Rotation #3: Internal Medicine (and pondering my future)

When I decided to go back to school to be a physician assistant, internal medicine is what I had in my mind. As a clinical dietitian, I had the chance to collaborate with APPs and loved the idea of being able to provide that kind of care to patients. One of the APPs who I had the chance to work with often while I was a dietitian became my preceptor for this rotation! It was very cool to be standing in the exact spot I had imagined back then. 

Back then, though, I did not appreciate just how challenging this job would be! I worked with a small private practice group that has privileges at various area hospitals, and my preceptor and I were based at one large metro-area hospital. The service was crazy busy the entire time I was there, and that was both good and bad. I got to see a ton of different diagnoses, a wide variety of patients, and was challenged to be relatively independent. But dang, it was hard to keep up most of the time. Honestly, I worked more and was more exhausted during this rotation than during my surgery rotation. And everyone told me surgery was going to be the hardest! Ha.

Here are some of the more unique diagnoses I got to see along the way:

• Thyroid storm: way too much thyroid hormone in the body that causes symptoms such as fast heartbeat, weakness in upper arms and thighs, insomnia, and delirium
• Endocarditis: infection in the heart due to IV drug use; the patient had to stay hospitalized for 6 weeks for IV antibiotics
• Hepatic hydrothorax: ascites fluid from liver disease goes into the chest cavity due to a diaphragmatic defect
• Cauda equina: spinal nerve roots are being compressed and cause bowel and bladder dysfunction
• Abdominal migraine: persistent nausea and vomiting in a patient with history of migraines, successfully revolved with new migraine medications
• Penile fracture: I think this one is self explanatory

And the coolest one of all...

• Diabetic striatopathy: this is a rare condition where hyperglycemia, usually in post-menopausal women, causes them to have choreiform movements and striatal abnormalities in their brains

Also worth mentioning is that a patient "fired" me because I had "bad vibes," and on my very last day I asked a patient with a tooth abscess and possible jaw osteomyelitis if she wanted nicorette gum, even after she told me she was having trouble eating due to the pain. Doh!

Pondering my future

I've been trying to assess as I go along what I want to do for a job when I graduate. And honestly, I think I have less of an idea now than I ever have! Did I love orthopedic surgery? You bet I did. But did I love it because I did absolutely zero charting and zero rounding on patients and zero differential diagnoses, and just participated in a ton of fun surgeries with surgeons who let me use bone saws and lasers because I was a bright-eyed student? Yeah, I have the feeling that had a lot to do with it! 

I recently participated in a virtual Q&A for an orthopedic surgery fellowship, which I am certainly interested in. However, I would be lying if I said I didn't have reservations about being a glorified student for another year. At the same time, the chance to dive so deep into a specialty and build my skills is also really appealing! 

This internal medicine rotation is the first rotation I've had where I feel like I've seen exactly what life is actually like as an APP in this role. General surgery was also very close to reality, but I did very little charting there as well. Either way, it's a lot to think about. I certainly miss the hands-on aspect of surgery. Surprising even to me, I really like the blood, guts, and gore. Taking out a big pilar cyst and doing a debridement of infected bilateral BKA wounds are a couple of my favorite memories so far. And let's be real. Wearing scrubs all day is the best. Ha. 

I'm trying to keep an open mind for a lot of reasons -- I am not even halfway done with clinical year. I have a lot yet to see. Who knows, I could fall in love with emergency medicine or one of my electives. And, perhaps this is due to the pandemic, but a lot of my former classmates who graduated this past May have had a heck of a time finding jobs. Many of them ended up taking jobs in areas they hadn't originally planned to go in to. The city I live in is very saturated with PA new grads, too. So I'll also have to consider if I'm willing to move for a job, or if I'd prefer to take when I can get here. 

Lots to think about!! And I'm going to try and just enjoy the ride and not get ahead of myself. 

Thanks for reading,

Olivia