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Thursday, February 24, 2011

In true form: Internal Medicine in Review

Of all rotations, I was most apprehensive about Internal medicine at Scott and White. I was scared of moving to a new place, away from my husband and my dogs and the comforts of home, as well as the magnitude of knowledge required just to get by. Before the rotation, I was certain I would work in a clinic setting post graduation. I liked the 8-5 life and the comfort of always working with the same people and getting to know patients and families as they grow. After spending two months at Scott and White, I realized my preconceptions about this rotation were all wrong.

Instead of being something I just had to get through, Internal Medicine became my favorite rotation and the time flew by. I did not mind the long hours and would often be the last student on my team to go home because I wanted to take on more patients. Internal medicine is a unique rotation because you get to see everything in medicine. I was never bored and always curious. Above all, I learned to think on this rotation. I was a valued part of the team and became more and more able to put my plans into action.

This is also the first rotation I had experiences with death. I made an objective to hear and experience end of life issues during this rotation. I made an effort to go with my upper levels to hear the discussions with families. However, these experiences were nothing like the first experience with my own patient. I remember when Mrs. M. came in to the hospital for decreased energy. My differential was small, she was eighty-nine and had eaten like a bird for the past week. My plan was hydration, Ensure and a medicine to increase appetite, PT/OT and home. We found she had a UTI and treated it and she was getting more of an appetite and improving. She was going to go to a skilled nursing facility but could not go over the weekend so we kept her until Monday. On Monday she was constipated, we kept her a couple days to try and resolve the constipation but then it turned into a small bowel obstruction. KUB led to CT and we found a mass in her pancreas and addition metastases to her liver. All I could think about when that report came back was the first time I met her in the ER. Mrs. M died within the week. I did not realize this was going to be the last time she came into the hospital. I did not think we were going to be her last doctors. Waking someone up every morning for more than a week makes you feel a connection to them. I enjoyed being part of a hospital team. I got to experience so much with my patients and their families over a very limited time.

I have learned so much on this rotation about treating people and practicing medicine. It was bittersweet to leave. I enjoyed my time at Scott and White.