Medicine Shmedicine

as obsessed as i've been with specializing in the treatment of the fairer sex, i have to say that i've really been enjoying internal medicine this summer. (internal medicine just means primary care for hospitalized patients- you're usually the ring leader monitoring and treating the basic issues (diabetes, hypertension, etc), ordering consults from the specialists when needed, and kind of in charge of the patient's hospital course).

i think i have my rhythm down. i'm getting pretty good at diagnostics and guessing in the ballpark what appropriate treatment plan to order. i'm still off on med dosing sometimes by a scary amount (i wrote for 32mg of something the other day, should have been 4, for example- what? so sue me! no one died!)...but so far i've either caught myself or been gently (indeed) corrected by a nurse or MD. my trusty PDA isn't always so trusty. i'm glad nursing and pharmacy will be checking and balancing me while i'm still getting it down.

while i don't want to do this everyday for the rest of my life, there are some really neat things about medicine and some amazing moments that i've shared in my time in the hospital. (by the way, "medicine" refers to all fields of primary medicine-family, internal, etc, as opposed to a specialty or surgery or something. the first time i heard a PA say, "i never thought i'd go into medicine, but here i am" when referring to how she chose her area of practice, i thought, "now that's odd...didn't you know when you started PA school that you'd be studying medicine? did you think it was, like, clown school or something?). aaaaanyway.....

certainly some encounters stand out.

i have a little sheet of notebook paper i've kept on my desk since my ER rotation that, in my hurried handwriting, says "THERE IS BLOOD IN YOUR STOMACH. WE'RE TAKING IT OUT WITH THAT TUBE. LEAVE IT ALONE. YOU'RE GOING TO THE ICU TO GET A BLOOD TRANSFUSION. YOU ARE VERY SICK. YOU ALMOST DIED." i kept the note, but i would never forget this patient anyway. he was a 19 y/o kid who had snorted so much heroin he had massive internal bleeding, was going into shock, and had completely lost his hearing. i will always remember his wide-eyed terror as he tried to pull his nasal gastric tube out and asked "am i going to be OK?". i keep the note to remind me that even on my dumb days, i have my moments. i was the only 'staff' in the room who had the common sense to, instead of just shouting louder when the kid shook his head and insisted he couldn't hear anything we said, got out a pen and paper and started writing to him, asking him the pertinent ??'s and trying to answer his. i may not have known what meds to push or how to intubate him, but i did know how to get through. and i guess i'm proud of that. something to hang onto.

i've had a few other moments that also felt like things are coming together for me. i've made a few pretty astute observations and diagnoses lately and i've had a few patients over the year who have gotten attached to me or i to them. we have one lady right now who is in a deep funk and in serious trouble medically, but who lights up every time i enter the room- we laugh together even while she's being dialyzed (kidney failure- machine does what your kidneys can't), on a rescue breathing machine, and dealing with pain from all the various surgeries she's endured. again- she's complicated, has a lot that needs to be tended to...which i'm starting to know how to tend....and she needs some kindness and attention...which i certainly know how to provide.

so i guess i like that things are making more sense to me and i'm more useful. (even though some days i'm still just a scut monkey). i'm again, over and over, so glad that i chose to become a PA. it's pretty darned cool.