August 19, 2007

• Great Moments In Medicine

  After 2 months rotating in internal medicine, I am finally beginning to feel like I have a handle on things. My History taking skills are pretty solid, my physical exam could still use some work, but what i do, i do well, even my assessment and plans resemble the ones actually decided upon by the residents. I also can totally relate to the characters in scrubs.

  The other day I was percussing a patients liver span, basically going through the motions like I had been taught in school, since I still had no real idea what the change was supposed to be, when all of a sudden, the percussion sounds changed. As in, I realized that without realizing it, i had actually begun to perform the exam correctly, and what’s more, I realized I was doing it correctly. I continued to percuss the patients liver and then spleen amazed at my newfound ability. A piece of the puzzle had finally dropped into place.

  Of course, being the mature young future physician that I am, in my head was playing on repeat Queen and David Bowies “under pressure” while i was percussing the abdomen to the bassline. “Doo Doo Doo Doo Doo Doo Doo Doo. Doo Doo Doo (tap tap) Pressure! pushing down on you, pushing down on me no man ask for”

  Any pain when i press sir? No?

  “Under Pressure-burns a building down, puts people on streets um ba ba dey”

  I think he can be discharged tomorrow after a scope

  “Its the terror of knowing what the world is about, watching some good friends scream ‘let me out’”

  Patient needs a colonoscopy, is declining, and requesting to sign out AMA (against medical advice)

  But yeah you get the idea. My life the scrubs episode.
  

  Funny AND true

  Another great moment I should share happened not to me, but my friend. He was taking a sexual history on an teenage adolescent and asked about partners, activities habits and the like. He then had to come back and mention to the patient on a completely unrelated note that she had a flare up of herpes type 1 (for those of you wondering, this is the one which give you cold or canker sores, occasionally vesicles on your lip, and is NOT sexually transmitted). Of course, when he delivered the news that she just had an outbreak of Herpes type 1, or oral herpes, the patient got quite offended and yelled back,

  “That’s impossible! I don’t suck dick!”

  *chuckles* oh, those patients.

  So my medicine rotation comes to an end this friday, and looking back, I would say I have enjoyed it greatly, both the experience itself, and those I interacted with during the rotation. As I make and update the list of fields I may want to go into this year, here is how things currently stand

  Josh’s Career-O-Meter

  Internal Medicine- Absolutely stays on the chart…about 60% of medical students go into IM out of med school, and it looks like I may not be different. In terms of specialties within IM

  Infectious Disease: Who Knew? I love seeing ulcers, abcesses, draining pus, and figuring out what exactly is going on with the patient. The more disgusting the better, and once you do know the disease, you immediately have an idea what antibiotic to start. This one stays on the radar, and it only has a 2 year fellowship! bonus!

  GI: How best to describe what I enjoyed about GI?

  
  that ought to do it well. And believe me, it is true true true

  Cardio: meh. Not super excited about it, but neither am I repulsed. It stays on the mind for the moment
  Nephrology: Same as Cardio, though I dont get excited about the kidneys the way I do about the intestinal tract

  Lets watch as the career o meter advances through the year, shall we?

  • 12:40 pm
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