Internal Medicine Wards

Tuesday, November 25, 2003 BLS and the last few days on the Internal Medicine Inpatient Service
7:42 PM

I was excited about today because I was going to do the BLS course. I reported at 8:00 am and found that there were only three candidates for the course. The instructors, Heather and Lory were lively, humorous and gave us enough practice. We learnt to do CPR, remove foreign objects obstructing airways and use the automated emergency defibrillator. We worked with dummies of an adult, a child and an infant. At first, I thought, ‘I will never remember this stuff, especially in a panic situation where something like this might actually happen.’ Now I think I will. At least, I’ll remember enough to do some good.

We rounded with Dr. W again. As usual, he asked some questions to which D (another medical student) and me did not know the answers. Oh well, this is the learning experience. I wrote out the discharge orders for P C (a patient on the service) – my first discharge order! I was amazed to learn that this illegal Mexican in the United States received such excellent medical care, a free glucometer, insulin and all the treatment he received, even though he has no money to pay for any of it. I must salute the charity and generosity of the US healthcare system that can still support such cases in these days of expensive healthcare. At the same time, I wonder at the justice of a legal, honest hardworking individual who has some insurance having to pay for healthcare to the extent that it might bankrupt him or her.

The rest of the afternoon, basically we hung around with one of our interns while she gave us ‘busywork’ to do – look up a patient’s drugs in the computer, fill out some papers, etc. I spent the time reading a portion of a chapter from the Washington Manual on my PDA.

At sign-out, we had only 9 patients left on our service. Interesting to see if we pick up several tonight. Y (another intern) is on call. I hope to be able to round on several patients tomorrow and learn more about them to present to Dr. W.

Tomorrow is my last day on the Dr. K's service (one of our attendings) before I shift over to Dr. M (a pulmonologist and critical care specialist) on Monday – December 1. This will begin my second month in internal medicine. I still feel like my head is swimming and I don’t know anything. Although, during this past month, I have:
Learned to write admit orders
Learned to write progress notes – wrote LOTS of those!
Learned to write discharge orders
Learned to write scripts
Learned CPR
Attended two codes
Learned about the importance of preventing DVT in hospital patients
Learned about the 5 W’s of post-operative fever.
Learned about the evaluation of chest pain and its treatments.

This is off the top of my head. I have seen quite a few things – it is taking time to put it in perspective.