I finished psych and somehow survived inpatient medicine. My very first day I cried in front of both my R2 and R3 as if one was not enough. I felt so overwhelmed by my patients problems and didn't have the slightest idea of where to begin. I scored my book trying to find an answer - at least one. the fear of failure, embarrassment, and not being able to help my patient spinning thru my head, like a mantra, that gradually wore me down to the point where I could hardly contain my tears from welling in my eyes and my there it all went i couldn't' breath and i felt my body convulsing with all the emotion I had been working so hard to keep inside. of course my poor resident didn't know what to do with me - a crying, convulsing medical student, he quickly apologized profusely, and felt horrible as if it had been his fault that i was crying. somehow i was able to stop and I he walked me thru the patients list of problems and sent me home. the days to follow were not as agonizing but difficult nonetheless. In my three weeks I had three case of EtOH Cirrhosis complicated by varices, HCC, ascites, etc. One patient with intractable orthostatic hypotension and diabetic autonomic neuropathy, and one with SLE. It was my own patients and all the patients in between that i took home with me emotionally everyday, I carried them with, and couldn't let them go. I still can't. The old man who lives alone, family and children nowhere to be found, he uses a walker to make his way across the street to where he says there is a restaurant where he occasionally eats since his arthritis is so bad in his feet, hands, back, elbows, knees he really can't do anything for himself. He tells us, they've tried everything, just let me go, there is nothing you can do. We beg him to let us call a rheum consult, to let us try to take him out of his pain. Really all we wish we could do is take him home and take care of him as our own, to feed him, listen to him, and give him love. He's so frail yet so full of spirit inside that we can see pushed to the back from being in pain. We walk away from the bed, as a team, with heavy hearts, and push it behind us, to linger in our minds for the days to come until it is replaced by yet another patient whom we feel hopeless for. On my last day of inpatient, I wanted to say goodbye to my little drunk as I liked to call him. He wouldn't wake up from sleep, so i whispered to him that I wished him the best and that I wished he would get better and stop drinking. I don't know when he'll be able to get leave, or where he'll even go to. No body wants him, and he is ready to go right back to the bottle. can you help someone who doesn't know they need help? or who doesn't want help? the days were long and arduous, climbing up stairs and downstairs, constantly on the move, constantly brimming with things to do and peole to see.
Now on outpatient the pace is much slower, my patients are on top of their health and want to be better. My patient gave me a hug today for being so patient with her because she couldn't hear. i can't wait to have my own patients, for whom I've cared for for many years and they know me in and out as i know them in and out. right now its hard to catch up on 25 years and no all of these patients problems. i am up for the challenge. and i am starting to feel smarter everyday even though i only pick up things here and there. one thing is for sure, i will never run out of things to learn.
