It's hard to believe that I only have 1 more week on Medicine block. The days are long and no one gets enough sleep, but it's the greatest experience ever. I swear I'm learning at least 10 new things every day!
Our days start at 7:30 in the ICU to take over any patients that came in overnight on emergency (if their condition requires transfer to medicine, versus neuro, surgery, etc). If I already have a patient in ICU, I come in around 6:15 or 6:30 to do their morning treatments and write their records before presenting their case to the resident/intern and Dr. P. We have rounds from 8-9 every morning, and appointments start at 9. I'm on the Tues/Thurs team, so we see appointments on those days and do procedures on Mon/Wed/Fri. Otherwise, we help out our classmates, help out in ICU, or read up on the next day's appointments or procedures.
An appointment at the Teaching Hospital is an all-day affair. We do our initial exam, take a history, and then leave the client in the exam room while we shuffle through notes, books, and articles and consult with our classmates about our ideas about the patient. We then present the case to the intern/resident/clinician and are grilled about our findings, our rule-outs, our recommended tests/treatments, and our general lack of knowledge :) There's so much to forget from the past 3 years, but once you've had a case or two that are similar, or have heard about a classmate's case, it gets easier. By now at least an hour has passed, and the client is pacing the room. We go back in with the DVM and they repeat our exam and ask any questions we forgot. Then we take the patient back to our ward to draw blood or do a more thorough exam and start submitting the reams of paperwork required to get anything done. Radiology and neuro consults are usually done within a few hours. Procedures (endoscopy, colonoscopy, etc) are scheduled for the next day (more paperwork!). Stable animals stay all day or overnight in our ward. Sicker animals are transferred to ICU for more intensive treatments (i.e. IV fluids). A patient remains in my care until it is discharged or a new block starts (when it is transferred to a new medicine student). This includes 7s (we try to group major treatments at 7am and 7pm), walks, medical records, daily written reports, discharge letters, paperwork for additional diagnostics, etc. On weekends, we have ICU rounds at 8am and are also responsible for regular patient care.
We are also assigned ER shifts (4:30-midnight for most blocks, midnight-7am for radiology students who have an easier daily schedule) during the week, and ICU duty (4:30-midnight during the week, midnight-8am/7:30-4:30pm/4pm-midnight on weekends). In addition, someone is responsible for 11pm treatments of any patients in our ward. An ER patient remains in the care of the ER student until the next day's transfer (or Monday if it's a weekend). All of this makes for a MINIMUM 12-hour day. I worked 74 hours the first week and 77 this week. It's a marathon!
Here's a link to a tour of the VTH:
VTH tour
Cases so far:
-Boxer with chronic vomiting and weight loss: developed seizures and was euthanized this week when MRI showed a forebrain tumor
-ER patient: mixed breed with 1 seizure episode
-ER: Husky with a probable pheochromocytoma (stress hormone-secreting adrenal tumor): cool case as this tumor is very uncommon. She goes to surgery this week with my friend Jeremy on her case.
-Dachshund with intervertebral disk disease (didn't really need an exam to suspect that's what he had!): 4 weeks cage rest and NSAIDs
-taken over from ER: Yorkie with immune-mediated thrombocytopenia
-Lab with bladder mass: polyps, not cancer! This lady gave me a hug just because she liked me and I loved her dog. Imagine how happy she'll be when she hears it's probably not cancer!
-beagle with icterus and immune-mediated hemolytic anemia:went home yesterday on immune suppressive drugs to be reevaluated at the referring vet next week. This lady is my new best friend...she was so happy her dog is getting better, even though we're not sure what caused her illness.
-Lab with intermittent vomiting
