Internal Medicine: Day 18, 19, 20

Finished with my first 3 week Internal Medicine Rotation. You might recall, earlier in this year, when I mentioned that I am amazed at how many people's lives we save, at how little death I've seen compared to what I thought I would witness. Well, I think I've made up for it. Turns out all of those sickest of sick patients who are suffering from chronic, debilitating diseases are on this service. Seeing those people with lots of comorbidities, slowing deteriorating from slightly functional to homebound to bedbound to the end of life, is the core of what I have been doing the past 3 weeks. Not very exciting. And since this hospital is in the downtown portion of this city, we have seen many patients who are chronic alcoholics, smokers, cocaine users, IVdrug abusers, with poor compliance of medications and little to no desire or ability to improve their health. That makes for some quite unrewarding days.

I have had the opportunity to spend time with patients who are being currently worked up for the diagnoses of different cancers (pancreatic, colon, thyroid, and hematologic cancers to name a few). I also have had the chance to get to know the families of palliative patients, and the opportunity to be there for patients in their last hours and days of life. I can't say that I enjoy the palliative floor or the palliative care, but I do find it comforting to see how compassionate the physicians and nurses are, and to be able to be a source of comfort for the patient and the patient's family/friends during such an emotionally difficult time.

I've seen a few interesting cases, such as the Antithrombin 3 deficiency patient who has a strong desire to improve her health, the newly diagnosed pancreatic cancer patient who had too many questions for the attending to answer and so I had helped to explain things to him over the course of several days, and the patient with a myeloproliferative disorder who was struggling through the final days of her life, and the patient who had primary biliary cirrhosis that had subsequently developed a large intracranial bleed who managed to recover a large (and unexpected) amount of function...but I have seen far too many drug abusers, so many people who are alcoholic, an unbelievably large amount of obese patients with no intention of changing their diet or beginning in any sort of exercise regimine... I suppose there is quite a variety in this field, which is exciting, but it can be incredibly frustrating when a patient refuses to make strides towards a healthier life, and subsequently rely on medications and hospital admissions to prolong their life. We aren't miracle workers, we need to be a team...and when a patient refuses to eat healthy, to decrease the fast food, to stop doing drugs, to quit drinking, to actually take the medications we prescribe, it feels incredibly frustrating. We know what can help, but we can't force a patient to be healthier, and when they deteriorate we feel responsible.

A photo from our peer-lead lecture of the week:

I will be working at Hospice this week. I love what they offer to patients and families, I love their compassion and commitment. I'll be sure to keep you updated as to how this week goes.