Wednesday, October 01, 2008

Inpatient Cardiology

This is my first week of inpatient medicine/cardiology. I think it works a little differently at the other hospitals, but at CCF, we spend two weeks on inpatient cards and three weeks on inpatient general medicine (IM). Most people do IM first, but I have been scheduled to do cards first.

Monday was not the greatest start. I had paged my senior resident a few days earlier to find out when I should get to the hospital and where to meet, and he told me to be in the medicine residents' room at 8 AM. So I showed up on time, but then I sat around for the next hour and a half while he wrote his notes. Fortunately I had brought something to read, so it wasn't a total waste of time. At 9:30, we met with the attending and the rest of the team and started rounding. This made me realize two things: first, I really hate rounding for hours at a time. Second, it felt pretty weird to be wandering around the hospital floors all morning when I had always been in clinic or in the OR by 8 AM up until now. I think this has been the first time that I've been up on the floors while it was still light out!

After rounding for what seemed like an eternity but was actually only a couple of hours, we went to the IM noon conference. I had been to a few of these before, but not every day like now. They're not the most exciting things either, and I think the biggest reason people like to go to them is because we get free food. Then, we basically spent all afternoon doing scut. Scut consists of things like contacting outside hospitals to get medical records, sending faxes here and there, and making phone calls to various people. It's not very exciting, but it's still better than rounding because at least I'm doing something.

Monday night, I got to go home around 6 PM, but last night I was on call. That pretty much involves admitting people and answering pages from the nurses for this or that. The bad thing about call for the residents is that not only do we have our own team's patients to worry about, but we also cover the patients for three other teams as well. It's impossible to really know the details about 80 different patients, and the pages keep coming in nonstop all night long. The good thing is that seeing the patients is fun, and now I have two of my own patients to follow. They came into the ER and I did the H & Ps (histories and physicals) before we admitted them. After that, I got to sleep for a few hours.

This morning I saw my two patients again on my own before I met with the team for rounds and presented them to the attending. After my first kind of disastrous surgery call experience, I have gotten better about being more organized when I present. Right before rounds started, I printed out all the notes I had written so that I'd be able to remember the details and all the test results from the ER, along with the most recent lab values and vital signs. My patients are both very sick with multiple diseases, so there is a lot of information to collate. Since we were post-call, we got to leave at 1 PM after we signed out to the other team. 30 hours can seem like an eternity, especially when it's all you can do to keep from nodding off right in front of the patients and the attending while you round the morning after call.

Besides me, the attending, and the senior, there is also an intern on the team. He is really awesome. Since he wants to be a cardiologist, he is very enthusiastic about cards and has been going out of his way to teach me and help me with my notes. I've been doing extra scut for him in return, not only because he's nice and it gives me something to do, but also because I felt sorry for him. I think medicine interns must have the worst job of anyone with an MD. But when he found out that I had to take overnight Q4 call (every fourth night) with him and the senior for my whole rotation, he told me that he felt sorry for me! I hadn't realized that at a lot of other med schools, students aren't required to take overnight Q4 call. That does not thrill me, but at least I get the rest of today off. Tomorrow I will be back in at 7 AM to round on my patients.

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