I started my Internal Medicine preceptorship at the beginning of Fall quarter with high expectations to see really awesome things and have a great student-mentor relationship with my attending. Unfortunately, the nocturnists here work 10 days on, 20 days off so that means I only get 2 consecutive weeks with each attending spread out among 3 attendings. While I saw some really awesome stuff (lots of liver/kidney failure, pulmonary embolisms, etc... and their sequelae), I feel that I missed out on that mentorship opportunity. Most days I would come hang out with the chief and junior resident with minor involvement on the attending's part. Dr. G was much more involved than the 2 other attendings, but the nature of the night rotation puts a lot of emphasis on the residents. There was not much continuity among the residents either as they are constantly switching through different services. That said, my last night was my best night all because of the 2 residents that I had earlier in the quarter, Andy and Elise, and Dr. G. I stayed from 7:30PM to 3AM, about 3.5 hours past my normal shift since I don't have class the next day.
Some notable moments:
- On my first day, a 3rd year brought me to Ms. J who came in because sepsis, alcohol cirrhosis of the liver, and cholangitis. She was waiting for a liver transplant, but had to wait for her cholangitis to settle before that happened. I ran into her husband 5 weeks later in the lobby and asked how Ms. J was doing. He told me that she was here for an appointment a few days preceding and she had fallen and broken her hip and numerous bones. He was distraught. He told me she was all he had and he quickly started talking about other things like travel. I think he just needed to get his mind off his wife. I went to see her and it sent chills through my bones. The happy funny woman I had met on my first day was now in very bad condition. I told them I'd keep them in my thoughts and I had to scurry off to start my shift. I am not sure what happened to her and I'm not sure I want to know. It would be too sad.
- Last night, my last night at this preceptorship, I drank a big cup of coffee and drudged into the hospital thinking that I just need to get through this last night and I can go off to another preceptorship next quarter. I came into the team room and a resident took me down to the code. I recognized Andrew and Elise. It sounded like a patient who had a CABG, endartarectomy, and angioplasty (that's what I pieced together from all the talk) had ventricular fibrillation leading to cardiac arrest. There were about 30 people in the room and they were doing chest compressions. Suddenly, another code went off and a bunch of people ran through the hall to the another room. I followed Andrew and ran with him. The main thought that was pacing through my head was "running through the hall in the hospital is AWESOME". Turns out that the code was called prematurely and the team in there had it under control so we returned to the other code. Suddenly I hear "OH FUCK" behind me and there was the family. One woman was standing against the wall in tears, soaking in the situation--the other one was audibly distraught. The attending described what was happening and the family decided to stop the compressions. It was the first death I have ever witnessed. It is not as harrowing as it sounds--I barely felt anything. When they called it, the night team and I went back to the room and just went on with our night like this was another checkbox on the list. Maybe because it was not their patients or maybe this is just what you have to do in hospital medicine to get on.
- I got my first dose of pimping. I decided to stay for teaching rounds. I wanted to stay on other nights, but I always had class the next day and teaching starts at 1-2AM. I thought it would be over my head, but we talked about adrenal insufficiency and we learned quite a bit about this in histology. Despite that, it took me awhile to apply my learning to real world situations. When Dr. G asked the group of residents, I was able to answer a few questions about: 1) HPA axis and control, 2) why patients with insufficiency also have impaired pigmentation (because ACTH and MSH are in the POMC pathway, and 3) what fluids do you give to these patients. Mic drop. Dr. G reassured me that the stuff I am learning right now is important and that I should not doubt myself in the face of residents because most of them actually forget this stuff. Andrew said that this is the kind of stuff he loves - working through problems, and you don't get that in surgery. Alright medicine, 1 point to you.
I am sad to go. If the other 9 nights were like the last night I had, it would have been the most ballin' preceptorship ever. The last night made the whole quarter worth it. Perhaps I will come back to shadow through a night.
On to orthopedics/sports medicine for Winter quarter.
