A tale of three patients

As I'm making my way through my month on the wards at the local VA hospital, I find myself slowly moving out of the realm of "OMG I'M SUCH AN IDIOT HOW DID I EVER PASS THE FIRST TWO YEARS OF MEDICAL SCHOOL" and more into the "ok, I may not know everything we need to do for this patient but I am at least competent enough to reason through what is for sure not happening and discuss with the resident the rest of what might be happening." In other words, yesterday for the first time I admitted a patient and was probably more than 75% correct about what was likely to be wrong with him and how to go about figuring out the exact diagnosis and treatment. I am also starting to feel slightly more comfortable about how to get around the hospital, call consults, talk to families, what my responsibilities are in terms of patient care, etc. It helps, of course, that I have a wonderful new team (for the most part)--one of the new interns is incredibly smart and with-it and also a really fun guy, and our upper level resident is much more approachable and less PIMP-tastic* than the previous one. My comfort level may change with the arrival of our new attending on Friday morning, but I'll hold out for my hopes that the progression of learning and competency will continue.

Today, I was carrying (aka in charge of seeing and taking care of) three patients. These three patients are interesting and challenging in different ways, and I think their stories are a really good representation of what medicine is as a career, a specific specialty, and a learning experience. So of course, for myself and posterity and all three people who might read this blog (Hi, mom!), I thought I'd share.

Patient A was the first patient that I "picked up" last week, who came to us with some pretty nasty diarrhea. A has multiple medical issues, mostly the result of years of rampant and untreated diabetes. A's medical problems are many, but we aren't really doing anything for most of them other than maintaining his current medications while we try to get his intestines under control. When I first met A, he was unhappy with me because I had to repeat a great deal of questions that he had already answered, and his attitude has not improved much since. Each morning that I speak with him, A typically tells me at least once or twice how little I know, how I am not paying attention to him, etc. This despite the fact that yesterday I stayed in his room an extra 20 minutes in order to cut his breakfast food up and assist him in getting ready to eat it. It can be amazingly frustrating to work with a patient who cannot understand that you are trying to help them, and A has been a learning experience if for no other reason than to learn how to do with people who will not be satisfied no matter what, and to treat them with just as much compassion as the kinder, easier patients.

Patient B was my next patient--a kinder, older lady who was recently admitted for a lung problem and was found to have a mass elsewhere in her body that we discovered essentially by accident. She is doing quite well, recovering nicely, but really needs to have the mass removed before it becomes a problem. Our surgeons want to remove the mass in the next few days while her lung function is still doing well, but she refuses to make a decision until she talks to all of her (many) children. We have stressed to both her and her spouse that sooner is better than later in terms of safety of surgery, and while the spouse seems to understand, she adamantly refuses to make a decision. I understand completely that this is a frightening choice that could have dire consequences, and therefore I have worked diligently to not rush B, but simply to present her with the situation as we understand it. Unfortunately, this too can be frustrating as you watch time tick away, betting against the clock that in the two weeks it might take to reach a decision that B's lung function will not deteriorate to the point that there are no more choices available.

Patient C is my most recent acquisition, a lovely gentleman with some intestinal issues. He and his family are sweet and wonderful and easy to get along with, and we will hopefully have a diagnosis for him soon so that he can go home and return to his normal and happy life. I look forward to seeing him every day, and the only challenge he presents is that of remembering how I treat him when I go see my other patients.

Medicine is interesting. I'm not sure if I love it or if this experience will tip me into the idea of Med-Peds over Peds, but if nothing else I feel like I'm learning a lot.

* To "PIMP", sometimes said to stand for "Put In My Place," is the process of attendings or upper level residents quizzing medical students on the intricacies of their patient's disease, some other random disease, or sometimes just ridiculously useless information that the attending or upper level feels the student should, by now, know. Usually comes with a negative connotation, as in those attendings who will continue pimping until the student doesn't know an answer, at which point the attending will ridicule said student for being an idiot who doesn't think his/her job is important enough to study for (even if that student had answered the first 99 questions correctly).