Today was up and down. I’ve had really enough of internal medicine. I’m back to jumping up whenever I heard the word “surgery,” no matter what the context – even if it’s just a “past medical history.” We had a lady with abdominal pain admitted overnight, and as soon as I heard in report that she might have the slightest chance of needing surgery, I hurried to assign her to myself.

Then, of course, we did have to consult surgery for her. The resident was certain that a potential abdominal abscess is a surgical problem, and I was pretty sure that recurrent diverticulitis is an indication for colon resection. Fortunately, it was a junior resident that I had to talk to, a friendly one that I knew from previous rotations. Even so, as soon as he asked a question, I froze up, and became certain that it was a very dumb consult (which I kind of knew to start with, because her belly was soft, and in fact non-tender this morning; by now I know that if the patient isn’t either writhing or rigid with pain, surgeons aren’t interested). It didn’t help that my resident was nearly as petrified when she had to call the surgery chief resident and tell him about it.

The nurse taking care of her had to call the surgery resident at one point, too, and she became so flustered that she started apologizing to me, I’m not sure what for. And these are nice surgeons. I’ll have to remember this in future; people are so petrified at just the name of surgery – there’s no need to make things worse by actually acting up to your reputation.

On the other hand, we had another patient whose story and history were so significant for a PE (pulmonary embolism) that we didn’t even bother to scan him (ok, plus the fact that his kidneys were failing, and wouldn’t benefit from dye). He needed an ABG this morning, and, although I wasn’t excited about doing this painful (and for me, tricky) stick on an alert patient (having previously practiced in the ICU), I made myself volunteer. To my total surprise, I got it with the first stick and a little readjustment. The patient didn’t complain at all, and it went smoothly for him. I was on cloud nine. Maybe I will be able to learn how to do central lines, and even become the expert at it that a surgeon is supposed to be.

I’m sorry there aren’t that many patient stories coming up here lately. In my opinion, medical blogs should be at least half of the story – they are, after all, our raison d’etre. But somehow I can’t find anything to say about medicine patients. Chest pain, yadda yadda, shortness of breath, blah blah blah. . . I know it’s serious for them, and for these residents, but it really doesn’t matter to me. I can’t wait to get back to surgery – and I am terrified about how little I know on the subject. I need to go read a textbook. . .

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