Internal Struggles

You know it's a good day when you wake up before your 5:30AM alarm on a Sunday and make funny little popping noises with your mouth - just because it's fun - as you head into the shower to get ready for a day at the hospital. Then again, there are the days when you stagger toward the bathroom in the dark and accidentally drop your retainers into the wastebasket, then have to kneel on the cold tile floor to dig for them because you've already taken off your glasses and refuse to turn on the light just yet. I had a lot of both types of mornings during my eight weeks on Internal Medicine.

On the first day, I wanted to quit almost immediately. The nine third-year medical students doing the Internal Med clerkship at my hospital during July and August had an orientation session for an hour and were then sent up to the floors to join our teams on rounds. I received the briefest of introductions to the team and then was swept up into rounds, feeling completely overwhelmed and unsure whether to try to participate (and if so, how) or to try to be as unobtrusive as possible. I became sure that I would be completely unable to function in this setting and that my performance would score far below expectations, and that this was absolutely not what I wanted to do for a career. There was no way I would be able get through this one day, I suddenly knew beyond a shadow of a doubt, let alone the eight weeks of Internal Medicine and the remaining two years of rotations.

Yes, fine, roll your eyes. I made it. It's just that I'm not good with change. I always hate the first day of school/work/anything because I just can't take the uncertainty. What should I do and how will I learn how do it and when should I do it? What is the schedule? (Oh please, God, let there be a schedule!) What I always want to know is, Is this how things are going to be? And if I can't know all of that right up front, can't someone at least show me where the bathroom is and tell me when I'm allowed to eat lunch??

You can measure how comfortable I am in a situation based on how many times I use the bathroom. None of us peed on that first morning, I think. Because really, how do you ask the attending or senior resident, "Excuse me, may I take a quick bathroom break while you continue with the whole healing-and-saving-lives thing? And if you don't mind my asking, where might I locate said bathroom?" You don't. You just figure it out, make a mental note whenever you pass a door with that relieving symbol on it, and stop drinking anything at breakfast, or, for that matter, throughout much of the rest of the day, at least until you get a better sense of when you might be able to run off quickly to relieve yourself.

Eight weeks is a long time to work 10- to 12-hour days 5-6 days a week with a lecture for your lunch “break.” I guess you could say it builds character. I did indeed figure out how to make myself useful, and at times I would like to think that I actually contributed to patient care. I definitely struck up some good relationships with my patients, and the feedback I received was, for the most part, quite good. I think it’s safe to say that internal medicine will not be my field of choice. It’s obviously an important field, training most outpatient adult providers, hospitalists, and those who go on to further subspecialize in cardiology, gastroenterology, hematology, etc. But there aren’t enough procedures for me, not enough laying on of hands other than for the daily palpation of a patient’s abdomen and the quick check for edema in the ankles. There also isn’t enough decisive action for my taste; many times the internists call consults from specialists and then decide which recommendations to follow. They monitor blood pressure and electrolytes and watch out for infections. But mostly, at least in the hospital, they coordinate and deliver care to damp down the latest exacerbation of a chronic illness that will not be cured upon completion of the patient’s hospital stay. Patients with COPD will still have COPD when they leave; they will just be able to breathe a bit better than during their most recent attack. Until we see them back again the next time.

Although it’s not for me, I’m glad that I started out with Internal Med because it gave me a great base on which to continue building my clinical knowledge and skills. But I’m really glad it’s over.