Good Medicine

Every morning this past month on the way to the VA I walked past the remains of an old hospital being torn down. Quite impressive actually, watching a building get ripped apart (though who knows how many toxins I inhaled), but also kind of depressing. And that's how I felt with my month at the VA...one chronic health problem after another slowly destroying these patients until something like cancer or an MI comes along and really knocks them down. There's not really a good endpoint...sure you can try to fix the acute situation, but death is always there somewhere. Plus I felt like every single patient had diabetes, hypertension, chronic kidney disease, hyperlipidemia and BPH. Good grief! They could be my dad!

Don't get me wrong, I actually really enjoyed the month...I liked talking to the veterans, I liked having a little more autonomy (or at least the illusion that I could make some of my own treatment decisions), and the hours were quite nice. I'd gladly do my sub-internship there next year (hopefully this calendar year) since I know how to work the system now. But so many patients just waiting for placement in nursing homes? So many patients coming in for altered mental status due to alcohol or drugs? So many patients in for COPD exacerbations with 150 pack year histories of smoking? Give me peds any day. Though I have to say I'm now a little torn on whether I'd want to do a Med-Peds residency instead of just a straight up peds residency. When I think of the quintessential doctor, it really is an internist. There is a huge array of medical problems you'd just never see in a peds setting (though apparently diabetes, obesity etc. are becoming bigger peds issues...yay), and I feel like for my own knowledge I want to know how to properly manage those diseases. Especially if I end up doing anything global health related...I've got to be ready for anything.

Today was my first day on the Hematology service at University...back into the world of chemotherapy, ANCs, and lots of things that are totally over my head. So much to do this month...hopefully I'll keep it all together.