This week I started a new rotation at the Veteran's Hospital in Dallas working in the Infectious Disease department as part of their consult service. Also on Wednesday and Friday afternoons I see patients in the Immunosuppresion clinic.
Rotations are a funny part of life/PA school because you are constantly in a state of flux/change. (BTW if you didn't know, I hate change). You spend 3.5-8 weeks at one place and then you are on to the next thing. The progression goes about like this-- deer in the headlights, to competent clinician, to saying your goodbyes and repeat. I just spent the last ten weeks of my life in family medicine. . . The work wasn't really hard or mental invigorating, the hours weren't long. So I don't mean to tell you that I work hard currently but working 8:30-4:30-5ish, eating lunch at my desk, always thinking about what I haven't thought of yet and what I am missing has made for long days this past week. However, I truly love it at the VA. I liken it to a circus. Every day before I am in the building I pass the crossing guard who waves and says things like, "Hey doc, looking good." "Hey doc, think of me it is going to rain on my today." "Hey doc, you have that seat in your car pulled so far forward!" I got a pat on the back this Friday. Needless to say I can't help but smile walking into the VA (veteran's administration). I walk past a popcorn stand, boombox blasting music, a player piano, a canteen (anywhere else it would be called a cafe). If you wear a white coat at the VA you can't walk with your head down like I normally do in the hospital, consumed in my notes, thinking about the next person I am going to see... nope you have to walk ever aware of your surroundings because everyone you pass says, "Hey Doc" "How you doing, Doc" "How's your day, Doc" When I weakly tried to correct the first gentleman "saying I was a Physician Assistant student" he just smiled at me with a couple teeth missing and said "good luck, Doc"
This isn't why I love the VA though. I love the people and I love the work. Infectious Disease sounds exotic and some of it is Histoplasmosis, or Rocky Mountain spotted fever, or the Bubonic plague (yup still exists). But mostly it is HIV and Hepatitis. The Immunosuppression clinic on Wednesdays and Fridays is almost entirely HIV patients.
I had never met anyone with HIV until my first day on my ID rotation.
He came in so sick with Disseminated histoplasmosis, an AID's defining illness.
(just as an aside to keep this story interesting to people not in a medical profession: That just means ... there are certain diseases that are more common in people whose immune systems are compromised. When you see them in patients without HIV, as a good clinician you need to test that person for the illness.) This man did not know that he was HIV positive. His first night in the hospital, his wife calls and says she is sorry, for years she has been treated for HIV and though they have been having unprotected sex she never told him.
I love the work. In college, I studied psychology. Alot of psychology is about combating stigma... stigma about the profession, the patients you treat, the illnesses. So I am used to stigma.
Stigma is the most interesting thing about my work at the VA. As a health care professional, I can say with first hand expertise (although probably not the same expertise as nurses, whom I would consider the experts in this field) there are many gross diseases. (So unprofessional I know) But there is a long list of things the little girl inside me thinks are super gross that I see and treat every day. Sometimes I smile thinking about how my mom wanted me to go into medicine like it was so academic or scholarly. As an engineer she had no idea...
But I really can't get my head around all the stigma associated with HIV. One of my goals for this rotation is to learn how to communicate with HIV patients professionally, being aware of privacy issues and in a way that dispels stigma and judgement. Because truthfully, I feel neither of those things when I am with my patients. They are all patients with illnesses that need treatment and luckily treatment has advanced to a stage that we are able to help patients live long productive happy lives.
In one week, I have already learned so much from my patients about medicine, HIV, and humility. I love the work. Working with people how have given so much for our country and now I get to take care of them. I see my Papa Carl in each one of my patients. Growing up, he would drive 3 hours to go to the VA in Oklahoma. He had the same quiet respect, joking manner and history of service that these men do. I love the work I do.