Wards

On Monday, I officially moved on from psych (well, technically I took the exam last Friday, but whatever) and began the three month adventure that is Internal Medicine. Medicine is our longest rotation of the year, and rightfully so, as no matter what type of doctor you end up being, the basics of how to care for sick adults is going to come up on a daily basis. Luckily, they break up the 12 weeks for us a good deal--we spend a month on the wards (the hospital floors where the sick people get admitted), a week on palliative care, three weeks on one subspecialty (something like cardiology, GI, endocrinology, infectious disease, nephrology, or ICU medicine), two weeks on another specialty, and two weeks on vacation. During my vacation weeks, I'll be spending a week in the NICU playing with tiny babies. The fact that I'll end my semester doing so is probably the happiest news I've received in months. I mean, have you seen how cute and tiny they are?!?! (Ahem. I digress.)

I was actually really excited to start medicine because, unlike psych and ob-gyn which are so focused in scope, here I would finally get around to something that felt like doctoring. Learning how to manage patients with everything from pneumonia to heart failure to cancer to HIV. Stretching my skills at diagnosis and discovering the best treatment modalities for things that I've heard about on paper but never seen in real life. The fact that I've still not ruled out med-peds as a dual specialization for residency was in the front of my mind when I started on the wards at our local VA medical center Monday morning.

Sadly, so far the experience has not exactly been what I was hoping. The first day or two were quite frustrating--full of lots of sitting around with nothing to do, working with residents who will leave me tomorrow and move to a new rotation and therefore have essentially stopped caring about anything but their most essential duties (not to say they're not caring for patients, mind you--they just don't really care about things like teaching me to use the computer system or going through a differential for my patient with a probable stroke). I get to start working with a new team tomorrow and Saturday, and I'm hoping they might be a little less jaded from their month at the VA and a little more enthusiastic about teaching. It's hard to figure out if you really might like to work in a specialty for your entire damn existence when the people you're working with don't give you a good picture of what it's like.

There are definitely things I can tell I like so far--I enjoy my patients and seeing them in the morning, cracking jokes while I listen to their lungs at o'dark thirty. I enjoy thinking through the process of exactly what is happening to them and why, and learning what there is to be done about it. These are the things I like about every specialty, and they are obviously quite available in medicine as a specialty option. The only problem for now is that I still feel so lost, so incapable of remembering enough to formulate a good differential (read: list of everything that could be causing the patient's symptoms, narrowed down to what's likely based on their history) and I just end up feeling kind of stuck wishing someone could sit down and talk me through what I'm thinking. It's getting better, and I'm getting more confident, but with only 4 weeks to get a feel for this business I'm hoping to pull a lot more out of the next several days.