I-med Grand Rounds: Peewee vs. Doogie

Four days into an internal medicine rotation. I'm enjoying it, even though I will definitely hit the eighty hour cap this week. My favorite part of this gig, so far, are the ER admissions. You get paged by one of the senior residents and told to go admit so-and-so in room-x, and you just never know what might turn up. A total crapshoot, my friends...

Today's gem was a 78 year old woman with a gangrenous toe. She and her daughter had already been to another emergency room in the city and signed out against medical advice when somebody mentioned that the toe might have to come off. Through the subtext of our exchange, it became clear that the daughter knew and fully accepted the likely outcome, but remained powerless to convince her mother of its neccessity. She was just playing along in hopes we would somehow admit her mother without anyone screwing it up by saying the "A" word (amputation).

Despite being left mostly paralyzed on one side of her body by a previous stroke, this lady was Feisty with a capital F. She nearly kicked to the floor the beefy surgical resident who made the mistake of conducting a "sensation check" on the rotten toe. A Kodak moment for sure, that woman's size nine foot planted firmly in that surgeon's gut. Although it was clear to all present that she was aiming a just a little bit lower...

Least favorite part of Internal Medicine? Grand Rounds. Let me tell you why. Grand Rounds, in theory, is meant to be this golden forum for the exchange of ideas; cases are presented for discussion, and ideally, there would then be this magnificent cross-pollenization between members from the varying subspecialties. In actual practice, Grand Rounds is frighteningly reminiscent of the trainwreck of a gifted-and-talented class I was forced to endure back in fourth grade: forty minutes (conservatively) of every hour are spent while the same four or five people to try to establish that they are the Smartest Person in the Room. The leading men at this particular hospital are an attending pulmonologist the residents call Peewee Herman, and an intern who is the Pakistani incarnation of Doogie Howser.

At certain points during these exchanges, I am sorely tempted to yank aside one or other of these jackasses and scream, "Look man, don't you realize you'd actually end up looking smarter if you stopped blurting shit out?" But, of course, I've never actually done that. Mainly because I am more or less content handling the situation the way I did back in fourth grade--sitting in the back of the room telling fart jokes.

Another thing I have noticed about this rotation: even on days when I manage to get home before dark, I am completely and thoroughly exhausted. I mean, noticeably more so than with other rotations. My theory as to why? Between the staggering amount of information we are required to process and the depth of emotion kicked up in dealing with the extremely sick patients who populate inpatient medical wards, even a very enthusiastic and very competent person would be bound to be tapped by day's end. (I haven't met that person yet, but nevertheless, I'm willing to bet they're as tired and crapped out as the rest of us by the time signouts roll around...)

Tomorrow: Friday night call in the ER. Guess I better go get some rest, Pilgrims, while the beeper's still behaving itself.