Internal Medicine: Intro to clerkships

I’m deep into my internal medicine rotation – exactly halfway through the 3 month clerkship. The journey from Louisiana to Maryland to Louisiana to Missouri was mechanically necessary, but uneventful. I have transitioned from the ‘being’ portion of my medical career to the ‘doing’ part of it. The hospital through which I am rotating is a hive of activity, and the days I spend toiling as a medical student in the wards are markedly different from those I spent guzzling information and regurgitating it for exams during basic sciences.

As it is with everything in life, the attitude you take with your endeavor determines its outcome. I have been blessed to have great attending physicians and residents thus far so as to nudge me along, and I know that there is always something to be learned from every patient I manage. Even if it is something I have managed just the day prior, even if it is only a comparison of outcomes to a treatment used in another patient with the same condition, the observation is made. With this attitude, I have taken the first few footsteps in the seemingly never-ending career of observation and solution that is medicine.

The hospital setting is ironically the exact opposite of the training environment I underwent to prepare for it. It is a bustle of activity and noise, with teams comprised of attending, resident, and students prowling the floors and corridors. The dynamics of walking as a group and presenting to the team is new to me, and occasionally I feel like a duckling in my short white coat walking behind the rest of the team with their flowing knee-length garb. Gone are the days of pure multiple choice questions, pure lectures, and pure solitude. Interpersonal interaction is constant, so much so as to make me lose myself in the present moment, rounding from one patient to the next, with any momentary lull filled by updates and notes. Being part of the the hospital feels like being part of a living, breathing organism, with a number of functioning systems and hierarchies that crosstalk to a common end. It is engrossing and enveloping, and I have found myself feeling idle on my days off.

I cannot say every experience is gratifying, as with internal medicine many patients are eventually discharged and followed up as outpatients, but when the interventions I suggest are appreciated and contribute to patient care, there is certainly a thrill and rush of easing another human of some suffering. My one dissatisfaction with the particular rotation – internal medicine – is the pace at which diagnoses and care take place. Many conditions are severe and inherently slow to recover from, and despite the fact that recovery is likely and prognosis guarded, the previous instant gratification awarded my multiple choice questions is long gone. My attendings have told me that internal medicine is a field wherein the big picture is important, with the little details falling into place. I look forward to my next few rotations, recognizing that while I have read about many things, I have seen few, so as I broaden my experience, I broaden my insight.

Cutting for Stone

Abraham Verghese, Cutting for Stone:

I chose the specialty of surgery because of Matron, that steady presence during my boyhood and adolescence. “What is the hardest thing you can possibly do?” she said when I went to her for advice on the darkest day of the first half of my life. I squirmed. How easily Matron probed the gap between ambition and expediency. “Why must I do what is hardest?”

“Because, Marion, you are an instrument of God. Don’t leave the instrument sitting in its case, my son. Play! Leave no part of your instrument unexplored. Why settle for ‘Three Blind Mice’ when you can play the ‘Gloria’?”

How unfair of Matron to evoke that soaring chorale which always made me feel that I stood with every mortal creature looking up to the heavens in dumb wonder. She understood my unformed character.

“But, Matron, I can’t dream of playing Bach, the ‘Gloria’ . . . ,” I said under my breath. I’d never played a string or wind instrument. I couldn’t read music.

“No, Marion,” she said, her gaze soft, reaching for me, her gnarled hands rough on my cheeks. “No, not Bach’s ‘Gloria.’ Yours! Your ‘Gloria’ lives within you. The greatest sin is not finding it, ignoring what God made possible in you.”