Fourth Year Rotations

I intended to post about all my rotations as I was going through them, but it turns I was pretty busy. Now that all of my exams, applications and interviews are behind me, I wanted to reflect back on some of my rotations from earlier this year.

I started my fourth year rotations with orthopedics. Orthopedics was what originally got me interested in medicine, and I wanted to experience it from a medical school perspective. It certainly lived up to its reputation of being a burly man's specialty. The funniest joke someone cracked during morning report was about a resident not knowing where the gym was. As with every rotation, I tried to picture myself doing that specialty in the future. I tried to latch on to the few women in the specialty and see how they fit in. During an incision and drainage of a foot abscess one day, I was working with a female surgeon. As she was closing and wrapping up the foot with gauze, she wove gauze in between the patient's toes. "Ooh it's like they do when you have a pedicure!" I commented. "Yeah, I think pedicures are the reason people have toe fungus." She replied. I realized talking about girly things wasn't going to get me far in ortho. I tried talking about kids a little, but this conversation also ended as a muscle flexing contest, talking about retracting a knee while 34 weeks pregnant.

My next rotation of fourth year was inpatient internal medicine. Typically a third year rotation, I was making it up from having missed it on maternity leave. I quickly learned that in medicine "everything is your problem." Anything that a specialist does not manage defaults to internal medicine. Typically surgeons own their patients, but I learned that medicine would often manage ortho patients who were medically complicated. People in the hospital for medical reasons, psychiatric reasons, social reasons, drug-seeking reasons, you name it, they were all on the internal medicine service. One cardiologist told us the reason he sub-specialized was that he wanted to be able to finally say, "not my problem."

The fun part of internal medicine is getting to figure things out. One patient of mine was admitted with a fever and diarrhea. He also started to develop a cough and headache after he was admitted. Additionally, his chest x-ray began to show signs of pneumonia. The differential diagnosis was wide open, and I asked him all sorts of strange questions. Any recent travel? sick contacts? gardening? pets? I was trying to find out what the source of his infection was. After asking him all about his recent activities I found out he had been trying to fix a sump pump recently. I thought of pathogens that might be found in stagnant water. It could be a protozoal pathogen (think wiggly things like amoebas - ew!) - that would explain his fever and diarrhea, but not so much the cough. Lots of other bugs cause diarrhea, like cholera, salmonella, shigella... but again not the lung findings. Leptospirosis is one I always hear about at the vet's office, but again doesn't explain the cough. We decided to test for a bug that can cause an atypical pneumonia, often associated with diarrhea - Legionella. Legionnaires’ disease was first described in 1976 during an outbreak at an American Legion Convention. This patient fit the classic description of the disease with high fever, pneumonia and gastrointestinal symptoms. The test came back positive! It was good that we tested for this bug because the antibiotics were different than the empiric ones we had been using.

I went from figuring things out to attempting to bio-psycho-socially analyze people on psychiatry, another make-up rotation from maternity leave. There were definitely interesting patients and stories, but talking all day long is not my cup of tea. We would spend hours talking to, and about each patient, then writing what feels like a judgmental note about what you thought, boxing traits that are normal in some people into diagnoses. It probably didn't help that there were way too many learners on the rotation so I rarely had anything to do. Fortunately the hours weren't too bad and I was in Hawaii, so I really shouldn't complain!

view from Ka'au Crater hike