Today was my second day of clinics. All I can say is… wow. The hours are long and will take some time to get used to, but it honestly feels like the 1.5 years I spent in basic sciences were like college. THIS feels like medical school.
I’m extremely fortunate to be part of an awesome team, and in two days, we’ve already encountered a case of bradycardia-tachycardia syndrome (a subtype of sick sinus syndrome) our attending has never seen to this extent. The patient’s heart rate would literally fluctuate back and forth from as high as 130 bpm to as low as 30 bpm in 15-30 second intervals. This fluctuation wasn’t paroxysmal either – it happened every minute.
I saw a severe case of aortic insufficiency (regurgitation) on an echocardiogram with an ejection fraction around 20%. We assessed the ventricular dilation over time, and noted several amazing physical findings due to the large pulse pressure characteristic of aortic insufficiency. For example, when a little pressure was applied over the patient’s fingernail bed, his capillaries would alternate between filling (red appearance) and draining (pale appearance). This is known as Quincke’s sign.
I also saw an emotionally uplifting case of a stroke patient who couldn’t move her right lower extremity and felt extreme pain over her entire body completely rejuvenated and glowing with happiness this morning on rounds. Great way to start off the day! 🙂
Between yesterday and today, we had two of the infectious disease professors from blocks 5 and 6 give noon conferences about infections in diabetics (yesterday) and streptococci (today). I had tremendous respect for both these individuals as lecturers during the basic sciences, and neither of them have disappointed during clinics! Plus, having something to eat while seeing pictures of gangrenous toes just enhances the experience. 😉
I took a history and did a physical exam in Spanish, I presented to my attending, I learned about the CHADS2 assessment for anticoagulation, and a whole lot of other stuff which I can’t remember at the moment. And this is in two days!
Now it’s time to eat an early dinner and get started on a brief presentation about the differences between a rate-control and rhythm-control approach to treating atrial fibrillation. I wonder what tomorrow will hold.