IM Team B

Internal Medicine: My old friend

So up until Internal Medicine, I had given up on adults. I had abandoned my sweet old ladies, my pain medication seekers, the chest painers, the crackheads, a lot of the patient population. I had given up on rambling histories that span decades. I had given up on those people that may or may not be neglecting information. Then I began inpatient internal medicine. This is the “wards” so to speak. If you’ve had the pleasure of reading House of God, these are the gomers and the TURFS and all the clever things Mr. Shems discussed. I would soon the medical student on Team B. My goal, not to make my residents and attending’s job any more difficult (per House of God). I expected to be let down, to side with the cynical resident, to resent the smell of .. well smell of patients in the morning, and to grow tire of the dreaded differential.

But ladies and gentleman (my loving readers), I didn’t. See, I started Team B and would be on Team B as the only student. There were two interns, an upper and our attending and me. I was the go to man so to speak and I loved it. A lot of my third year experience so far has been shaped by the people I work with. The residents and attending set the tone. For me, pediatrics was probably one of my more stressful, anxious rotations I worked in. Don’t get me wrong, I still want to do pediatrics , but not just pediatrics. Medicine was the complete opposite. We joked around, we said really inappropriate but hilarious things behind closed doors. We just didn’t get worked up over little things. So let’s discuss what it means to be on a team, who we are and what we do and how we do it. (queue “this is how we do it”)

The Team (from Top to Bottom)

The Attending - The boss, the fearless leader. The attending is the source of knowledge, the captain of the ship. He probably interacts less with the patient than any of us, time wise. The attending really spends the morning and early afternoon on the floor and then has other things like clinic and whatnot to do later.

My attendings: I had two different attending for my 8 weeks. One was an Indian guy who’s lifelong dream was to be a cardiologist. For anonymity , we’ll call him Brown Doc. So Brown Doc was essentially a coolster. You see, he was the kind of attending who liked to be involved in jokes and wanted to know why everyone else was laughing. He also thought he was funny when he made really inappropriate comments in public (public being the not safe zone of the floors vs. the rooms for residents/doctors that’s our safe areas). Brown Doc was also a one upper. If he asked you a question, and he does, a lot. You can have an answer and it may be right but he’ll ask you for another differential or something related just to one up you. For example:

Brown Doctor : Young AA Athelete drops on court from heart condition, what is it?

Me: HOCM , Hypertrophic Obstructive Cardiomyopathy

Brown Doc: Tell me about that

Me: ramble on for a little about sarcomere mutations, val salva maneuver, outflow obstruction, preload.. AD inheritance

Brown Doc: What’s another possibility?

Me: uhhhhh.. I don’t know

Brown Doc: [one up time] how about ARVD?

Me: uhhhh

Me: [waits for anyone else to chime in] What’s that?

Brown Doc: ARVD is arhythmogenic right ventricular dysplasia…

Me: [awesome]

Brown Doc grew to like me after first pissing me of my obnoxiously calling me my last name when first meeting me. He also was very appreciative of my efforts and thought much more highly of me than he let on.

My other attending , we’ll call him Dr. G. He is from Georgia, a southern gentleman. He is the quintessential IM attending. He’s very paternal in nature. He jokes enough where things are lighthearted but not overwhelmingly so. He was a big fan of boards questions, MKSAP questions. He’d print out one-three questions every day for all students and residents and we’d do these between rounds. He was also a stickler for rules which is mostly fine unless you’re trying to sneak out of a lame lecture after being on call overnight. He also made sure he pointed out good pathology and wanted you to do a thorugh exam. One of his other learning techniques was to assign us topics based on patients. For example, we had a patient that may have had HIV associated lipid dystrophy. Basically, it was my job to go home and read up on it and in 90 seconds , present the group an overview of the topic. This was actually really useful because he’d assign it to students and residents and we’d learn from one another. Dr. G, definitely one of my favorite attendings ever.

The Upper Level – The upper level is second/third year resident. They’re the team leader. Really, they’re in charge of overseeing all patients, acting as a liason when we consult other specialities and check behind the interns . My upper level, Josh was a cool guy. Josh was able to fart, laugh till he cried, just keep things light. At the same time, he was always on top of the ball. He taught us important things and encouraged us to be independent. One of the perks of being Josh though began one fateful call day:

[Robert heads down to the ER]

Robert: Hey Josh, what’s up

[biggest grin on Josh’s face ever]

Josh: guess what you get to do?

Robert: what’s that?

Josh: DRE man, snickers

[DRE is not the rapper but rather “digital rectal examination” – finger… in the butt, which for a lot of people is one of the most disgusting things ever, but I had grown desensitized to it during surgery]

Robert: got it man, consider it done

I’ve zinged Josh twice , perhaps more but twice in medical things. Once, I thought I heard an aortic regurg murmur, a low grade on this guy who had aortic ectasia on chest xray. Truth be told, I was listening super closely because I knew the chest x ray findings but even then.. Josh said he didn’t hear a murmur. The next day, Dr. G definitely said… there’s a murmur.. a faint one.. but it’s there. Robert -1 Josh – 0

The next zing was me totally dashing Josh’s dream diagnosis. We had a patient who had some finding that Josh felt a differential of aorto-enteric fistula was warrented. He was all excited and proud of himself when I ask: So, question, if he had said fistula, wouldn’t he be really sick? I mean if there’s a conduit from gut to aorta.. that’s serious. Josh, just started at me and said “thanks Abdullah”. Robert -2 Josh –o

Now in all fairness, Josh called me out on a variety of things but he really taught me a lot and we got along awesomely. He tried every now and then to catch me. One time we had a patient and Josh tells me to listen to her and tell me what I hear in front of the patient and family member. IN my head, I’m like… this’ll look really bad when I miss some kind of crazy thing like.. missing heart for example. So I listen, I hear what I think is a mechanical valve and I pull the ole medical student safe question re-ask:

Me: She doesn’t have a mechanical valve does she? [you see, if he says no… I can strike that off, but if he says yes.. it’ll confirm what I think]

Josh: I don’t know,does she

Me: [well played Josh, well played] Yes, I believe she does

Josh: good job

Because I had been the solo medical student for four weeks before working with my awesome partner, K Dub, I got a nickname for my frequent DREs. I was called rectal king. “King of the Rectal Exam”. Later, after one of the interns misheard my two nicknames Rectal King + Sexy Dark Chocolate, I became rectal candy.

The Interns – The interns are the workers, the grunt doctors of the medical team. They work the closest with the medical students. We are their personal bitch. If they need something, or something done, they will ask us. I worked with several interns. I’ll try to sum them each up

Captain Nascar - nuff said

Slick family medicine resident – so we also get a family medicine intern on our team as well, this guy was pretty cool and from Lebanon

Eminem’s little MD sister – this resident was one of the funnest, most hardworking residents I’ve ever worked with. She would throw down sick beats randomly and bust a move in the middle of rounds.

SS – SS was cool as well, she was laid back but worked hard and didn’t waste your time.

Persian – The Persian was a cool guy, really big about bedside manner

The Students – we’re the bitches on the team. Essentially, any rectal or random non-MD task goes to us. We see the patient for the longest period of time. We were fortunate on our team to be taken seriously for our suggestions. If I thought our patient was a good candidate for CPT, I expressed it.

Me – Well I’m pretty much an awesome medical student. But seriously, my MO is quiet sneaky but effective. I think a lot of people mistake my initially quiet and reserved demeanor for being shy. The thing is, given a few days, I was joking with my residents and helping make their life a little easier. I’m not the student that jumps on every question. I usually wait my turn and when thrown a curveball, attempt to hit a double. I’ve also learned to smile and joke with my patients, if they like me.. it makes my day a whole lot easier.

K-Dub – I worked with K-Dub, a classmate and friend , for four weeks. You see the things is, working with someone on a rotation can be quite different than hanging out with them watching Glee. In the hospital, you want to work hard and be seen as helpful. You also want to not ever make your partner look bad ever. Thank goodness, K Dub and I got along like PB and J. We supported each other greatly, kept the mood light and always gave each other credit in front of the attending. We also took our hits together, as a team.

So, IM was fun. Q4 call is the only downside to being on IM. We got to see crack chest pain, GERD chest pain, STEMI chest pain, NSTEMI chest pain, GERD chest pain, chest pain NOS. We saw a case of neurocystercircosis , unfortunately I was unable to visualize any worms in the patient’s eyes. We son tons of ascites patient, whether it was from alcoholism, cirrhosis, cryptogenic cirrhosis, etc. We saw diabetes, tons of diabetes. Anywhere from newly diagnosed to foot amputee diabetes. We also read tons of EKGs. Remember Brown Doc attending is heading off to cardiology fellowship so he loved having us cold read EKGs. I saw some interesting pathology like AML with sweet’s syndrome.

There’s probably a lot more that I’ve seen and have forgotten but needless to say, I miss IM Team B.