Half time

This is where we spent the last two nights of our honeymoon. And although it has been some time ago now, I will never forget our experience there.

The first half of the internal medicine rotation is nearing, and I can't begin to tell you how much I have learned. Not only that, but what I'm learning is far different from anything learned by reading a book. They say we learn best by doing; well, they is correct. There's nothing like admitting a patient with some rare disease and then reading all about it at home and how I will spend the next few days treating the person.

The residents/interns/attendings switch rotations at the end of the month. Yes, even attendings get assigned a month of ward or clinic duty here and there, just like on House. I suppose what I'm getting at is, yesterday was my last day with Andreoli and that team; today was a whole new bunch (sans one intern) of interns, a resident, and an attending. The students, however, don't change locations until the beginning of next week. This gives us some continuity between groups - those patients covered by the students can easily be made familiar to the new interns and resident during the students' last few days on the ward. Almost everyone is moving either between wards and clinic, or perhaps from one ward to another. I, however, not only am on wards again, but I am on the same team. In other words, our new team today is the team stuck with me through the end of August. The other three students with whom I work will change on Monday and be replaced by two others. It will almost be an all male team, except the attending and that one intern who also didn't change locations. The two of us will stick out seven out of our eight weeks together (they started in July a week before we did).

I've seen a lot in these last few weeks. I've seen large, draining chest tubes go in guy and stay there for a week draining nasty fluid, a few different venous lines go in or come out of folks, I assisted on a lumbar puncture (spinal tap) (which I probably shouldn't have since the guy was HIV positive); I've seen some patients wither away to death and others come back from looking like death was near; and I've seen diseases at the VA that one is much less likely to come across while working at University. This is because our patients, the veterans, come to us, and only us. Other people can to to University, Baptist, St. Vincent, their little clinic in PoDunk BluffVille, AR, or wherever they want, thus spreading out the locations of rare conditions. The vets, on the other hand, come to us a total train wreck - sick as hell and unable to go anywhere else.

Another thing, even more gratifying than anything else, is that most of my patients really seem to enjoy my company. I even had one of them tell me today that I was the light of his day - he was referring to the otherwise bleak overview of his care by the nurses and others at the VA (more on this later). Others have just flat out said, "I like you Dr. Bradley." Yes, I have been called Dr. Bradley - no new Dr. Bears yet, though. It's not that I'm a better people person than the interns and docs on the team - it's just that I only have three or four patients at a time to take care of, meaning I can spend more time with each one of them answering questions.

But I have learned other types of things, and have had some not so good experiences as well. I have come to realize the unbelievable unreliability of some of the nursing and assisting staff. Our team has a wonderful social worker, a greatly knowledgeable pharmacist, etc - I am not referring to any of them. It's the nurses and their aids. We want to monitor a patient's urine output, but we can't rely on what has been recorded except on rare occasion when we know there is a trustworthy nurse on our side. I want my patients to get their pain meds on time so we can get a potentially painful procedure done on time and pain free, but I often have to hound them until it gets done. Now there are many of them, particularly on our floor, who are just wonderful and will bend over backwards to get anything you want done, done. But when we have patients on another floor, the simplest of things can be a huge fiasco. It most aggravates me when I see a note written by a nurse, perhaps even an APN or PA (advanced nurse practitioner or physician's assistant) from an outside clinic, that claims no abnormal physical findings on a certain part of the exam when it is clear as daylight - it may even be behind their chief complaint. The inaccuracy of some of the charted notes about these patients makes life difficult sometimes.

In other news, still anxious to get to the new (used) house. We've got colors for the walls picked out and painting supplies purchased. Just two weeks until we begin painting and moving. Come over for dinner sometime.