My fourth rotation was Internal Medicine, where I was at Northshore University Hospital in Manhasset. I got to go to lots of different units throughout the hospital and have a variety of experiences. In addition to being on the general medicine unit, I also got the opportunity to go to the endoscopy unit and watch and assist in endoscopies, colonoscopies, and ERCP, as well as the Cath Lab, where I watched and assisted with angiographies and stunting, and hemodialysis, where I learned about how it is done and watched it being initiated from various ports. I also got to spend a few days in the Medical ICU, where I really got introduced to very critically ill patients, learned a lot from the thorough rounds, and got to participate in various procedures.

Although I had seen sick patients before, this rotation, during my time in the MICU, I was exposed to some patients who were literally swinging between life and death. I learned how to manage these types of patients, and the challenges that arise from them, such as ethical challenges. For example, there were often questions about whether patients should be treated with certain treatments that may save them or prolong life but would leave them in a very incapacitated state, or the treatments were risky and could potentially cause other issues that could be life-threatening. There was a great amount of problem solving, ethical decisions, and weighing risks and benefits, because with such sick patients, there is never really a great option and you are always dealing with a great deal of unknown- a treatment can work, or it can backfire and cause other issues, and it is not always so clearcut before trying, Another challenge with this population was discussing with families. There were a lot of family meetings that went on, where a team of an inter professional team of medical practitioners and social workers had to explain to weeping family members that they are doing as much as they can, but the prognosis is still grim and they should prepare. As I walked around and saw families sitting by their sedated loved ones and discussing with doctors “is there anything else you can do,” the reality of these difficult situations really struck me.

An unfortunately memorable patient I had was a 61 year old woman who came in with angioedema. My first week in the MICU, I was involved in admitting this woman from the ED, and watched her get intubated as a precautionary measure since her angioedema was subjectively getting worse and they did not want to wait until it would potentially be too late to intubate. I was with her the rest of the day and  watched as she was cared for, as well as met her family members who did not seem so concerned and explained what was going on (and that she should make sure to no longer take ACE-inhibitors), that we were really just monitoring her but with the medications she should be extubated and get better soon. I came back to the MICU  one week later, and to my horrific surprise, this patient was still in the MICU, and was basically on her deathbed, awaiting ECMO since her lungs were shot. When I inquired what happened, I learned that she had gotten necrotizing MRSA pneumonia that had spread to her arteries,  she was hemorrhaging everywhere, and she was probably not going to make it. It was my first time being exposed to a situation where a simple issue had turned life-threatening, and I felt like I had seen the whole progression. I was literally with her when she got to the hospital, where she was laying awake in the hospital bed calmly chatting on the phone with her husband (albeit with a little difficulty since her tongue was swollen), and to see her like this a week later was very scary and difficult for me to deal with. It introduced me to the harsh reality that medical mistakes happen, difficult situations occur, and as practitioners, we can only use our best judgment and do everything we can to help a patient, and the rest is our of our hands.Though a truly awful and unfortunate experience, it was definitely a very humbling one as well.

I also learned some new techniques during this rotation. I attempted venipuncture on some really hard sticks, and learned that we could really take blood from literally any vein, though some are more painful than others and small veins are really slow and blow more easily. I also learned how to do an ABG using a butterfly needle, which was something I had never seen or learned before neither in school nor in past rotations, and I actually thought it was a great way to do an ABG. I also saw how it is possible to take some labs from arteries instead of veins in cases where someone is an exceptionally hard stick ( or has an enormous amount of edema) and it is nearly impossible to get venous access.

Something I really want to improve on is procedural skills. Though I was able to get some more experience during this rotation, I know that it is not something I am so naturally comfortable with or good at, and I would love to get more experience and practice so that I can become more comfortable. I am excited for my next rotation in the ED, where I hope to get more opportunities to practice various procedures and learn some new ones that I have not done yet.  

Something that I learned about myself during this rotation that surprised me was that I love the MICU! More broadly, I loved the fast paced nature, especially when someone was coding or desating or had a serious issue that needed to be dealt with right away. I also loved all the medicine and problem solving involved, since the sicker the patient, often the more issues that have to be balanced against each other, dealt with, and worked through. We did detailed thorough rounds where we spent around 30 minutes with each patient, discussing all the issues involved, the science behind it, and how to go about doing as much as we can to save them and make them better, and I really appreciated hearing different practitioners opinions and logic behind their thoughts, and coming up with my own.  Finally, I enjoyed watching and assisting in so many different types of procedures, though, as I mentioned, I am not so comfortable with procedures and am not sure how I would feel about performing them myself 🙂  Before I went into the MICU, I was dreading it, and was so excited for my days there to be over. By the end, I loved it so much that I asked to come back in again. It was something that was not on my radar at all before, but definitely something that I am thinking more about now. 

  Overall, I really enjoyed this rotation and learned a lot!