House of God

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.

Heart Anatomy

During a second year Intro to Internal Med course, part of the course was made up of clinicals. I was placed in cardio. One day, while waiting for the doctor, one of the students and I had a conversation.

Student: “So today we’re doing valvular diseases, right?”

Me: “Yeah.”

Student: “Sometimes this doc is so complex, so I prepared a bit for this session. And I figured I’d go over some of the basic heart anatomy too – ’cause, you know, that’s probably useful to know, right?”

Me: “Of course, I should really take the time to go over the vasculature of the heart. I still get confused with it.”

Student: “Right, so want to do a quick review?”

Me: “Sure, we’ve got time to kill.”

Student: “Ok, so let’s start with the pumping action of the heart. Blood travels from the right atrium to the left atrium, and then to the right ventricle and finally to the left ventricle.”

Me: “…”

Student: “And the first valve at the atria is the tricuspid and between the ventricles you have the mitral.”

Me: “…”

Yes… someone in med school really told me this. And not a first year. This is someone who passed first year – someone who passed anatomy and physiology. I spent a few minutes explaining to this student how venous blood travels into the right atrium-tricuspid valve-right ventricle path before being pumped into the lungs, and then how this newly oxygenated blood returns to the left atrium-mitral valve-left ventricle path before being pushed into the aorta. I think they understood me.

Later, while we were examining a patient’s heart via echocardiography, the Doc kept talking about heart valves and leaflets. At one point, the student whispered a question, “What’s a leaflet?

MD2

The second week of school isn’t even over and I feel like I’ve been back for a month! I am really glad to be back though, and this semester (compared to last year) is so much more relaxed! Not necessarily easier, but there is definitely more time to live a little.

This week I saw my first real autopsy. It was spectacular. It was smelly. And I can’t wait to do it again next week. The patient was suspected to have died (in hospital) due to an MI. The pathologist did find signs of an MI in the muscle of the left ventricle, along with a few other irregularities – samples of which were sent to histology.

My current classes consist of a lot of pathomorphology, pathophysiology, and pharmacology. There is an introduction to internal medicine course that runs all year as well, and it’s probably one of my favorites because it’s so clinical. Finally!

My neurosurgery clerkship ended in the beginning of September. I am now a pro at drawing blood, and I learned how to suture (pig legs)! I do miss being in the hospital. One of my favorite observations was seeing how well some patients improved after having their brains and nervous system exposed and poked. It was fascinating!

I will always remember “Mr. Teletubby,” who gave himself the nickname because of the drain he had in his head after surgery. He was classic!

I’m so happy to be back!