Can't make this stuff up

I haven't written in a long time as I've been on a rotation that is notorious for being the hardest and most grueling. i.e. internal medicine (also fondly referred to as infernal medicine).

Since I have an exam in two days and I don't really know why I've been compelled to write so late when I should be studying, here are some clinical vignettes for you to peruse, for a taste of life as a clerk in internal medicine.


CASE 1 - TRANSFER OF CARE

Mrs. C is a patient that I've followed since the very start of the rotation. She is now medically stable and has been transferred to a floor specifically for patients waiting for nursing home placement. I went in to say goodbye today, and the conversation went a bit like this:

Me: So Ms. C, you've been transferred to a new floor and you'll be waiting here for a nursing home.

Patient: Yes, that's what they tell me.

Me: So you're medically stable now, and I won't be able to see you everyday. I also start a new rotation next week, so I won't be here. I wanted to say goodbye and good luck.

Patient: Oh, I see. Well, thank you dear for all you've done. I've appreciated all your visits and I wish you the best of luck in your studies.

Me: Thank you Ms. C, it's been my pleasure.

Patient: Well, maybe I'll see you again one day.

Me: Oh that would be nice, but I should hope not, as I want you to be happy and healthy.

Patient: Well, maybe one day I'll see you in heaven...

[I smile and nod.]

Patient: ... or in hell!

[I walk away perturbed.]



CASE 2 - THE LOWLY CLERK PART 1

My attending is a swell guy but he just does not know my name. I'm not quite sure if he cares to, but my fellow clerk and I have been called "young ladies" ever since we've started. Here is a taste of what it feels like:

"So young ladies, what shall we learn about today?"

"So young ladies, what do you think?"

"So young lady, are you ready to see the patient?"

"So young lady, have you seen resident so-and-so?"

And today was the best because when I answered a question wrong, I got:

"NOOOOO young lady, that is not correct."



CASE 3 - THE LOWLY CLERK PART 2

Twice a week us clerks go to teaching sessions taught by residents. It is one of the few times where we can participate in friendly banter, uncensored. It goes something like this:

RESIDENT: So if your patient has a raised anion-gap metabolic acidosis, your differential diagnosis would include -

OVERHEAD: CODE BROWN, FLOOR 5. CODE BROWN, FLOOR 5.

[All the clerks turn their badges around to check what a "Code Brown" is. It means "hazardous spill".]

RESIDENT: Betty, what did you do this time?

ME: What do you mean, are you saying I have diarrhea?!?

FELLOW CLERK: Yes, Betty has a code brown on floor 5, every day, all the time!

[Laughter ensues, teaching session continues. Teaching session finishes and I go to the bathroom as I haven't had the chance to urinate all day. I exit the bathroom and everyone is outside waiting for the elevators.]

OVERHEAD: CODE BROWN ALL CLEAR. CODE BROWN ALL CLEAR.

[More laughter ensues.]


CASE 4 - END OF AN ERA

My team and I meet on a floor where a problem patient lives. When left unattended in her room, she screams and bangs on the furniture until she is let out and placed beside the nursing desk so she can scream some more supervised. She has been a fixture of our floor, because she has been there at least since January, when I started my surgery rotation way back in the day. The funny thing is, she'll yell and yell but if you ask her a question she'll stop screaming and give you the most normal response. Then she'll start screaming again. It's a bit like this:

Patient: HEY YOU! HEY YOU! HEY YOU!

Me: MJ, did you have a good night's sleep?

Patient: Yes. Very good.

[I walk away.]

Patient: HEY YOU! HEY YOU! HEY YOU!


This morning, I saw the patient in a stretcher and asked where she was going. After almost a year on the floor she is being transferred to a long term care facility. Later in the day, we didn't hear her screams. It felt hollow. It is truly the end of an era.



CASE 5 - MISTAKEN IDENTITY

I had to perform a mini physical exam for evaluation and I really wanted to impress the doctor marking me. So we happened to do the exam on one of patients who liked me very much and I thought this was great. It went a bit like this:

Me: Thank you very much Mr. V. for being the subject of my exam.

Patient: Oh yes, for sure dear, anything for you. [He looks at my evaluator]. She's been great, you know, I'd be lost without her. She's taken care of me very well.

[Evaluator nods approvingly.]

Patient: She's even set everything up for me at home.

[I beam.]

Patient: Yes, Betty will make a wonderful nurse one day.


D'oh! The whole time he didn't even know I was a medical student.


In my medical opinion, you know you've gone crazy when: You're on the internal medicine service and 1) you ask and beg for more work; 2) you cannot stand or sit still in one position because you feel you must be busy doing something all the time; 3) you'd rather stay in hospital past 5 PM than go home to what you perceive as "nothing"; 4) you're insanely jealous when everyone has the new RED pocket medicine and you only have the old blue one; and 4) you think that you actually would enjoy internal medicine if forced to specialize in it.


This post is dedicated to my former middle school teacher Ms. Clark, who told me a personal story that inspired me to ensure all my patients were happy with their care in hospital, especially their meals. When one of my patients failed to receive a turkey dinner over the Thanksgiving weekend, I immediately switched her from a minced diet to full diet. While I worried that night that she could have aspirated on solid food as she had no teeth, she was alive and well in the morning and quite happy with having solid food from then on. While I can't change the fact that the hospital food is actually delivered from Ottawa (because it is apparently cheaper than actually making it in Kingston?!?) I was glad that she could get the turkey she was dreaming of for days.