Monthly Archives: February 2009

Eight weeks after the beginning of my Internal Medicine clerkship, I feel as though I have spent a year in a remote and foreign world, its terror and beauty laid bare in each moment spent within the white walls of the hospital. Not unlike the aboriginal “walkabout,” I find myself a hundred miles from my starting point, having traversed a wilderness inhabited by bickering doctors, lackadaisical nurses, fingerless social workers (that can’t seem to dial phone numbers), and the many faces of suffering, whether by random chance or self-inflicted. In returning to New Orleans, I knew that my learning experience would have a unique flavor: what better place to explore a wide cross-section of functional and dysfunctional systems, to witness the downfall of American health care as well as the battle over its rebirth, than the fractured backdrop of post-Katrina New Orleans?

For me, Medicine has been a rite of passage: it is during this rotation that I feel I have come into my own. Despite a difficult team, I was able to thrive and learn. Despite the most bizarre, belligerent, and unlikable patients, I hope and believe I have maintained my commitment to suspend the tendency to judge those I take into my care. Despite the missed sleep, missed meals, and missed opportunities to enjoy my life outside these white walls, I have not given up my passion for medicine and my commitment to guide and help people through their most vulnerable and difficult times.

Although my passion still remains with Vascular Neurology, it will be a challenge for me to decide how much Internal Medicine training I will want: should I do a sub-internship in Medicine, should I do a preliminary year in Medicine or a joint Med-Neuro residency, should I do medical school or residency electives with Medicine subspecialty services? I may reject the attitude of many Internal Medicine physicians that “internists are the only real doctors,” but it does contribute to the core of my training: how strong will I make that core? During the competitive mystery case-solving sessions of “Tuesday School,” my team solved one of the cases and won pins displaying the emblem of Tulane’s Internal Medicine department. When I move into the next stage of my training and my career, I will carry with me that reminder of my experiences: the chaos and confusion of the charity hospital juxtaposed with the steady hands and excellent instruction of my attendings, the endless scutwork alongside the moments spent holding the hands of my patients and their families while reassuring them and explaining the medicine, the good nurses and motivated social workers I worked alongside and who helped take care of me, and the kind compliments from my patients whose lives I was able to better in some way.

Since my last post on the usefulness of the medical iPod Touch, a large number of new applications for the platform have emerged that have facilitated both my learning and my effectiveness as a physician-in-training. In particular, I’ve found great usefulness in:

Instant ECG by iAnesthesia – This app provides a instruction on ECG electrophysiology, examples and explanations of common pathologic rhythms, and quizzes and diagrams to assist with the learning process. It is very useful for a medical student; whether it is useful at a later stage of training is unclear to me, but I’m just getting started. The pathologic rhythms are accompanied by movie clips that show the rhythms in real time as if on a monitor: for some reason, this helps me remember the rhythms better as my eyes follow their progression. Additionally, the company that makes the app recently added in high-resolution (zoom-able) images of example print ECGs on the classic pink paper with brief case descriptions (e.g. patient demographics and presenting symptoms/condition).

Mediquations – Not a new app, and I have written about it before. However, I’m constantly impressed that the creator updates the app frequently with new equations and provides explanations and source information.

Lose It! – Not a medical app, per se, but I find this diet tracking app fascinating. In addition to facilitating calorie counting, it also helps track nutrition proportions in an effort to help people reach that “ideal” 30-30-40 ratio (30% fat, 30% proteins, 40% carbs). Sadly, my proportions are way off, which makes gives me pause to reflect now when I advise my patients to change their diets (low sodium diets, heart healthy diets, diabetic diets, etc.).

Epocrates Rx – The free Epocrates app now has a few new features, and it appears that it contains the shell of the full package that you can activate with a paid subscription. The free app now has a “MedMath” section that contains a variety of useful equations, similar to those found in Mediquations and other iPhone apps. Additionally, a dose calculator now appears in the dosing section for certain medications requiring adjustments for weight, renal function, etc.

My lack of posting in the past several weeks speaks to the intensive schedule that is Internal Medicine at a charity hospital. I just completed two weeks without any days off. On a team consisting of one resident, two interns, and three students, we had on average 18-24 patients at any given time (while other teams ranged from 4-12 patients). I’ve seen an incredible amount of medicine during these past five weeks and a wide spectrum of the troubles facing a broken hospital: I’ve served in the roles of student “doctor,” nurse, and social worker, all at once. The experience has been a trial by fire, and I hope that I have managed to survive it and improve along the way. If nothing else, I now know just how bad conditions can be in a hospital (with respect to the inefficiency, the patient load strain, and the lack of good ancillary support).

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