Internal Medicine, その2

I can hardly believe that there is only one week left of my Internal Medicine rotation. While it does feel like I’ve been at Wyckoff forever, it also seems like time has flown by, especially with the (grade-determining) final exam only a few days away. It’s been a busy month for me so I haven’t had time to update as much as I would have liked, but here’s a brief description of how the second half of IM went for me.

For the other half of IM (which may come first, depending on how one is scheduled), students are assigned to an attending and are basically responsible for the care of that attending’s private patients. This is different in that one generally follows around 2 or 3 patients at a time from admission to discharge. Although students are not assigned to any interns or residents at this point, there are residents involved in the patient’s care who also follow the patient, and to whom a student must go to to order any labs, imaging or studies. The differences between this set-up and service duty are significant – generally, the patients are long-time patients of the attending. These patients have, in general, better insurance (which does make a difference, sadly). The most significant difference is that the students act as the go-between not only between the patient and the attending but between the attending and all the rest of the medical staff on behalf of the patient. The ultimate illustration of this is that students (ghost)write the attending notes. These notes are (sometimes) reviewed by the attending and become a part of the patient’s (legally binding) medical record. When I realized the implications of this, it kind of blew my mind.

At first, I was a little overwhelmed at the responsibility I held. One  morning, I came in to find that one of my patients who’d been on the telemetry floor was suddenly moved to the ICU – I beat myself up for a whole day wondering if I’d missed something in the labs that would have heralded her decline. I later realized that even if I had predicted that she’d develop unstable tachycardia, the only thing I could’ve done was ask the resident to send her to the ICU anyway and monitor her more carefully, which I did. She was eventually moved down to a regular floor and finally, sent home. In fact, I was lucky that all of my patients eventually were sent home.

My attending has been pretty cool – he loves to teach and share anecdotes about his days as a medical student, experiences as a resident and the different kinds of patients and crazy cases he’s seen, not all with happily healed endings. Occasionally, he’ll also dispense sage wisdom about random things to do with life in general or chuckle with the group about idiosyncrasies of the medical profession. He’s even offered to take the group out to dinner after our final, which is really very generous of him. Even though I was skeptical at the beginning, I’m glad I was assigned to the attending I got.

Everyone complains about rotations at Wyckoff but my experience has actually been pretty good. Dr. D, the head of internal medicine is actually really great and while certain attendings are better than others, there are so many opportunities to learn, whether from other attendings, residents or interns, or even other students. I even had the opportunity to do some research, volunteer and join a pediatrics interest group.  A few moments that really stood out for me: once, I was in the ER with Dr. M, my intern idol, when this other (tall, dark & handsome) resident asked if he could borrow me to assist with a physical exam. There was a an unresponsive patient spiking a fever and he wanted to search to see if there was any external source of infection. I suppose he could have done it on his own, but I’m glad he asked me to assist because it was an opportunity for me to practice my PE skills and to learn as well. It still gives me a little thrill to think of how he said my name and beckoned me to come with him.* Another time, I was visiting a patient in the early evening and Dr. S, an intern from the service group I’d been assigned to during my first six weeks, had just inserted an NG tube on the other patient in the room. He saw me and put me on the spot, asking how one can tell if an NG tube has been inserted properly. I had no idea. Instead of castigating me, he showed me how (use a syringe to blow air into the NG tube and listen with stethoscope over the epigastrium – if you can hear the air in the stomach, it’s in properly). That’s something I will always remember.

For my last week in IM, I’ll only have one patient to follow (a gentleman who has just begun radiation and chemotherapy but is in great spirits despite that) which is good because I really need to buckle down and study for the final exam. Even though the attendings evaluate us, the actual grade is determined by the final which Dr. D writes and nice though he is, I don’t think he’s going to pull any punches with the questions. Let’s hope I can score well on in so I can get 12 weeks of A on my transcript. Wish me luck!

*For a second, I marveled, ‘Wow! He knows my name!” but then remembered that it was right there on my ID badge, right below the most unattractive picture ever taken of me. :::sigh:::

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4 Comments on “Internal Medicine, その2”

  1. Anonymous Says:

    You are very inspiring to me…I take the step in 2 months and your story gives me hope. Wish you nothing but the best.

    Fellow rossie ’13

    • evilangelfish Says:

      Rossies Unite!
      Inspiring? This silly blog? Really?
      I’m happy that you’ve gotten a glimmer of hope from reading about my experience. Even though I’m only a few paces ahead of you on the path, we’re on the same journey, and if my stories can encourage you to keep going, then I’ve done something of worth, and not just rambled about randomness.

      I’ve rhapsodized about USMLE World and First Aid – they are excellent tools to use in your preparation to conquer Step 1. I wish you all the best – diligence, discipline and success. Good luck!

  2. Anonymous Says:

    What are the hours like for IM at Wyckoff? Thinking about commuting from Long Island…

    • evilangelfish Says:

      Hi Anonymous,
      I am so sorry that it has taken me so long to reply to your query! If you aren’t already at Wyckoff and have discovered for yourself the amount of time IM students spend there, here’s a rough idea. IM students are expected to attend morning report, which begins at 7:30. After morning report, they usually gather info on their patients or handle scut work from the residents until rounds, which generally take place between 9 and 11 but this may vary based on the attending’s schedule. There may also be an 11:00 am lecture (sometimes there will be a 3:30 lecture instead) and more scut work and patient care to do in the afternoon. Usually, students are done by 4:30 but occasionally, there is short call and students will be expected to assist in the ER following lecture until 7:00 pm. I hope this answer hasn’t come too late!

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