Cardiology, Week 3

It was a rough transition from Family Medicine to Cardiology, as it was also a transition from a private practice clinic to a specialty practice, half in the hospital, half in the cardiology group's office (which, conveniently, happens to be in the hospital building). The first few days I didn't know how to do anything. I finally started getting the hang of how to do rounds and write simple notes on patients' progress each morning. It still takes me at least half an hour per patient, but in my defense, med students haven't been allowed access to the computers, and the majority of patient info is on the computer. I always have to ask nurses and techs to look up lab work for me on the computer, and I'm sure I'll look back on my dependence on them as good practice in interacting with other members of the medical team, but it's such a pain as a shy person to have to interrupt their work flow to ask for things.

An interesting case I saw in the clinic was a patient with an old aortic dissection. This means he got a hole in the inner layer of the biggest artery of his body, the aorta, and blood gushed in between the layers of the aortic wall, tearing them apart from each other. A very painful process and often deadly, but he lived and I got to hear abnormal blood flow sounds. It sounded like an undulating wheezing noise over top of the typical heart sounds. If you've ever heard a prosthetic valve, it sounded like that, starting simultaneously with a normal S1, decreasing through systole, then picking up at S2 and decreasing quickly at the beginning of diastole.

An interesting patient in the hospital was one whose kidneys decided to stop working. He was on Coumadin (you may know it as a "blood thinner"), and when he came in, his blood was a few times "thinner" than it should have been (INR ~5, if you're wondering). They decided to do a kidney biopsy to see what's going on since he had none of the typical risk factors leading to kidney failure. Since a biopsy entails cutting a small piece from an organ, the patient needs to be able to stop bleeding when it's performed. They were only able to get his blood thickened a little bit (INR 3.1), so he ended up bleeding when they did the biopsy, and he went from mostly alert right after the procedure to being barely able to open his eyes and reliant on a ventilator the next morning. Granted, a good deal of his decline was probably due to pain medication, but it was a good reminder that patients can go downhill and even die at any time. I'm glad to say that he was alert and conversive again today, but he could still die before getting out of the hospital.

I have been trying to avoid free food from drug reps, who are basically salesmen trying to pitch their company's products to physicians. For the most part, I eat my own lunch every day, but the last two nights, I've been to fancy restaurants to listen to discussions on medical topics, and the dinners were totally sponsored by pharmaceutical and medical device companies. My dinner total for the two nights was probably over $100, at no cost to me. Ridiculous.

I've got to study; hopefully I can write more later.

Scott