A classmate and I started out on one of the “Morgan” general medicine teams at VUH with a resident, an intern, and a 4th year doing a sub-internship. We each carried 2 or 3 patients at a time, often following them from admission to discharge. When we weren’t in class or talking to our patients, we spent our time writing notes, observing bedside procedures, helping put in orders, making phone calls, obtaining outside records, and learning about topics that the residents chose to teach us in their free time.
Although I expected to encounter “bread and butter” cases that would teach me about management of congestive heart failure or proper workup for chest pain, I didn’t see many in my first two weeks. There’s a quote often used in medicine that reminds us to consider common diagnoses before those that are more interesting but less likely: “when you hear hoofbeats, think horses, not zebras.” However, I encountered a handful of “zebras” myself. One of the more memorable cases involved a woman with a recent history of adverse reactions to multiple antibiotics who had come in with a fever and subsequently was found to have a very low white blood cell count. When it was determined that her symptoms were likely a reaction to yet another antibiotic, our attending wondered if there might be an overarching disease that might explain her numerous illnesses. I’ll have to visit her electronic medical record to see if there are any new developments.
Unlike several inpatient teams that admit every day, the 4 Morgan teams have their own unique call schedule. Each team cycles through an “accept” day (hearing about overnight admissions that morning), a “short call” day (admitting a set number of patients before 2pm), a “long call” day (admitting patients from the time the short call team is capped to 5:30pm), and a “pre-accept” day (no admissions). My classmate and I were often with the team until 7pm–sometimes even later. Writing notes on admission days was tiring–for internal medicine, medical students are typically expected to not only write a thorough history and physical but to also include an in-depth discussion of a particular topic related to the patient’s case, complete with references. I stayed up late many nights to finish notes before bed and found myself fairly drowsy during the day. I’m honestly surprised I didn’t acquire a taste for coffee.
Despite this, I tried to make time for self-care any way I could. Even though Morgan was a very time-intensive service, I still managed to DJ (read: provide a spotify playlist) for the school-wide Halloween party (I went as a mouse this year) and share a reflection I wrote at church one Sunday.