Today marks the end of my second week of internal medicine. I’m laying in bed huddled under my comforter while contemplating medical scenarios I’m uncertain how to deal with.
For example, how do you respond to a patient who inquires about the etiology of his or her new lung cancer diagnosis and has no prior history of smoking, asbestos exposure, family history of cancer, or the like? It’s not very scientific to attribute a condition to “bad luck”, but I simply can’t think of a better explanation. Most patients don’t care about the biology of cancer or the complications of treatment. They empirically know that cancer is “bad” but simply want to know why they got it.
Another scenario deals with noncompliance. How do you explain to a poorly controlled diabetic that the reason we need to do bilateral above the knee amputations (AKAs) is because they never checked their glucose levels, took their Metformin or insulin injections, lost weight, exercised, etc. Now they have gangrenous lower extremities. It’s frustrating how many things you see in a hospital which could likely be prevented (or at least postponed) by either a.) sticking to the treatment regimen or b.) adhering to a healthy lifestyle in the first place. I know I’m in no place to judge, but it’s becoming more and more obvious how important preventative medicine is. *Sighs* At what point do physicians just stop trying to advocate for noncompliant patients?
I’m beginning to also realize what a comprehensive profession I have entered – one filled with a deep understanding of human biology, yet also the compassion you would expect between caring people. I feel like I’m getting trained in both simultaneously, and it’s incredible.
Finally, I’m continuing to learn how IM doctors work-up cases ranging from potential malignancies to chronic conditions like hypertension and diabetes. I’ve seen things like Stevens-Johnson syndrome, textbook diffuse infiltrative lymphocytosis syndrome (low CD4 counts, swollen parotids), how to cath a female, how to remove a central line, slides of inflammatory bowel disease, and when it’s appropriate to place certain consults (derm, GI, wound care, nutrition, etc.). I’ve had patients complain about nurses, and other patients bless me. In spite of constantly feeling incompetent and unable to aid my patients like a real doctor, I’m grateful for whatever opportunities I’m given to help.
I wonder what the coming week will bring. 🙂
PS – I love how Ben Taub is situated across the street from the Houston Zoo. In between seeing my patients, I’ll intentionally take the stairwell which provides me with a great vantage point on the 6th floor to see the animals. A dose of sunlight does the body good. 
