Early to rise

Today I had to get up at 5:15 in order to make it to EKG lecture at 7:00. It was a very basic introduction, we didn’t actually look at any EKGs. At 8:00, those of us on outpatient stayed for chairman’s rounds, which is where the chairman of the department of medicine sits with us for an hour and talks with us about what field of medicine we want to go into, and how we should go about it. Very nice of him to take the time to do that. Breakfast was even provided (I always think it’s ironic that these free breakfasts for doctors and medical students always have several plates of donuts and pastries. There were other options, though, and only one student out of about 20 ended up having a donut which is a good sign since we spend so much time trying to convince patients not to eat junk food). He said several interesting things, one was that he believes that the city the school is in is “still in the ‘80s” as far as the medical lifestyle goes. Apparently, many students are scared away from going into surgery and OB/GYN based on the doctors’ not having a life outside of the hospital. According to him, in most other cities, doctors have more balanced lives. Encouraging, but I’m taking that with a grain of salt.

After chairman’s rounds, I drove out to the clinic. The doctor was pressed for time, so I basically just observed. Several interesting cases, though. I saw a man a couple days ago who hadn’t been taking his diabetes or cholesterol medications for two months, but came into the office because he had hurt his knee. Also, he noticed his vision was getting blurry. He said that he had lost 20 lbs, felt great, and that his glucometer had said his blood sugar was 18 for the last month, but had been about 300 the month before (normal is 70-100). Since this was clearly impossible, I assumed (but did not tell him) that his blood sugar wasn’t 18, it was just so high that the glucometer couldn’t read it and was going haywire. The doctor got him to the lab. Today he came back to hear the results. Turns out his blood sugar had been well over 300, his triglycerides were almost 700 (normal I believe is less than 150), and his HbA1c (shows how well the diabetes has been controlled, healthy people have about 5.5, well-controlled diabetics have about 6.5-7) was 14.1. I think this scared him badly enough that he is going to be serious about taking his medications, so it is probably a good thing this happened.

I saw a couple today who were both in their nineties. The doctor had me listen to their hearts, and I was able to correctly identify their murmurs (the man had aortic stenosis, the woman had aortic stenosis and mitral stenosis), so I have learned something these last two years. Funny thing, the man was examined for the army during WWII, and a heart specialist told him he had six months to live. Well, he was only about 60 years off!

I got a chapter of the textbook to review a couple days ago, and I started reading it last night. I was afraid that I wouldn’t have anything to contribute, but after reading the first paragraph that is no longer a problem. I am guessing the author’s native language is not English, or else he just isn’t used to writing text-book style. The information is all really good, but is very choppily written.

Today, I got a chance to have my notes evaluated. The doctor told me they are too wordy, I can definitely see his point. Apparently it is better to write not quite complete sentences so people can quickly scan the note and not get bogged down. For example, he said that instead of “The patient states that he began to feel nauseated three days ago. He has not had a fever, cough, or abdominal pain. He took two ibuprofen two days ago which helped a little.” It should be: “Nauseated for three days. Denies fever, cough, and abdominal pain. Ibuprofen somewhat effective.” I think it is going to be a little hard for me to get used to that, I’m very glad he told me now before I developed bad writing habits that would be hard to break down the road.