Saturday, July 11, 2009

(Almost) 2 Weeks Down...

Wow. I knew the internship was going to be a lot of work but, by a rough estimation, I've spent 170 hours at the hospital over the past 13 days. The rotation I'm on now is called "DOD" or "Doctor on Days" or "Doctor on Duty" or something like that. What this entails is me being at the hospital at 7:45 am to round with the overnight intern on all the hospitalised cases then taking over care of those cases as well as seeing any emergencies that come in between 8 am and 8 pm (or so). Basically, my job is to keep an eye on the patients and notify the primary doctors' on the case if something goes awry. I also have to see patients and either treat and release them, or route them to the appropriate specialty service. This last part often becomes a game of hot potato for the services depending on how bad the case is and how annoying the owners are, with me in the middle playing the go between. Even more frustrating is when there are, essentially, no cases all day until 6 o'clock, then (like happened Thursday) a dog is admitted in status epilepticus with a 107.9 fever, and 10 minutes later a Lab puppy with a front limb de-gloving hit-by-car injury shows up 5 minutes before a hit-by-car Bichon with a large tissue defect wound on its right hip. On days like that, the 8 pm end time is mythical and I get home closer to 10 pm or 10:30 pm...just in time to throw food in the general direction of my mouth, collapse into bed, and start the whole thing over again.


What's even stranger than the schedule, though, is...I'm having a good time. I'm tired but, for the most part, I feel like I'm actually getting to participate in practicing medicine. I definitely still have "money cases" and whacko's to deal with, but at least 50% of the clients I see are willing to see a specialist and try to identify a problem, even if it is not a positive outcome. For example: Monday morning a 6 year old Rottweiler scheduled for bilateral total hip replacement later in the week came in unable to use it's rear legs. In general practice, I would have discussed a transfer to a neurologist, the owners would have declined, I would have given the dog steroids and euthanized it a few days later without knowing if anything could have been done. On this dog, the neurologist went over the exam with me and confirmed my findings, took the dog to MRI and I got to see the previously silent spinal tumor in the images. Still not a great outcome for the patient, admittedly, but the process of making decisions based on evidence gleaned from diagnostics was allowed to take place. How novel.


It helps, as well, that the vast majority of the specialists LOVE what they do. They are excited and enjoy working up the cases and helping you see it the way they do. I've yet to get the feeling that I'm annoying the surgeons or the internists when I bug them about a case I saw and admitted to their service. Maybe this is still all the "honeymoon" period with the new interns, but I'm hoping it stays this way...with maybe a few less hours, though.

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