Tuesday was a good day. As I assume is the case with most jobs (not that this is quite my job, yet), most days are OK, some suck, and a precious few validate all the work I do the rest of the time. On this medicine rotation I've had a surprising amount of moments that remind me why I love medicine (the royal medicine, not just internal medicine). Tuesday just had a few more than normal and it felt nice.
I explained atrial fibrillation, in extreme detail (diagrams included!), to the elderly daughter of an even more elderly patient and she was super grateful. Then I correctly called that that rhythm wasn't actually atrial fibrillation even though my supervising intern and resident both thought it was. (It turned out to be MAT). Then I saw another patient in the ER and spent more time asking questions than anyone else on the team (because I need to know useless answers to useless questions for assignments that residents don't have time to ask). After asking if she had any questions or needed anything else, she said no thanks and to tell my parents that they should be proud of how they raised me. Not bad!
Unfortunately, I next had to go up and tell that first patient's daughter that the elaborate explanation of AFib that I gave earlier (and the CT scan we sent her mother for) were unnecessary due to that misdiagnosis. So I redrew the diagram and honestly explained why we changed our mind and why that's a good thing. To my surprise the daughter wasn't mad. In fact she thanked me with big hug (after asking if that was ok).
Some days being in medical school is miserable. We rarely do anything useful and we mostly get in the way. Tuesday was not typical, but it was a needed reminder of why we suffer through the rest of the days.
MondayIL: BIBEMS is an acronym for brought in by emergency medical services.
TuesdayIL: The dosing scheme for azithromycin is different depending on what you're treating. For an STI, like chlamydia, you give 1 gram one time, but for pneumonia, you give 500 mg on the first day and 250 mg for the next four days.
WednesdayIL: The MAZE procedure is a really stupid, really cool surgical treatment for atrial fibrillation. As a last ditch effort to keep the heart beating normally, if a surgeon is already doing open heart surgery for another reason, they can slice or burn up the arium, literally making a maze for the aberrant atrial pulses. The SA node gets a straight path and can beat the sickly AFib depolarization to the AV node. This is a terrible way to fix this problem, due to the numerous complications of... you know... purposely scarring the hell out of the heart.
ThursdayIL: *Those really annoying standardized patients - the ones that torture us by not giving useful information until you ask about one very specific part of their history - are actually very accurate representations of many patients. I had a patient today that we were medically clearing for the psychiatric team. So, knowing that, I very gently asked about her current mood and then pressed a little to find out what had made her depressed. She listed a couple things but it didn't seem like enough to put her on suicide watch. Flash forward to ten minutes later. I'm asking about her smoking/drinking/drug habits (just to be thorough) when I learn that she is 30-something years sober. Great! ...also, uh... from what and why? Turns out she heavily used alcohol and cocaine after her husband and two children were killed in an accident. Only at this point did she offer up that this might still be part of why she's depressed. It can be hard to know what questions will get the patient to offer up that crucial detail.
FridayIL: The rheumatologist at my hospital teaches his subject matter with the ease that a dentist pulls teeth; even with ample pain medication it still hurts like a bitch. But after a tortuous half an hour of asking non-rhetorical questions to a room of unknowing and uncaring med student, we did eventually start learning a thing or two about messed-up-looking hands. Some takeaways:
If it looks like twisty-boney joint deformities: osteoarthritis. If the DIP joints are hyperflexed, the PIP joints are hyperextended, and the MCP and wrist joints are swollen: rheumatoid arthritis. If an old woman with fluid-filled solitary joint enlargement: gouty arthritis.
*Patient details changed for anonymity*
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