Internal (Eternal) Medicine: Part 1 of 4
November 2, 1998
Monday
HELLO TO [my captive audience] ALL [old and new] SUBSCRIBERS OF MY ONLINE E-MAIL JOURNAL OF INTERNSHIP!
Think you missed an issue? Wrong. The journal had been out of circulation for about 2 1/2 months due to computer inaccessibility…. In other words, I haven’t been home since August (or was it early September?)^ because of my 10-week rotation in Internal Medicine. In fact, we sometimes call it “Eternal Medicine” because it’s the longest rotation of Internship (and of Clerkship too). It’s going to be difficult putting the events of the past 10 weeks into this letter, but I’ll try anyway.
The first two weeks or Internal Medicine are spent at the Outpatient Department (OPD). It’s your usual doctor’s office – waiting room, a desk, a chair for the patient (and companion) and another chair for the physician. There are several such set-ups in one big room, divided by panels into “cubicles”. We interns (usually 8 of us) see patients from Monday to Friday, about 40-50 per day; after doing the usual interview and physical exam, the intern presents the patient to an Internal Med resident, who checks the patient out and agrees/disagrees with the intern’s diagnosis and plan of management (treatment and lab exams). This is called practicing medicine under a licensed physician’s supervision. It is scary that in less than a year, I’ll be practicing medicine without anyone’s supervision. Good luck to all of us (?).
The OPD rotation is where you really feel like a doctor. This was the “fun” part of Internal Medicine, not just because of the ego-trip of being a doctor (instead of a student), but also because there was ample time to go watch movies, eat out, shop, and do whatever else. “Gimmick* everyday!” was our pseudo-motto, as we were about to go into the wards…
Weeks 3 to 6 were spent in the wards. We practically lived in the interns’ callroom, which is about 4×3 1/2 meters (20 sq. meters area). This “home” had a bathroom, refrigerator/freezer, air conditioner, several computers, shelves and 2 double-deck beds (=4 beds); it’s shared by 18 (!) people, who are (thankfully) not there all the time. We go on duty every 3 days, and on duty days we are assigned to the wards (two of them – one for males and the other for females) for 2 4-hour shifts. It’s scutwork galore – “scutwork”, meaning IV [intravenous] line insertions (“dextrose”), blood extractions, monitoring patients’ vital signs, Foley catheter insertions (for the non-medical people, this is a rubber tube inserted into the urethra, or urine passageway, attached to a uro-bag for collecting and measuring urine). Yuck. Internship is mostly scutwork, and you don’t learn anything much doing them. Each duty group is composed of 6 interns, who share the 4 beds in the callroom. Make that 3 beds. One bed is for our bags and stuff. Patient care during the first two weeks (weeks 3 and 4) consisted of collecting blood, urine, etc. to send to the laboratory, and referrals (“student-in-charge to please refer patient to Ophthalmology”, “student-in-charge to please drop follow-up referral to Surgery”, “student-in-charge to do urinalysis today without fail!”).
For’ the last two weeks of our ward stay, we were allowed to manage our patients – again under the supervision of a licensed physician. So whatever we write in the chart (patient’s record) should be countersigned by the resident (“increase Gentamicin from 80 mg BID to 80 mg TID IV” – in everyday terms, the antibiotic Gentamicin with dose of 80 mg should be increased from twice a day to 3x/day, via the intravenous route). On top of that, we still did the labs and the referrals. And we would sometimes write to ourselves, “student-in-charge to do wound OS [culture studies] if not yet done” – talk about antagonizing yourself. For 4-5 days, you are also the “Junior Admitting Physician On Duty”, or JAPOD. You follow the admitting physician around, and you should know all the patients admitted at the ER and subsequently at the wards. Very tiring, but fulfilling too. For these 5 days, you do the patient census (thank God for computers) but don’t have to handle patients in the wards (some break).
That’s only the first 6 weeks of Internal Medicine. This letter is getting too long, and I must leave for Manila (I’m on duty tonight). Internal Medicine Part II – see next week’s issue.
PS: Your subscription will be terminated in 6 months. No renewals. I’m graduating in May!
Notes:
^ In 1998, internet was accessible through a dial-up modem – i.e., it was not ubiquitous. I did not have reliable access to the internet and my email when I was away from home.
* Gimmick – Filipino English for “leisure activity” or “fun stuff”; during internship this generally meant going out to eat or going to the movies.
JOINT is the Journal of INTernship, a series of email messages to family and friends (“journal subscribers”) written during my yearlong medical internship from May 1, 1998 to April 30, 1999. Internship is one of the requirements before taking the Philippine Physician Licensure Examination (also known as the Medical Boards). Journal entries were edited for clarity in January, 2020. Read more about it in the first blog post, Introducing JOINT.
