Internal Medicine Week 1

The last week has found yours truly busier than a priest at a summer camp full of boy scouts. [What? All I meant was that boys at that age seem to need a lot of guidance; and priests are wonderful counselors of our youth. ;-)]

Anyway, the dearth of posts is a direct result of my trying to keep a bunch of balls in the air [OK! Knock it off you filthy minded juvenile!]

Internal Medicine has turned out to be much more demanding a rotation than previously advertised and has required a bunch of hours of reading at home to keep up. At the end of the first week, I have only a few impressions. Firstly, Chaos seems to be the team motto at Internal Medicine. There are about 18 minutes throughout the day of focused work, punctuated by hours of running from conference to conference and making sure you make it back for rounds. Rounds, at least for our little group, are quite good. Our attending happens to be the Assistant Chair of Medicine and has quite an enjoyable teaching style. He maintains a good mix of scathing sarcastic criticism with asking questions and making sure the big-picture remains in focus. In what was one of my favorite bit of ranting on his part, he accused a resident who was futilely trying to correct electrolyte abnormalities without understanding the underlying condition, of practicing "Hospice Medicine". This is particularly funny since the patient in question is not terminally ill. Truly a man after my own heart. Another student and I had to stifle fits of laughter when he came out with this little gem.

The most interesting patient that I encountered this week was a poor soul who presented to the ED with a series of ulcers about his legs that were doubling as a hatchery for these guys:



In case your entomological skills aren't quite up to snuff, these are maggots. It seems that along with the myriad of physical maladies this patient is suffering from, he also has a serious case of self-neglect. Interesting note: it wasn't the wriggling of his wounds that brought this man to the hospital, it was his anemia-induced weakness that prompted him to seek some medical attention.
The mind boggles.

OB-GYN...Check!

Well, today was the last day of my OB-GYN rotation and it went rather well. I must admit I have enjoyed it much more than I originally thought I would. Not enough to consider it as a career, but as far as the rotation went, it wasn't too bad at all. There was a nice mix of clinic, delivery room, and operating room experiences that kept things pretty interesting- I imagine this is one of the draws of the specialty.

Academically, it was not incredibly taxing at all. My advice for those going into this rotation is: pick a good book ( I used Blueprints for OB/GYN) and read a chapter or two everyday. Most, if not all, of our weekly didactic lectures mirrored material in the book. I abandoned my trademark procrastination and actually stayed ahead of the curve with the reading and it paid off. I have done a bunch of sample questions and it seems I have learned some stuff about the old vertical smile during my time with the fine folks of the Vaginas and Pending Humans Department at Brooklyn Hospital. ;-)

Next up : 12 weeks in Internal Medicine starting Monday.

2 Quick Rileigh Pics

Giving Pooh bear a hug:




Showing off her sign language skills (her version of 'Daddy')

Seeing the Forest Through the Vagina

I don't consider myself to be a particularly wise man; in fact, even the most cursory of conversations with my wife will convince you that the converse is quite true.

I have however, gleaned a few important gems during the 19.7 or so odd million minutes I have been spewing out CO2 on this lovely little rock. For instance:

• Toast will always land on the buttered side when dropped onto the floor.

• Plumbers and proctologists should NEVER bite their fingernails.

• You are most certainly more drunk than you think you are- and on a related note, signing voices rarely improve under the influence of ethanol.

• It is universally accepted that the Emergency Department(ED) is the red-headed, bastard step-child of the hospital.

It is well established that the ED is the bane of many a medical specialties collective existence. After all, they are called to the ED to evaluate patients for for either admission (the horror!) or consultations as to recommendations for further care. This of course means more work, and that is seldom appreciated. This is but one of many the reasons that EDs have the much maligned reputation they do.

A brief disclaimer:
Since I have spent a goodly portion of my professional career working in and around emergency departments, I admittedly have a soft spot for those who suffer the slings and arrows of outrageous fortune while mired knee-deep in a wonderful concoction of bodily fluids and human pathos in the trenches of America's hospitals. I assure you there are no finer a group of people you want to be around when the shit decides to hit the proverbial fan. These are my brethren! ;-)


Last night, I was once again, On-Call with the fine folks in The Vaginas and Pending Humans Department(VPHD). As usual, as if scripted, there was to be a battle with the ED. I would love to regale you with another yarn of how the ED in all of its glorious righteousness was simply "misunderstood", but alas kind reader, this was not the case.

It seems a young lady presented to the ED with complaints of sudden onset chest pain and associated shortness of breath. She also happened to be in the first trimester of a pregnancy. Perhaps this is what confounded the situation. The ED physician on duty "admitted" her to the VPHD with the presumptive diagnosis of r/o pulmonary embolism. Seems reasonable, right? Well, in this particular case the only treatment or diagnostics performed were a chest x-ray, the insertion of an IV and CBC and basic chemistry panel. Nary an ABG, EKG, cardiac enzymes, d-dimer, venous doppler, VQ scan, spiral CT or anti-coagulant was ordered.

I had 2 questions:
1. Is the OBGYN team the most appropriate choice for the management of a potentially life-threatening medical emergency?
2. While I understand a possible sense of reluctance to perform tests and or treatment that may be harmful to the fetus, isn't maternal death harmful to a first trimester fetus? I'm just sayin'.

The vagina, and in particular-the gravid vagina, continues to mystify and perplex!