I still feel like I am where I belong. Not as a student, but in medicine in general. I enjoy doing what I do, even if I did have to spend the week looking like an idiot trying to learn the ways of the ward, and I have a ton yet to learn. Perhaps I will describe a typical day to you.
I arrive on the floor around 7AM, since, for now, I am new to this and arrive a little early to give myself extra time to get things done. On a day I am carrying three or four patients, which is most days from here on out, I see two patients between 7 and 7:45 after reviewing their charts for any overnight events. You never know when your patient fell overnight and required a head CT because no one will tell you, not even the patient if they hit their head hard enough. I then make the ten to twenty minute trek over to University Hospital where those of us students in the IM clerkship have a daily (except on Wednesday) one hour lecture. I then go back to the VA and see one or two more patients before 10 AM. At this time, Dr. Andreoli arrives and we go over any X-rays, CT scans, or MRI's which might be useful. Andreoli then inspects our clothes and our pockets for labeled pens before we head off to see our patients. Our team usually carries between 15 and 20 patients, each of which requiring a stop by the entire team in the morning. Frequently, in between patients, Andreoli will drill (pimp) us in the hall; sometimes it's about something pertinent to the patient we just saw, and other times it is only pertinent to him in the form of history about some famous doctor we've never heard of. One might ask just how famous are these doctors, then? I can't give an answer for this one. When rounds finish around noon or slightly before, the upper level resident runs through the list of patients and comes up with plans as far as what to do about them. Then it's lunch time. Often times, there is some conference we are expected to attend. Sometimes there is lunch at said conferences, but sometimes there isn't. Unfortunately, these too often require a trek over to University. After lunch, we head back to the VA and write notes on all of our patients - the so-called SOAP notes where we address the Subjective and Objective aspects of the patient's condition, followed by an Assessment and Plan for patient care. By this time, we have sent some patients home, and others have come to us. It is up to us to then go do complete histories and physicals on these new people. After all of that is done, and the gathered information is written up into the patient's chart on the computer, it is time to go see our other patients to see how they are doing. At last stop, it is wise to take one final look at the patient's chart at the end of the day to see what actually got done and what got put off until the next day. And, of course, mixed in all of this is the occasional little task to complete or lecture by our ward's director to attend. All in all, the average day on wards ends between 5 and 7PM. They make for long hours, but they usually go by at a decent pace. Tomorrow, I begin my first of a twelve-day stretch without any days off. Good times.
In other news, we finally looked at a rental house today. Aside from it being pretty far out west, it's not a bad deal. It's a three bedroom, 2 bathroom, 1200 square foot house for $850 a month. The best part is, there aren't any neighbors right next door, and the area is pretty heavily wooded. It would be a good deal, but I want to look at a few closer houses yet. It may not be too long before we move out of this dang apartment. Of course, if we do decide to move to a larger place, this will undoubtedly come with a higher rent than what we pay now, and I will just have to put off getting a new car until my truck dies beyond repair (i.e. spontaneous combustion, alien abduction, drowning in the river, nuclear holocaust, etc).
I arrive on the floor around 7AM, since, for now, I am new to this and arrive a little early to give myself extra time to get things done. On a day I am carrying three or four patients, which is most days from here on out, I see two patients between 7 and 7:45 after reviewing their charts for any overnight events. You never know when your patient fell overnight and required a head CT because no one will tell you, not even the patient if they hit their head hard enough. I then make the ten to twenty minute trek over to University Hospital where those of us students in the IM clerkship have a daily (except on Wednesday) one hour lecture. I then go back to the VA and see one or two more patients before 10 AM. At this time, Dr. Andreoli arrives and we go over any X-rays, CT scans, or MRI's which might be useful. Andreoli then inspects our clothes and our pockets for labeled pens before we head off to see our patients. Our team usually carries between 15 and 20 patients, each of which requiring a stop by the entire team in the morning. Frequently, in between patients, Andreoli will drill (pimp) us in the hall; sometimes it's about something pertinent to the patient we just saw, and other times it is only pertinent to him in the form of history about some famous doctor we've never heard of. One might ask just how famous are these doctors, then? I can't give an answer for this one. When rounds finish around noon or slightly before, the upper level resident runs through the list of patients and comes up with plans as far as what to do about them. Then it's lunch time. Often times, there is some conference we are expected to attend. Sometimes there is lunch at said conferences, but sometimes there isn't. Unfortunately, these too often require a trek over to University. After lunch, we head back to the VA and write notes on all of our patients - the so-called SOAP notes where we address the Subjective and Objective aspects of the patient's condition, followed by an Assessment and Plan for patient care. By this time, we have sent some patients home, and others have come to us. It is up to us to then go do complete histories and physicals on these new people. After all of that is done, and the gathered information is written up into the patient's chart on the computer, it is time to go see our other patients to see how they are doing. At last stop, it is wise to take one final look at the patient's chart at the end of the day to see what actually got done and what got put off until the next day. And, of course, mixed in all of this is the occasional little task to complete or lecture by our ward's director to attend. All in all, the average day on wards ends between 5 and 7PM. They make for long hours, but they usually go by at a decent pace. Tomorrow, I begin my first of a twelve-day stretch without any days off. Good times.
In other news, we finally looked at a rental house today. Aside from it being pretty far out west, it's not a bad deal. It's a three bedroom, 2 bathroom, 1200 square foot house for $850 a month. The best part is, there aren't any neighbors right next door, and the area is pretty heavily wooded. It would be a good deal, but I want to look at a few closer houses yet. It may not be too long before we move out of this dang apartment. Of course, if we do decide to move to a larger place, this will undoubtedly come with a higher rent than what we pay now, and I will just have to put off getting a new car until my truck dies beyond repair (i.e. spontaneous combustion, alien abduction, drowning in the river, nuclear holocaust, etc).
7 comments:
Need a roommate? I kid, sounds like good times. How are the patients? Do you seem to have an inordinate amount of mouthbreathers or are most of them ok?
Patients on the ward are much different than the patients you saw on an outpatient basis. My patients are all acutely ill, most of them over 65 years old, and several aren't in a normal state of mind. It's therefore hard to call anyone mouthbreathers, some have just been negligent of their medical needs and clinical visits until worse came to worse.
All I heard there was... "I don't feel comfortable calling them mouthbreathers out loud yet... some are dumbasses, some are demented, some are ok." I saw some ill people in the ER, and I did rounds in Hope on hospitalized patients and the majority of them were fine, there were angry ones and demented ones, however. I think you need to read House of God so when I ask you about your GOMERs you know what I mean ;-).
I do understand that most of them are severely ill, but people that are ill still can be ok to deal with or total pains, I was just curious how you found your patients to be, aside from needy.
I think you'd be surprised. Most of the patients at the VA are overly greatful for the care we provide them. Some of them quite enjoy having an entire team take care of them; it allows them frequent human to human contact with many different people. While some of my patients have made poor decisions in their past, I refuse to call them stupid. Besides, outpatient follow up isn't our concern like it is family practice; so, in that respect, call them what you will, I have no experience.
Fair enough, I was just curious of how you saw the patients. It's encouraging that you see them in a predominantly positive and remarkably objective light. Granted no one is perfect and everyone makes mistakes, my comment about the patients being stupid or dumbasses was intended more out of comic relief for the patients that drive doctors crazy than out of true disrespect or cynicism towards the patient individually.
Garrett's turning into House more and more everyday.
That's a bit harsh, eh? I have no retort, but I'm not even seeing patients, how can I be that diabolical? I like most patients...
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