i think i might be almost adjusted to waking up at 4 to get to the hospital at 5 to be ready for pre-rounds at 6 and then class at 8 and then big rounds at 9. almost. i come home and then take a long nap. i haven't gymmed in over a week, probably almost 2, sleep is more important. my eating habits are all whacked out, but i'm doing good on not overdosing on caffeine. i've managed to stick to my one cup a day habit...
medicine is going well...my team is great. the residents are amazing. the cases are interesting, i enjoy looking at all the lab numbers and thinking and whatnot, but i have to say that sometimes, i find certain patients' conditions to be disgusting. case in point...i can now confidently say i do NOT like anything to do with COPD. the coughing noises and the spitting up gross stuff and the heaving...GROSS. other than that, medicine isn't so bad. i don't know why the lung stuff just freaks me out. i certainly haven't had that "oooh i want to do this" sort of emotion, but it is interesting and it's growing on me. who knows.
i've seen a lot of sad stuff too...most of the people in the hospital are there because they smoked their whole lives. people, JUST DON'T SMOKE. you do not want COPD and to hack up a lung everyday and not be able to breathe. you don't want esophageal cancer so you can't eat. there's a patient on the service right now with this huge tumor on the side of his head that is ulcerated and infected. he has brain mets. he has at least a dozen lung mets. it's so sad. then there's another guy with a decubitus ulcer. i saw his FEMUR through the open wound. no pain. i'm sure the ulcer hurt like hell when he first got it, but as it got worse and worse the nerves are killed off and then it doesn't hurt anymore. but i saw his bone. *shudder*
when we present our patients we have to follow a certain format. "mr. so-and-so is a ___ year old ___ male with ___ who was admitted on ___ for ___." well, it's sad when their problems list is a bazillion things. i had a patient who's medical history list was at least 10 items long. it amazes me how people don't take care of themselves. granted, sometimes, it just can't be helped that you get ill. but a lot of these chronic diseases occur because the patients just didn't eat well enough, or exercise enough, or smoked for too long, or just didn't pay attention to their bodies. if you think something is wrong, get it checked out. don't sit around and just let it fester. then you end up with brain and lung mets, when if you had just noticed that maybe you had a funky looking mole on the side of your head, you could have gone in, gotten it removed, and call it a day.
other than the sad cases, we do have some good ones. i like it when the patients come in sick, and we make them better. i know, it's basic, but i like it. i especially like it when a really ill person comes in with no hope of survival, and their families have decided to put them on comfort measures only. i think that's the most humane thing anyone could do for a loved one.
ha, so not to end on a depressing note, we had a 94 year old patient who was SO CUTE. omg, so cute. (also, he was my first patient to do a FOBT on...ha! and i still have my finger! it didn't get sucked in or anything...) he talked so much about how he worked on building the panama canal and various bridges and how he loved fishing in montana and whatnot. yes, he was super old, but his brain was very sharp. too bad his talking couldn't keep up with his thinking...
so on my list of things to do is take a nap, do some reading on FeNa and the various classifications of kidney failure. oh, and finish up some H and Ps. busy busy.