Back to Medicine!

I literally felt taller the day I got back to North Carolina. It was like a weight was off my shoulders. All year I have been talking about getting back into medicine, and this week I was finally home. Finally home. My Family Medicine "Acting Internship" (AI) began on Tuesday, and it felt so good to be back in the hospital. I was finally back doing what I love (have I used the word "finally" enough?!). I left Boston with mixed emotions. It was difficult to leave, and the week prior to Day #1 was a tough transition, for personal reasons. But when I showed up for 7am rounds with the team, I was so ready to be back.

So ready, but not so ready. Have you ever heard the expression, "If you don't use it, you lose it...?" Well, I lost it. Badly.

I could've used a few less white russians in Cambridge.

The week actually started off well; however, my presentations were horrible. It was like I was relearning how to talk to a physician about a patient. I was dropping all the wrong words, repeating phrases, going through the work-up in the wrong order. It literally took me until today before I really felt I could give a solid presentation. Today I had my 3 minute, 1 minute, and 30 second verbal notes ready. I finally nailed the first sentence, was coherent, and could put together a decent plan together for my people. So it does come back fairly quickly (please everyone, stop tell me it will come back quickly!), but it took me four days to relearn what I had honed in one year of training. And the battles continue...

On Wednesday, I admitted (or "attempted to admit") to the hospital a child with an asthma exacerbation. I ran down my history and tried to ask all the right questions. What medications do you take? Has this ever happened before? How many times have you been to the hospital for your asthma in the past year? Ever? I performed my physical exam, chatted with the family, and then left the room to discuss the patient with my resident. I recounted the tale briefly, and then he asked me what I wanted to do for management. With confidence, I told him I would do this-this-and-this, and absolutely, by no means, under no circumstances, would we start steroids in this patient (because there was no evidence to suggest that steroids work for an acute exacerbation, I stated emphatically!).

My resident stared at me blankly. Then he said, "We will absolutely be starting her on PO steroids. That's what you do for an asthma exacerbation in the inpatient setting." Then he looked at me funny.

It took me a couple hours to realize that I had confused an acute asthma attack with a bout of pediatric RSV. So I went off to Starbucks to do some more reading on the topic.

There seems to be a lot of that going on. Once I see something - a diagnosis, lab value, or physical exam finding - I remember it again. Then it sticks (hopefully). And off and on I will remember the random things, such as the mechanism behind right upper quadrant pain in a patient with transaminitis or what Kerr's sign is. But then when someone says that a patient had "HCC," I draw a blank. I have to look up a lot of stuff up that I already knew (HCC stands for "hepatocellular carcinoma" by the way). It's coming back, slowly but surely. I just wish it would come back faster.

The days fly by in the hospital. We begin at 7am, and when I look at the clock again it's noon. It feels like only minutes later we are signing out to the night float resident. It is amazing how fast this week has gone. Ten or eleven hours in the hospital, then eat, workout, study for an hour, catch-up on emails and finish lingering work, read, and repeat. It's nonstop and I love it. Screw work/life balance! Who needs it?!?

I'm sure that philosophy won't last.