The good and the bad from my internal med rotation

I finished the first part of my internal medicine rotation today at the Royal Alex. It ended up being a lot better than I anticipated, and my only problem with my preceptor was that she tended to round a little too late for my liking. Otherwise, there were good teaching opportunities and many patients to learn from. Some of my better and worst moments are as follows:

I seemed to really have a good experience with my more recent admissions. Mr. G, a nice 82 y.o elderly gentleman, came in for a pneumonia. He had apparently been not coping well at home and got sick. Eventually, he ended up on the floor of his condo and couldn't move for a few hours because he was so weak and tried to drag himself across his floor to the phone, but couldn't. He was eventually found by home care and brought in to the hospital. It was a bit sad, though, because he's also depressed since his wife died, he had his driver's license revoked, and his children wanted him to move out of his condo to get a higher level of care. Essentially, he felt like he was losing a lot of independence in his life. I guess because I spent so much time empathizing with him, he actually told my preceptor that I was one of the best "physicians" he had ever met. That made my day, since I don't get those comments too often!

My other two admissions from my recent call shift, Mrs. W and Mr. M, were equally as pleasant. Mrs. W came in with presumed pneumonia, but then we realized she was in heart failure. Hers was an interesting story because she has an irregular heart beat (atrial fibrillation) and then had unusual abdominal pain on New Year's day, that we later realized was related to her heart failure. She was quite pleasant throughout the whole management, though, and I'm glad I had the opportunity to meet her. Likewise, Mr. M was a pleasant individual and quite agreeable to our management with him. Unfortunately he had quite severe pulmonary emboli (he was coughing up blood and having quite a bit of difficulty breathing), so it's unsure whether or not he'll survive this hospital stay.

Two other patients I quite enjoyed were Mrs. M (my 94 year old patient with cognitive impairment that I talked about in some earlier entries) and another Mrs. M, who came in with a cellulitis and diarrhea. The former Mrs. M was probably my favourite patient during this rotation, as she was normally quite pleasant. I hadn't seen her for over a week because of my winter break, but to my surprise, she recognized me when I returned and actually told me that she had missed me (as you can tell, I've been having a pretty good week)! Because of her cognitive status, she always found a way to amuse me as well. For instance, today, she spent time telling me how she had been having a rough day and had convinced herself that one of her roommates was a prostitute (her roommate, was in fact quite sick, and had probably kept Mrs. M up all night with her moans of distress)! The latter Mrs. M was also quite pleasant, and I always had fun talking with her because she would listen to what I had to say. It's too bad her family is so overprotective of her and that her diarrhea still hadn't resolved even though she's been in hospital for quite a while.

In terms of my not-so-good moments, I particularly remember Mr. G, a cantankerous elderly man who had a previous stroke. He was quite dehydrated and hypernatremic (high sodium in his blood) when I saw him. He was also quite sick, so I don't blame him for being so grouchy. We always had the hardest time understanding him because of his previous stroke, but because I saw him more often than the rest of the team, I began to make out words. Unfortunately, as I began to understand him, I realized that he was telling me to "F* off," and to "get the hell out of here." I was not very pleased, even though I later realized that he was that unpleasant with the nurses as well.

Another day I did not relish was the time one of my Mrs. M's had her heart failure and I had to stay late in hospital because I had to dictate some discharge summaries as well. One thing I never enjoy is having to stay late on a Friday evening when I could be home taking an evening nap. :P