The “House of God” was written by Samuel Shem. It was about a doctor, freshly graduated from medical school, and starting his internal medicine residency. I had to re-start reading the book about three times, because each time I’d get about half-way through and then something would come up. When I’d try to pick up from where I left off, I’d be so lost that I just thought it better to start at the beginning. I wasn’t a big fan of the work. I mean, the story was interesting to read as a medical student, but the writing style was ugh for me to follow. And I thought the protagonist was far too pessimistic and cynical.
When I started my fourth year internal medicine elective in the general internal department, I felt like I was at the BMS Hospital myself. Gomers and gomeres abound. One gomere yelling, “Ma’am! Ma’am! Ma’am!” over and over again somewhere down the hall. Another patient urinating in his bed pan in the hall. The smell of C. diff diarrhea floating abound. I lost count of how many palliative patients there were on the ward. Many were frequent fliers. I don’t think I saw a single patient under the age of 40 during my stay there.
Maybe it was the book, but my view of internal medicine has forever been tainted. And having shifts in the ER was the worst. Awesome trauma cases would roll in. All the doctors would jump to their feet to see what had come in. As a student, I was excited, watching all the action. I even got to perform CPR on a patient one time. But that was about as exiting as it got. Because these cases would be handled by the surgical side of ER. As an internist, I got stuck with the headaches, the pneumonias, the diarrheas, and the drunks. And there was no treatment. There was partial diagnosis. There was the BUFF and TURF, as Shem would put it. Every single patient, every single ER shift. The resident I worked with prided herself with clearing all the beds – either through discharge, or by shipping the patient off to another department.
When I started medical school, I always considered internal medicine as one of my top choices in case I went the medicine versus the surgical route. During the third year rotation, I hated internal medicine. But I hated it because of the way the course had been structured, and not necessarily because of the patients and practice. In fourth year, however, internal medicine has completely fallen off my choices for residency. Maybe it was Shem that did me in? Maybe my experience? Maybe a bit of both? Who knows. But what I do know is that I can’t go down that route. It’s just not for me unfortunately. But I do realize what an important field of medicine it is – if I do go into general surgery, there are many things that I’ve learned in rotations like Gastroenterology and Hepatology that come in very useful. In fact, if I go down the UK-route, I do hope to rotate through an Internal Medicine elective at some point in my Foundation year. I just can’t do it for the rest of my life.