So i started Internal Medicine today. It wasn't nearly as bad as I'd heard--- knock on wood. All of the residents and attendings are Indian. Not that its a problem except I can't understand them. They talk very quietly and mumble-- often switch from Hindi to English. But they answer my questions and seem nice enough.
I followed one of the residents to watch about 8 patients and then do rounds on 20. The social dynamics of the hospital are exactly and I mean exactly as portrayed on television. I was surprised that the stereotype turned out to be true. Rounds get announced over the intercom, but there are 4 IM teams so announcements are constantly being blared in the halls. When you finally find where you're supposed to go you give the attending approx 4 sentences to update them on your patient you just spent 1 hour checking up on. He nods, mumbles in an indian accent and then goes to see the patient himself with his gaggle of white-coated students (pharmacy, medical, and nursing) and residents. We crowd around the bed and he asks the patient the same questions you did only to get a better and more complete answer from the patient. The chief resident, also indian, tries to get the last word in edgewise and must always be at the attending's side, even if that means shoving you out of the way to do it. The attending, who must practice this, struts down the hall at freakin light speed with the chief resident trying not to run to keep up, shouting facts about the next patient. It was ridiculously hilarious. The attending didn't actually ignore me or the other students and often told the chief resident to shut it with a derogatory finger. The questions he asked were ones I used to know once upon boards. Things like: What are the contraindications to metformin? Why are we using coumadin here? What are the side effects of ACE inhibitors? What are the complications of liver failure? etc.
The attending also gave us assignments or topics to read about that night. It felt like every other sentence was "read about that." At the end of the day my palm sized notepad had 3 pages front and back dedicated to subjects to read. Let me tell you, none of them were simple readings. For example, he said to read about anemia. There are so many categories, subcategories, causes, etiologies, treatments, tests that you could write a 200 page book on it and still not know everything. I left the end of the day at 3 and couldn't wait to start reading on topics to hopefully know what was happening better than I did today.
I felt like an idiot constantly getting lost or going to wrong wing. I didn't know where charts were or how to use the computer. I was also mildly surprised at how little interaction the nurses actually want with you. They didn't want to help me, they told me what I needed to know so i would go away. Or at least that's the impression I got. And it probably is frustrating because not only do students rotate in and out every month, but so do the residents. I didn't know that residents also have to do rotations except they are in charge of the patients. And that's a scary notion, one i was vaguely comforted and horrified by. The first year intern girl I was with didn't know anything more than I did. She could do a good physical exam but then would summarize and look at me actually asking "What do you think I should do next?" or "What do you think that means?" and I was all WHAT! I DON"T KNOW ANYTHING!
I thought for at least 2 cases she was just quizzing me, but when the attending asked her the same questions she admitted she didn't know. So then I took her questions more seriously. There were several cases where she just took my word for it (what it said in the chart) or wrote down my possible differentials and claimed them as her ideas (that actually made me kinda proud). At the end of the day, despite my lack of confidence in her ability as a doctor, I asked to be with her tomorrow. It forces me to learn and think on my feet (i hope).
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