I’m a week deep into my Internal Medicine clerkship and I’m happy to report that I’m loving it so far! Sure the days have been long, but there has been virtually ZERO instances of boredom within these past few days. Plus, the interns and residents I worked with this past week have been gracious enough to let my classmate and I out at least a couple hours early each day. (I’m supposed to be at the hospital from 6AM-7PM. Lol, yeah.) I’ve been learning so much new & pertinent information so far and have been able to watch that information be applied on real patients. I was in the CCU (Cardiac Care Unit) this past week, so the patients that I saw were those who had critical heart issues and who needed to be monitored on a constant basis. It was an intense environment full of healthcare workers who had to be attentive at all times to all the patients there. There was also a death on my first day there and a couple of other patients who were transferred to hospice care to prepare for their own passings. A pretty sad way to start off my third-year…but on the other hand, there was a good number of patients who were adequately treated and discharged from the unit! Also, the team that I worked with all week was full of pretty awesome people!
But before I get too deep into my experience at the CCU, let me step back real quick and touch on what I did on the day before I started working in the CCU. On Monday of last week, we (we as in the 30-or-so of us in the IM clerkship) had an orientation session specific to the Internal Medicine clerkship. Because I had flown in late the previous night from Miami and had gone to sleep around 2 AM, I was TIIYYAAD all day on Monday. But I was able to stay awake long enough to glean the important information given to us that day. We finally began to understand the sub-rotations that we were assigned to within the overall IM clerkship and we made our call schedules for specific sub-rotations that necessitated them. (I’ll be working four weekend days and a week of nights during this clerkship. Say it ain’t so! 😅) My IM schedule consists of:
- 1 week of Cardiac Care Unit
- 1 week of General Cardiology
- 2 weeks of Renal
- 1 month of Transitional Care
- 1 month of General Medicine
So as you can see, third-year is quite complicated to understand. I’m here still trying to figure out how all of this works, and I’m the one living through it! However, we got a better understanding of what to expect during this clerkship and we were handed a bunch of papers to better supplement our knowledge. We then attended a few sessions, which included a Geriatric interactive presentation where we talked about different ways to properly care for the elderly, an ultrasound activity where we practiced how to perform a transthoracic echocardiogram, and a trip to the Crisis Control center where we participated in a simulation that enabled us to consider what living in relative poverty felt like and how powerful the concept of “generational poverty” can be on underserved populations. ‘Twas an interesting & busy day but by the time the last session (Ultrasound) rolled around, all I could think about was how nice it would be to collapse on my bed. I ended up crashing around 9 PM…only to wake up at 4:30 AM to start my first day on the CCU.
My first day up there was not really what I expected it to be. Then again, I had absolutely no idea what to expect in the first place. I walked up to the unit dressed up in a shirt and bowtie, only to be notified that I was supposed to be wearing scrubs. Go figure. After changing into scrubs, my classmate and I got assigned patients, which surprised us because we were previously told that we were going to be merely observing today. So we researched our patients and went to meet them. My patient had suffered a heart attack and was scheduled to have stents placed in his heart to open his occluded coronary arteries. He was a pleasant man to take care of, and I was actually able to watch the procedure he needed (Percutaneous Coronary Intervention) the next day! After getting the information I needed for my patient, the team and I all began our morning rounds, where we presented our patients to the attending (head doctor in charge) and visited our respective patients as a group. This took almost FOUR hours. FOUR. HOURS. It turned out that this was a particularly busy morning and that rounding this long was unusual, which relieved me. The experience was really cool though and having to present to the attending on my first day was quite challenging, to say the least. Especially since I wasn’t aware that we would have to do so. But she was understanding and gave both me and my classmate some useful advice for presenting patients, something that she continued to do throughout the week. After that marathon morning of rounding, we were notified about a patient who was not recovering from his acute condition and who would end up passing away that day since there was nothing that the team could do for him anymore. My classmate and I joined the Cardiology fellow on our team as he sat with the patient’s family to discuss the unfortunate circumstances that he was in. The conversation was a heavy and sad one where the whole family was in tears, but they were also understanding of the situation. The fellow handled the conversation very well and I’m grateful to have been able to witness that conversation, because I’ll definitely have to have those conversations with the families of patients that I will be helping to treat in the future.
The afternoon consisted of a third-year med student conference that we were required to attend (we have these conferences almost every day), following up on our respective patients, writing notes on them, sitting in on an impromptu lesson from the fellow, and talking with the team about a variety of things. I was actually surprised as to how flexible our time in the afternoon was. I found that I could actually get quite a lot of stuff done in that time, which is very good to know moving forward. We were free to leave around 5 PM and I immediately felt the fatigue hit me once I got back home. Crazy thing is, I needed to study and review material that I had forgotten during my post-Step vacation. I also realized that my mind was still in vacation mode, so I had to force myself to snap out of that mentality. I got a little studying in, but ended up crashing again around 9 PM, only to do it all over again the next day.
I won’t go into length on what I did each day because then I’ll be sitting here typing this forever. But it’s worth noting that each day had a similar schedule and although it has been a busy week, it certainly beats having to watch a lecture in the classroom. Even the whole “having way less free time” thing hasn’t bothered me that much (yet). I think my body is quickly adjusting to this new lifestyle of waking up before dawn and going to sleep at the same bedtime I used to have when I was like 10. In addition, I was able pick up a new patient on my second day, but I struggled on my presentation because he had multiple co-morbidities that needed to be addressed in addition to his chief complaint of chest pain. Turns out he had a stomach bleed that I was able to see via an esophagogastroduodenoscopy. (EGD) (Try saying that five times fast.) We had to take care of that before getting to the chest pain he had, which hadn’t bothered him ever since his stay in the hospital. I stayed with this patient until I left the unit on Friday and as for my first patient, he was discharged on Thursday. As the week progressed, I found that I was getting better at giving presentations, I was getting more accustomed to the flow of rounds, I was learning a lot more about asking pertinent questions & performing pertinent physical exams, I was bonding quite a bit with my patients, and I was running around with my classmate trying to watch various procedures being done on multiple patients. We were able to watch a Foley catheter being put in as well as two heart stents being placed in the cath lab, but we missed the placement of two arterial lines and a thoracentesis. Darn. The team was also very gracious to us in answering any questions we had, chatting with us on the topic of choosing specialties and in giving us very helpful tips on necessary third-year skills. They were also getting a laugh at how enthusiastic we were about this new lifestyle. Before I knew it, it was Friday afternoon and we were leaving the team that we had befriended pretty quickly. My classmate and I were legitimately sad to have to leave them because we had been having such a great time with them. But alas, we must continue to expand our medical horizons!
Overall, my first week of third-year has been a great one! I’ve already learned so much and I was made aware of just how much more information I need to learn. I also found myself thinking about various things like how much medicine has changed over time and how amazing procedures such as PCIs can save someone from heart damage in 20 minutes while a heart attack 100 years ago was, as far as I know, pretty much a death sentence. I also noticed myself often thinking about both the patient and their family’s perspective in the hospital in parallel with my own perspective as a third-year medical student and just how different our worlds were in the moments that I saw them during rounds. No wonder many doctors have written countless books about their experiences in the hospital…this type of stuff really gets you into deep thought. I could personally write a narrative on the thoughts I had while helping to take care of the two patients I was assigned to this past week. And that’s just after a week of being in the hospital. Who knows what I’ll come across these next twelve months and in the foreseeable future as I continue my medical education.
But as for now, I’m done with this post. I gotta review some Cardiology for this upcoming week lol. I hope you enjoyed reading this! Have a wonderful week!
“One can choose to go back toward safety or forward toward growth. Growth must be chosen again and again; fear must be overcome again and again.” – Abraham Maslow
– Black Man, M.D.
P.S. – Today is the two-year anniversary of my one and only acceptance to medical school! Shoutout to the Wake Forest School of Medicine for taking good care of me! I’ll be forced to (literally) repay the favor to the government for temporarily funding my education, but this is one investment that I’ll voluntarily (though quite begrudingly) go into debt for!