A day in the life...

After our unexpected week of "hurrication", I'm now about a week into my medicine rotation. Medicine is a rotation that I think most of us approach with a sense of intimidation; the schedule is notoriously tiring and the amount of information that you're expected to know is pretty much limitless. So far, that's probably been the hardest adjustment after coming off of OBGYN: going from having about 12 major possible issues to deal with to facing literally infinite possible diagnoses anytime you see a patient. It's pretty interesting though, I feel like I'm finally getting to see how all the stuff we learned in the last 2 years applies in "real life".
I realize for most people, the logistics for how inpatient hospital medicine works is kind of a mystery (it was for me until about a week ago). I figure I'll try and explain it here, so that my schedule is a little easier to understand. First of all, internal medicine docs are organized into "teams"; in our case, 1 attending (the "boss"), 1 resident (a 2nd or 3rd year), 2 interns (1st year residents), and 3 med students (that would be us). We are on a q4 schedule, which means that we're on call every 4th night. On days that we are on call, any patients that come in (usually through the ER) are admitted by our team and followed by us for their entire stay in the hospital. When a patient comes in, one of us will be assigned to see them and do their history and physical, as well as come up with what we think the problem is. An intern and the resident will see the patient as well (which explains why, if you're ever admitted to a teaching hospital, it may seem like you have about a dozen doctors seeing you).
As far as our daily schedule, on days we are not post call we have "work rounds" with our resident at 8am. Before this, we need to see our patients and write up our notes so that we can discuss them and clean up our presentations with the help of our resident and intern. At 9 we have usually have morning report, where an interesting case from the week is presented, and then we round with our attending at 10. This can last anywhere from an hour to 3, depending on how many patients we have (our first day we had 14, luckily that is not the norm). During this time we finalize treatment plans for our patients, decide who can go home, etc. After that, we do whatever work needs to be done (writing orders, calling consults, etc). If we're not on call, we are done whenever our work is done (although most week days we have classes in the afternoon). If we are on call, we stay on until we've admitted at least 1 patient (usually til around 11pm, but this can vary). We get to go home on call nights, since the hospital doesn't have anywhere for students to sleep, but the residents and interns stay all night to admit new patients and take care of any problems that come up with any of the patients on the floor. The morning after call, we round at 6:45 and 7:30, and try and get our work done so we can get out early. This is great when its a weekend, not as nice when we have lecture until 5pm!
So, that was a very long description of what my life will be like for 7 weeks. So far, I like it pretty well. Internal med is notoriously Tulane's strongest program, the organization and enthusiasm among everyone involved is amazing. I'll update more as I get more experience, things are sure to get even more interesting when I go over to University hospital next month (aka the new Charity).
Some random, non-medical thoughts:
- We obviously did not end up having to evacuate for Ike. As horrible as I feel for everyone in Texas, I think everyone here breathed a big sigh of relief.
- Went to the Saints opening game last weekend. Hadn't been to an opener before, it was pretty awesome (esp. since we won). Too bad we couldn't follow it up this weekend.