Expectations of Internal Medicine Rotation

Xixi once passed on a piece of wisdom from an attending whom I like to lovingly refer to as Mary Lou.  Though my interaction with Dr. Mary Lou is limited to having attended several of her large room lectures and anecdotal accounts from the lucky few who have been her students, I have developed an immense respect and admiration for her. She is pediatric hematology-oncologist. Some may say it's a morbid job title...a doctor who attends to the unfortunate children whose short lives are or have been plagued by cancer...but I can only begin to imagine the joy and optimism of a job that can help to grant some kids a normal childhood, longer time with their families, and perhaps a healthier future.  My preconceived notions of her strength of character, emotional maturity, and unrelenting optimism aside, I have found her advice to Xixi down-to-earth and helpful.  Dr. Mary Lou told Xixi, nearing the end of her second year in medical school, to reflect upon and document her expectations of a certain specialty at the beginning of each rotation, and after each rotation to journal the actual experience.  Though family medicine and psychiatry rotations have come and gone, I will not let yet another rotation slip by.

Inpatient internal medicine at the VA:

I have my first month of medicine at the Jesse Brown VA, the hospital where I completed practicum and psychiatry rotation.  Logistically, I am more or less familiar with the VA computer system, which should be a plus when documenting patient charts.  Other than that, my expectations of my first month is laced with fear.  Now, at the end of the coveted orange space, I cannot say I am not disappointed at my lack of academic productivity.  Though I have accomplished lots of cooking, cleaning, and driving, I have not made much progress (if any) on research or studying.  Sadly, and perhaps inevitably, the knowledge of medicine that I hastily stuffed into my brain for Step 1 is slipping from my hippocampus like a rapid, uncontrollable mudslide.  I am afraid of being asked questions by my residents and attendings and only providing answers that consist of blank stares, mistakes, and vague shadows of the knowledge that used to exist. I am unconfident of my interviewing skills, my physical exam maneuvers, ability to make differential diagnoses and order pertinent tests, let alone devising a treatment plan. And the sheer breadth and depth of information is overwhelming, to say the very least. So, my expectation is that I will need a ton of help from a mightily nice group of teachers. At the VA, it's been my experience that the major types of pathology include various forms of heart and pulmonary diseases, diabetes, chronic pain, drug use and their exacerbations. Though I would love to see a wider range of diseases, I cross my fingers and hope that my first week is a lot of heart failure and COPD.  I am also uncertain about inpatient medicine, which invariably has sicker, more severe patients that require a higher level of monitoring and care.  I am afraid of making mistakes that are irrecoverable, which can bode very unwanted outcomes.  Before I digress into discussing all the possible mistakes I'm afraid of making, I feel a sliver of excitement over the increase severity of pathology and ability of follow patients through a prolonged time course until they are well enough to be discharged.  Seeing patients get better before my eyes was one of my favorite aspects of inpatient psychiatry and I am hoping for something similar in inpatient medicine.  By hearsay, the VA medicine nurses are not the easiest to work with.  I am going to need to put my best foot and manners forward, but I am expected to do that same everywhere. So when I wake up tomorrow to head for the VA at 7:30 am, I will take a large dose of enthusiasm and courage, and hopefully be blessed with a little luck for a enjoyable and educational month. 

Medicine at Mercy:

Mercy Hospital is where my mom works as a respiratory therapist.  From her frequent gossip regarding her run-ins with the medical residents, I am dreading the experience a bit.  Most of the residents at Mercy are foreign medical school graduates.  Though I should refrain from making any judgments of their medical skill and knowledge, I can't help but have notions of decreased calibers of teaching and less enthusiasm with students.  And, a community hospital like Mercy, in my opinion won't have the rigorous application of evidence based medicine and prudent medical decision making.  Hopefully, I am wrong.  Ok, I will adjust my attitude and check in with myself a month from now. 

Final words:

Internal medicine is an important rotation for me as I will most likely become a resident in this field.  Therefore, it is important to me that I enjoy this rotation.  Yes, I have been barely lukewarm about my placement at Mercy, but that just means I will try hard to make the best out of it. My goals are to learn as much as I can and obtain a solid foundation of medicine. At the same time, I would like to keep an open mind in the event that do not enjoy this rotation. Wish me luck!