Monday, April 9, 2012

Internal Medicine - first 2 weeks

Internal medicine for the first four weeks is to be outpatient, so I am essentially back in Family Medicine.  The only difference is we see a lot more older patients, and instead of being with one doctor for four weeks and another for four weeks, I am with a total of 4 or 5 different doctors, and usually two different ones in a single day - one for the morning and one for the afternoon.  It's a challenge getting used to what they expect in terms of presentations and their personalities - harder to get a good rhythm going, so it feels more chaotic and stressful.  Also with all the older patients that I see, I can't help but feel a little depressed thinking of myself one day being where they are with lost loved ones, being unable to get up and around, unable to hear, or demented.  Two days a week I work with a doctor or a nurse who each goes to skilled nursing facilities.  I see a lot of demented people there, who are so far gone they can only half-feed themselves, smack their lips, and don't recognize their family members - who wish they would hurry up and die because they are quickly destroying their life savings.  I asked and you are able to stipulate in your advanced directive that if you are unable to recognize family members or have an acceptable quality of life for someone of your age and physical condition (not mental) that you give permission to discontinue all medications, including ones that were being given prior to mental deterioration.  The catch with dementia is you can't stop any treatments once you've started, but you can abstain from starting treatments.  So a patient with palliative care lung cancer patient starts bleeding per rectum, you don't have to go looking for colon cancer, you can just keep doing what you're doing and give narcotics.  It's a tragedy so many families are trapped watching the husk of someone they once loved deteriorate further and drain their finances that could put their grandkids through college, or help pay off debts.

In other news, I've been adhering to a stricter study schedule and trying to make sure to get my quota done each day - if I don't, it means no fun time.  Last week it definitely cut into my fun time, so I have to become a faster reader...  I also have to give a presentation next week, so this coming weekend will probably be spent working on that.  Also been busy trying to get rotations set up for fourth year.  Soon I'll need to call another place in Sacramento, but hopefully after I hear about two other sites because I don't want to be stuck without a rotation...  So much stress.  Wish I could just be done with medschool and onto residency.

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