart stopped while undergoing anesthesia for a cosmetic surgery). Basically, anything that brings attention or excitement is a bad sign for the anesthesiologist. If you're doing your job right, it can be a pretty thankless one. You're kind of behind the scenes. Usually, the only time you get noticed is when something goes wrong. But ultimately, I think you really have to both like and understand physiology to do well as an anesthesiologist, and I doubt that is me. The overall package is pretty tempting, though.
| | |
|
