Back on Call



And believe it or not, I'm not complaining about it. Why would I? After my first week of internal medicine, I've come to realize that when I'm on call is the only time I'm going to get a chance to do any real medicine. Sigh.

Honest, I'm not complaining. Thankfully, it looks like my experience in Internal Medicine is gearing up to be WAY better as a resident than it was as a medical student. For starters, I'm now working in a centre with much less of an emphasis on "shame-based learning" as we affectionately refer to the art of pimping. People seem more interested in making sure you learn something than they are in publicly humiliating you for what you don't already know. Second, my team rocks. I have an attending who is so nice that she often has trouble convincing people that she's an internist. My senior is very non-initmidating, reasonable and approachable. I haven't met the other junior yet... she's on vacation this week. But so far, so good...

The teaching on this service is amazing. We get a minimum of two one-hour teaching sessions a day. Very different from family medicine, where I got... well, none. So far I've learned about aortic stenosis, aortic sclerosis, toxic epidermal necrolysis, nonspecific elevations in liver enzymes, what those clotting tests we order ACTUALLY measure, atrial fibrillation, asthma, rheumatoid arthritis and a bunch of other topics that I've probably forgotten already.

But believe it or not, call was good. And not only because I actually got some sleep (although those of you who have been reading my blog since my surgery rotation can understand what a difference an hour or so makes) but because I got to practice medicine. See, internal medicine isn't exactly medicine. Or at least it isn't medicine if you're the JMR (Junior Medical Resident). My days are spent 'managing my patients'. In plain English, this means chasing down lab results, filling out paperwork, attending endless "meetings" to plan discharges for people who are just taking up acute care beds with no acute medical issues.

At night, however, things are different. And not bad different. Rather than being left on my own to sink or swim with dozens of very sick patients with no backup (yes, referring to that damn surgery rotation again), I am part of a team. I have someone to refer to if I feel like I'm in over my head managing the ward. In addition, I get to see the consults to medicine from the emergency room. Some interesting stuff comes through there. My night on call saw two acute coronary syndromes (one STEMI and one NSTEMI), a post-ictal (after a complex partial seizure), a superior vena cava syndrome from a huge goiter, a new-onset SVT in a cancer patient, a COPD exacerbation and a rule-out Guillain-Barre. Pretty interesting stuff.

Internal medicine call. Interesting. I must be losing my mind.

Bring on the codes.