First day of rotations!

Here is an outline of what happened to me on my first day of internal medicine! (I apologize for the rushed, typed out medical speak this may be in, I'll do my best to translate)


7:30: arrive at hospital

8:20: The orientation woman/scheduler finally shows up (orientation being HIPAA training, filling out paperwork, and that's it); also I am told by this supposed scheduling person that she doesn't do the scheduling for IMED and I have to call my preceptor...slightly start to panic because I never contacted my preceptor in the first place last week because my school's paperwork said my contact person for scheduling was the orientation lady

8:30: get ID badge

8:35: realize ID badge says medical student, have to wait to get another one made (happened to the other PA student from my school at this hospital too, who is doing surgery, thankfully  he was there to endure all this with me)

8:40 call supposed preceptor number, the one listed on the my school's paperwork, and told it is the wrong number and she doesn't work there...started to panic since orientation was at a different campus than the hospital I was doing orientation at and I was like "not only does my preceptor not know I'm coming, I don't even where I'm supposed to be right now"

8:45: find orientation woman who is able to tell me my preceptor's pager number, page preceptor, find out that I'm actually at the campus that orientation was at, not the one listed on our paperwork from my school, preceptor comes up to get me, and I get a flash tour of the hospital and intro to EMR

9:30: am told to go sit in the library and study because there aren't any admissions

10am: get a call to come shadow an admission. Patient #1 was Russian, couldn't speak a word of English, chief complaint was difficulty breathing, was on 17 meds and had like 10 comorbidities, was initially dx with acute respiratory insufficiency but then as serial troponins kept coming in it was obvious she was having an NSTEMI. At the beginning I had 5 mins to review the 15 page chart and they said "Ok, so what do you think?" and "Interpret this EKG" and there were a ton of abnormal labs and I really had no clue what was going on. They were nice about it though when I told them it was my first day of rotations, and then they said "Well ok that changes things in terms of expectations," haha, and they helped go through things step by step.

12ish: start shadowing for second pt, with a cc of "elbow pain and diarrhea" (??), was on 23 different meds (yes 23!!), who somehow had a nondisplaced fx of the radial head without a hx of falling or anything? (she did have osteopenia though) and had weird small pleural effusions in her lungs. I still don't know what is going on. However I did get to feel a thrill (?) from where her dialysis fistula was!!

2:50ish: they let me go to lunch, but I get lost wandering around the hospital and by the time I get my food I have just enough time to eat half a sandwich

3:15: they ask if I want to see pts by myself, I say yes!!, and they say "go see room 20." I pick up the chart and room 20's chief complaint was CP and dementia so I was like "Oh great, what a wonderful first pt to have." It turns out that it was early stage Alzheimers so she was still definitely easy to get info from. The interesting thing though was that she said "I don't like arguing with my kids, it makes me angry" and I asked her what they argued about and she said "well they try to get me to go out to be social but I just want to stay home by myself" and it dinged in my head that agitation and social withdrawal were some of the first signs of Alzheimers (thanks oral boards!!)

6pm: get to go see my second pt by myself , this one's cc was fever but had tachycardia as well. She also didn't speak a word of English, so I have to get the history from her daughter which theoretically you're not supposed to do, but they told me to do anyway bc it takes so long to get a translator. She was interesting bc I definitely heard my first wheezes and rales. I figured out that it was her lung problem that was causing her fever, and the radiology report said she had pneumonitis (I didnt get to see the chest xray though bc I dont have access to the EMR system until Weds, which just added to today's complications). So I was happy that I could figure that out, but completely blanked on what was causing her tachycardia, although it was soooo obvious (fever, in pain, she was on beta blockers, had shortness of breath, dehydrated, was taking corticosteroids). So that was my derrrr moment.  Theoretically I was supposed to be done at 8 but bc it took me so long to assess the pt and write my H&P (history and physical) and whatever I didn't get out until after 9.

We also had another pt whose blood pressure was 214/190 or some other ridiculous number and it wasn't budging with all the meds they were throwing at her, but then we figured out that she had stopped taking her clonidine 2 days ago and was probably experiencing rebound tachycardia which we definitely learned in pharm! I didn't get to see if restarting her on clonidine worked though but I thought that was an interesting moment.

So yeah...good day overall. Definitely overwhelming and my brain was still in vacation mode, but it was cool being able to put everything together and not be studying. It absolutely flew by too. I also didn't do my H&Ps and PEs according to my school's standards so I'd have to work on that! haha.