Medicine...the last frontier (clerkship)

I've been in the hospital consistently since July 7th of last year...and now 5 weeks into my medicine rotation and I'm ready to gouge my eyes out with my stethoscope (I'll find a way). It seems that the more I grow as a medical student, the more I stay the same.

It's not that I'm disinterested in the material, I'm just burnt out. There's only so many months that I can go through the motions of writing patients' notes without actually synthesizing any of the decisions contained within them. Sure they let me throw in my 2 cents with regard to diet and how I think the patient is tolerating their treatment and what the lab results mean...but in the grand scheme of things, the residents do EVERYTHING. That includes saving the patients from horrible attendings who may be actively trying to kill patients (if it weren't for the Hippocratic Oath...sometimes I wonder whether they really knew what they were vowing).

Truth be told, I actually am enjoying medicine in terms of the breadth of patients that I'm seeing and the opportunity to finally flesh out my basic medical knowledge. But rounds are possibly the most painful exercise invented in the history of man. I mean really...why do I have to see the patient if we're all going to then go visit him a few minutes later and find the same findings that I did and repeat the same exact exam that I did and come to the same conclusion that I presented to you because it was what we said the plan was yesterday.

And to make things worse, why are you pimping me during hour 11 of my 12 hour weekend call day, in the middle of the emergency department on differentiating pre-renal and renal azotemia in the acute setting? No I haven't gone over the causes of acute renal failure yet because half of my patients chronically run a BUN in the 70's and a Creatinine in the 4's. Yes, this is the first healthy patient that with acute renal failure that I've ever seen that may have a slim hope of recovering function. no I still get mixed up calculating FENa ((Una/Sna)/(Ucr/Scr)???). Oh yeah, asking your indirect and vaguely worded question in broken English is not making life easier for me. Yes, I'm still going to say "I don't know" because I'm a third year medical student and I really haven't ever encountered alot of things in my clinical career because my clinical career has only been months long. And yes I still hate the kidney...despite my attendings insistance that all medical students love nephrology because it makes sense. I'm sorry, when you have 4 types of RTA numbered I thru IV where IV is not actually a tubular problem and type III is as common as a unicorn, I have already given up hope because so have most nephrologists. Sure I'll give a presentation on monday...it's not like I had other plans for my sunday like catching up on my write-ups.

Anyway, I have no idea how I'm doing thus far and I'm living for my one-week vacation before I start up with my Massachusetts-based EM electives this summer. Oh the little things in life that get me through the hours of standing there staring off into nothingness trying to look interested. ...:).

1 comment:

The Lone Coyote said...

Ah yes,sounds like Internal Medicine. I agree that without the rounding it can actually be really interesting. Hope that you get an attending at some point who likes to be more to the point. They do exist in the academic center, though rarely. Hang in there, you are almost done!