It's been over a month since I've written and I feel that so much has happened since then. I see so many things in the hospital, and as I've written about in my last post, sometimes it is just easier not to think about them. Of course, the unconscious thinking doesn't, or rather, can't stop.
In any case, I'm currently on my neurology rotation, and it's been among my favorite so far. I finished two tough weeks in the Neuro ICU, spending long hours seeing very, very sick patients, most with such poor prognoses. I love neurology. I love how diagnostic it is, how doing a thorough neurologic exam correlates with the pathology. These neurologists are some of the best observers and diagnosticians that I've seen. I love how academic the field is, how we spend hours discussing patients and case reports and latest treatments based on clinical trials and pathology and pathways. At the same time, it intimidates me a bit. What I don't love is how little we have to offer these patients. Stroke - okay, let's watch it and make sure your BP doesn't dip too low. In the meantime, you're weak on your L side, encephalopathic, and probably just lost half of your ability to function.
At the beginning of third year, my top choice specialty was oncology. A field within internal medicine is still at the top of my list, and if I couldn't go into IM, I'd probably pick neuro. Neurology and oncology. Two extremely academic specialties. Two with very high morbidity and often, mortality. Tell me why I'm attracted to fields where the patients are sick, sick, sick and often die?
Other thing is that I really need to work on my physical exam. I can do the motions yet, but I certainly haven't any where near mastered the ability to elegantly palpate a spleen, access a thyroid, listen for heart murmurs. I like this site that I found from Stanford's Abraham Verghese, a physician-humanist who wrote The Tennis Partner. It's 25 "must know" physical exam techniques to master, called the Stanford 25. Yeah - go Stanford! It's here at: http://stanford25.wordpress.com
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