Wednesday, June 13, 2007

Week 1, Part 1

8.15am - Start 'rounding' with Dr. R, Hospitalist. See a number of patients she already had from previous days, so no full workups. Some interesting cases, including Acute Renal Failure secondary to Rhabdomyalosis after running a marathon. And a homeless patient who had been in hospital for several months (since February), who tried to drink his own urine. Twice. While IN hospital.
Only saw a handful of patients. Dr. R assured me that this is not the normal case, and she normally has twice as many.
Side note: She kept introducing me in this manner: "This is Dr. AMiB (well, my last name), he's actually a medical student who's shadowing me today." This got me confused, because didn't someone who went through a normal US school and residency have students with them on rounds, and know how to introduce them? I tried correcting her every time, but she kept doing it...i dunno.
11am - 'Grand Rounds' is what I'll call it, it was more a meeting, really. Went down to the Hospitalists office, met with the 2 other docs who were in hospital at the time, the Medical Director (also a Hospitalist), and the Case Managers from the different floors. Went over all the patients they had, and let the case managers know what is going on and what the plan of action and time frame would be. (Heard of a case of Necrotizing Fasciitis!)
After GR, saw a couple more patients, then Dr. R...left, the hospital. I was quite confused, really. I understand that being on call means coming in and admitting any Medical patient the ER decides to admit, but after rounds, what is there really to do? (At the time of this writing [Tuesday night], I have no idea what Hospitalists do for the majority of the day. I plan to ask tomorrow.) Hopefully I will find out or find something to do, because leaving at 12 after a few hours of seeing patients is kind of boring, really. Don't get me wrong, I enjoy the patients I see, but because I'm not allowed to go see patients by myself, should I just literally follow the doc wherever they go?! Most of them take care of personal things, or work on charting. This is time that could be spent wisely seeing interesting patients, but guess what?! Can't do that. (I'm not still bitter - I promise! :-P)

7.15am - Arive in OR
7.30am - Dr. C, Neurosurgeon, arrives in OR
9.35am - After 2 hours or prepping the patient, first incision is made. The patient was an elderly gentleman, struck by an auto. He had a mechanical heart valve, and was on Plavix (clopidogrel), a commonly used anticoagulant. He had a broken shoulder, open tib-fib fracture, as well as pretty severe head bleeding (due to the Plavix). Also, he has a Type 2 odontoid fracture. His C1/C2 joint is unstable, and his C3/C4 joint has rotatory dislocation. Also, the facet joints all the way down his C-spine are opened/problematic. At the C6/C7 joint, there is subluxation and the thecal sac is endangered. He is 10 days post-incident, and Dr. C believes he is ready to have surgery. An Occipitocervical Fusion is performed, fusing the occiput of the skull all the way down through C7. Graft taken from the right iliac crest, as well as allograft bone marrow was put near the rods to hopefully fuse them. The patient will have absolutely ZERO range of motion in his neck, as if he were permanantely in a halo. I really hope they caught the guy who did this.
3.15pm - After nearly 6 hours in open surgery, and 8 hours in the OR, Dr. C starts closing and I head out. I had had an amazing vantage point, standing at the head of the patient, looking straight into the posterior cervical incision. Dr. C was to my right, and a Trauma NP was to my left, assisting. I didn't even have to scrub in, since I was on the non-sterile side (I hate being sterile, and would've died if I had to have been standing there for this long). All in all, was an amazing day. Not many people my age or in my class can say they've seen what I've seen, and while I bitch and moan about what I don't get to do, sometimes (like these), I realize how lucky I have been.

8am - Started rounds with Dr. A, the Director of the Hospitalists group that does the Internal Medicine call for out hospital (the guys I'll spend most of the summer shadowing). Saw a number of interesting patients, most of which I can't remember at this time, except Necrotizing Fasciitis! Dr. Adrian says he hates that diagnosis, since it grosses him out, but as a student, I can't help but find it cool. So sue me (no seriously though, don't - I have no money, being just a lowly student! :-P)
Dr. A was an Attending at the same teaching hospital where he did his residency, and is very skilled in the way of Academic Medicine. He introduced me properly, as "AMiB, one of my medical students", and gave me my first real dose of PIMPing. For those of you not from the medical profession, here is a definition of pimping:

The term pimping is common slang in medical education to describe the process of attending physicians asking physicians-in-training (i.e. resident physicians or medical students) difficult questions — some would say just questions in general. This is usually used in a derogatory fashion by those being on the receiving end of questions, as in, "I got so nervous when Dr. Smith pimped me about the causes of pancreatitis!" According to The Art of Pimping by Brancati, German surgeon Walter Karl Koch first recorded "Puempfrage" questions in 1889 to be used while seeing patients with his students in Heidelberg. In America, Abraham Flexner noted on his visit to Johns Hopkins in 1916 that Osler (likely William Osler) used rapid-fire questions on his students.

And let me tell you - it sucked. I'm taking this as a sign of how little I know, although I believe Dr. A was asking me questions that I wasn't really supposed to know the answer to (the only one I got right was looking for splinter haemorrhages in cases of Infective Endocarditis). Wow, I just realized how overboard I'm going with these links. Oh well.
We had a few admits in the ER, including a homeless man in alcohol withdrawal and associated seizures, who chose to use the ER bathroom floor instead of the toilet to take a dump. How nice of him!
Also, a patient with renal failure, probably due to an unknown obstructive uropathy (wheee I love big words :-D), and a really nice lady with cellulitis of the arm.

Near 1ish, Dr. A told me he was going to step out for a bit, and to go grab lunch. He said he'd call me when the next admit came in. So I went to the Physician's Lounge, grabbed some of the free pastries and coffee they had there, and just sat and watched TV while I waited for a phone call. Eventually it came in, and we met up again in the ER. We admitted the cellulitis lady, went up and saw a patient who had been in surgery during morning rounds, and then that was essentially it. He said I didn't have to stay till 6, as I had probably seen plenty of good patients. I agreed, and said I would head home. But I kind of wanted to see what he would have said if I had wanted to stay the whole shift. Would I have just sat in the Physician's Lounge again? Maybe done nothing in their windowless office (it's in the basement, definitely not their fault lol)? I dunno. Will see when I go with Dr. S tomorrow. Apparently, Dr. A says that if I thought his pimping was bad, I just have to wait until Dr. S's. I'm a bit scared. Will bring my PIMP Protector with me!

OK, so I've decided to post this first half of the week, just to see if you guys like it, and just so you don't think HIPAA has dragged me off the face of the earth (which they may well do after this post! :-/) Please leave feedback in the comments, lettering me know if the style of the post is good. I thought that small, daily posts would have been too annoying, so decided to go for a Weekly one. If y'all think it's cool, I will probably continue like that for the summer. So...yeah. Here goes!