I’m coming to the end of my Internal Medicine rotation. I am so glad that it is almost over. Internal Medicine is very interesting, but it’s also very complicated and can be very sad. More often than not, our patients are extremely complex- dealing with multiple chronic illness, combined with complicated social and personal lives. I have learned so very much in my 6 weeks on the ward, but I still feel that I am completely useless 97% of the time. I just don’t have the mind for details that Internal Medicine requires. I simply don’t remember off the top of my head what the 1st line drugs for hyperthyroidism are or the top 10 systemic manifestations of rheumatoid arthritis, let alone what are the differences between 2nd and 3rd generation cephalosporins. (If that none of that makes sense to you, don’t worry, it doesn’t make any sense to me either.)
I have learned a lot. I can dictate discharge summaries, I can read nurses notes, I can muddle through all the chemistry and coagulopathy studies that come back on each patient. I can write a progress note in my sleep (literally, my 1st call shift = 2 hours of sleep in a 36 hour period). I can take information from the unbelievably amazing staff that we work with and amalgamate it together to help my patients. I can speak nurse and physiotherapist and pharmacist and occupational therapist and social work, more and more fluently every day. I can translate in between.
I can calm and help a patient who is fighting to breathe. I can talk to family members who are afraid that their mother’s cancer has come back. I can reassure and comfort and explain what that brochoscopy is actually going to be like and what we hope to learn from it.
I can listen.
I think that these skills are even more important that being able to rattle off a differential diagnosis for the top 14 causes of haematuria. Because really? I can always look things up on dynamed. Lexicomp will always have the doses for me, and even if I screw them up, the amazing pharmacists will call me back and say “um… did you mean 750mg? or 250mg?” and they never tag on “you moron” to the end of their phone calls. I love the hospital pharmacists. Unfortunately, I don’t get marked on my ability to explain a procedure to the patient, or on my ability to comfort a family member. I get marked on my ability to answer random questions about the path of the radial nerve and all it’s functions. I am praying for a pass. And I’m trying to be grateful, that after next week, I won’t have to answer 3 am pages that start with “Mr. So-and-so’s breathing is getting worse… could you come down and take a look at him?” or “Mrs. Such-and-such’s blood sugar is still at 24… what would you like us to do?”
Those pages scare the shit out of me. So much so, that I have been too terrified to go to sleep, even if we do get a minute to rest. So, call has become a place to channel my fear and panic into something productive and soothing: I’ve been knitting. Simple patterns, with simple durable wools, that mean I can do endless rounds of stockinette while willing the phone not to ring.