Adios, Internal Medicine: On to Neurology

My first two weeks of Internal Medicine ended on a happy note, when my very sick little patient of colonoscopy fame who spent a full 12 days in CCU was finally discharged.

Unfortunately, that kiddo's discharge to his loving family didn't happen until I'd spent a personal record of 73 hours at the VTH in a 7 day time period, including 9 hours this weekend.

It's okay, sleep is overrated. At least that's what I'm telling myself to keep from sobbing in the corner. Thank goodness for the 5 hours of naps I logged this weekend.

Internal Medicine started as a pretty stressful rotation for me. The cases are multifaceted and complicated. Internists have to have a vast knowledge base that encompasses clinical pathology, surgery, radiology, pharmacology, neurology, and many other subjects. Plus it was my first specialty rotation, having only been on community practice previously.

However, I really settled into Internal Medicine well after the first couple days, if I do say so myself. I put in long hours at school (averaged 12-13 hours on weekdays), and often spent an additional 1-2 hours studying up at home in the evening on the things from that day that I needed a refresher on.

So it was gratifying when the head internal medicine clinician from last week pulled me aside on Friday to tell me how much I had impressed him, that my medical knowledge at this stage in my career is "amazing," and that I was "leaps and bounds" ahead of my classmates on this rotation. I'll also admit to a little extra pride when one of my rotation-mates said to me at the end of the weeks "So this is what you're going to do after vet school, right?" and I said no, I want to do general practice, and they said "But you're so awesome at this!"

OK, let's move on to neurology and bring on the humility.

It's always a little challenging to start a new rotation (haha, as though I really know what I'm talking about, this being only my 3rd rotation -- maybe it gets easier as the year progresses?).

Each rotation is staffed by completely different doctors, nurses, and support staff. They have different procedures, different forms, different paperwork to complete. Appointment schedules are different; procedures for new patients versus rechecks versus inpatients vary widely. I've heard the senior year of vet school compared to starting a brand new job every 2 weeks, and that's really what it feels like sometimes. Just when you've had a good 10-14 days to settle into knowing how to deal with the clinicians and nurses, which forms go where, who calls the owners every day, and where all of the supplies live, it's time to up and move on to something totally different. It's frustrating.

Neurology started this morning with both of the doctors arriving late, then doing a very brief orientation, then shuffling us off to handle transfers, inpatients, and new appointments.

While I have to admit that I've not been looking forward to my neuro rotation since neuro has historically not been one of my favorite subjects, I nonetheless feel that that attitude toward neurology has not colored the following opinion I developed after my first day of neuro today: The neuro doctors are some of the pissiest, whiniest clinicians I've ever met.

I'm serious. The day started off with a round of bitching about clients that want to come visit at "inopportune" times for the doctors (i.e. any time on weekends other than 8-9 am), how the other services always want neuro to help with their cases that have neurologic dysfunctions, how the CCU nurses call them at night (when one of the CCU patients meets the "call the clinician if" criteria written down by the clinicians themselves, I might add) to ask about how to handle an exceedingly painful inpatient, etc. There was no end to the things that these people found to complain about (and not very nicely).

It was pretty funny to hear the contrast between the neuro doctors, who seem to have an attitude of "I am the almighty doctor and I will say what hours you can visit your dog and if you show up at a different time then God be with your soul," versus the internal medicine doctors, who, in my opinion, were much better at caring for clients in addition to caring for pets, and were willing to stay an extra hour or two on a Saturday morning so an owner could come visit, or discharge a hospitalized patient at 6:30 pm after the owners got off of work instead of insisting on a 4:30 discharge appointment.

I'm trying (and I think succeeding) not to take the bitchy attitudes personally. I feel that certainly on the first day of any rotation, it's reasonable to give the new students a little leeway and help them along and overlook (or point out politely) minor errors that have been made in procedures. And yes, we'll all become more efficient within a couple days of being neuro students -- hey, we were a lot faster by the end of the first day already.

So take a chill pill, docs! Otherwise it's gonna be one heck of a rotation...