Family Medicine: The nucleus

During April I rotated through my mandatory family medicine ‘elective.’ About a year prior, I began my first rotation ever, and, of course, I had formed many opinions of rotations and specialties before I even had them scheduled. Rotating through M3, you hear the stories of other students and their trials and tribulations, misfortunes and misgivings. Everyone’s a pariah. Somewhere along the line, I had formed the opinion that FM was among the more banal rotations, and, naturally, this was supported by mountains of anecdotal evidence.

However, regardless of my preformed inclinations, I always try go into a rotation with an open mind and an eager spirit because there are great teachers everywhere, and prejudgment leads more often to disappointment than substance. I was taken aback by the versatility and welcome of the program I rotated through. It was ideal for a student, and the residents were excited and genuinely caring and kind. The attending physicians were surprisingly well-attuned to listening, and were receptive to our presentations. The structure of the rotation was also well-designed; two weeks of clinic, one week of inpatient nights, and one week of inpatient days.

The population served had abundant pathology and disease, and I was thrown into the thick of it during my first overnight shift when a patient coded and I performed compressions. That memory will stay with me for some time – the code itself was successful, but, I had asked myself that night, at what cost? After the fact, I learned that the patient was on her way to hospice care and her daughter had wavered that day on a Do Not Resuscitate (DNR) order. The code was grisly. Throughout the whole ordeal there was brown seemingly feculent material streaming out of the patient’s mouth. I performed compressions as the resident valiantly attempted intubation, intermittently suctioning. The large laparotomy wound on her abdomen that was leaking serosanguinous fluid was held together tenuously by staples; these began to tease apart during only the second round of compressions – by the fourth or fifth the thing had come undone. The anesthesiologist intubated, and I was rotated out of the compressions, and that pause let me absorb the scene. Somehow we attained return of spontaneous circulation (ROSC), though the patient was unresponsive.

Other memorable events included management of post-surgical hemorrhagic shock overnight, textbook rheumatoid arthritis, and of course, clinic. The abundant clinic time gave me comfort in that setting and I was able to see the wide swathe of patients that FM encompasses; from routine pediatric visits and obstetric patients to idiopathic pulmonary hypertension and sepsis, FM is the first line for many encounters. I remember suturing supervised with a resident’s and attending’s guidance in one clinic encounter – never during surgery had that ever happened.

In short, I had a great time on FM. I learned much, was actually able to get up close and involved with some of the management aspects of ward medicine, and worked with extremely kind and caring physicians in a clinical setting.

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