My rotation with medicine is now over and I have started with general surgery for the next two months. I really enjoyed medicine, but was somewhat ready to go. I got really sick of doing H&P’s and writing notes. There are rare opportunities to actually do a procedure of some sort, and pounding the keyboards all day long became monotonous. Despite the keyboarding, I DID enjoy medicine. My rotation started at Provident Hospital, a hospital in South Chicago that is part of the Cook County Health System. Due to budget cuts, the inpatient medicine program was cut from this hospital and moved to Cook County. I saw this as a better move because the complexity of the medical problems is greater at County. I learned a great deal at Provident, but I felt like the learning hit a plateau (not that I learned everything there is to learn), but because you were not exposed to a variety of different problems. At Provident many of the cases were 23 hour observation of asthma/COPD exacerbations, foot ulcers, diabetic mgmt, or chest pain admissions to rule out heart attacks or PE’s. At County most of these patients are admitted to a 23 hour observation area and discharged when the case is controlled. This leaves room for those who are in need of more focused attention. Medicine was great because you learned how to do a very thorough H&P, you were exposed to diagnosing new onset disease, managing exacerbations of disease, and working with other services in the hospital to arrive at solutions to medically manage the disease. I think most OMS’s like to solve problems quickly and efficiently, and myself being no different, used this quality to serve me well to get things done during this rotation.
General surgery is slightly different. The patient list is longer, the hours are subsequently longer, and there is some OR time. We started off slow with about 6 patients on our list. In a couple of days the list grew to 20. We round anywhere from 5:15 am to 6am. We go home at about 7 unless you are on call. The interns take call twice a month and are responsible for taking care of all the busy work on the floor with the medical students. The program is top heavy so we do get some OR time here and there, but mostly the senior residents are scrubbed in. I did make it to the OR once during this first week to remove a lipoma from the inguinal ring. On the floor we write notes (not as much as medicine, we slave the medicine students out to write many of the notes and we addend them), change dressings, make sure patients get consulted by other services, get to their procedures on time, and make sure that labs are drawn, etc. Hopefully the random OR times will keep me sane. It also helps if you have a motivated co-intern with similar interests in getting things done. I got home at 5pm today, somewhat early, it’s a Friday, and it is time to enjoy my first weekend off in 6 weeks.
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most common) Improper application of pressure. Painless discoloration under the skin. Management: Remove tourniquet and needle. Apply pressure to area. Ice can be used to constrict vessels.
