FIRST MONTH as a DOCTOR: Gastroenterology Rotation

My name is Siobhan, I'm a first year medical resident. And welcome to my blog or welcome back. I can't believe that I'm already updating you about the first month of being a doctor, it's flown by. I did a month in gastroenterology, so I'm going to tell you what the best part, the worst parts, craziest things I've seen and the most embarrassing moment I've had so far. 

So first an update about how residency has been going so far. So I feel like I'm getting used to the role. Oh, I have a new way of introducing myself. I now say ''Hi, my name is Siobhan. I'm a resident doctor.'' So I think it's still somewhat informal because that is my first name, but then I say I'm a resident doctor, so that I'm not being confused for any other role. So I think that's working for me and I feel pretty good about it. Alright, so a quick primer for those of you don't know. Gastroenterology or GI is a subspecialty of medicine that looks at your whole digestive tract. So everything from going down your throat, into your stomach and then your intestines and all the different organs that come off of it. So your liver or your gall bladder, your pancreas, things like that. 

I can give you a sense of what a typical day is like for me on this service, on the gastroenterology service. So basically I get to the hospital around 8:00 a.m. We have a special group team room and so I meet with the med students, residents, fellows. So they're the ones who've done at least four years of residency and have decided to specialize in GI. And so at that point we run through the list of patients that we've got and that's helpful. We decide on what the issues are, we divide up the patients, who is seeing who that day and all of a sudden we scatter and go and see our patients. And then it's a bunch of sort of classic doctors things, you know... 

We check on their lab work, and we do physical exams and talk to them, see what issues that are happening talk to the nurses, talk to the team. At that point we get together before lunchtime and sort of tidy things up. So we know what's going on on the ward. But in the meantime a couple other things are going on, which is what makes this such a busy day. So one thing is that part of the team is scoping, which means that putting cameras down people's throats or doing colonoscopies, they're going up the other way. And it's pretty cool, because when you get to watch, you can see immediately what the issue is. You can see if someone is bleeding or actually you can just see what the inside of us humans look like. It's pretty crazy, so you get a sense of how things move and how the stomach looks so wrinkly. 

And it's weird to think that I actually have a stomach that looks that wrinkly all the time. So it's... Yeah, it's very cool. But the other thing that we do during the day is we're waiting for consults. So people from the emergency department or from different parts of the hospital come and they'll phone us up and say ''Okay, so we have a patient and we're worried that they are bleeding from their colon.' So you guys are the colon experts, send them over here. Take a look, what do you think?'' So that's a typical consult. And I'm trying to get faster, but honestly consults still take me a long time, because I want to be thorough. So like, maybe an hour to an hour and a half. 

So that's sort of what the day is like. Sort of a mixture of all sorts of different things. You follow the same patients for a period of time, so you get to know them well, but you never really know what's coming. Maybe a new consult, maybe you go down and see a scope, you never know. Best thing. Man, there have been so many things, it's been incredibly exciting. Such a well supported month, I've loved it. But I think the coolest thing is now having med students that I get to teach and get the help look after, so it's a bit of a role reversal. 

I'm starting to see what an incredibly valuable role they play on the team. I always thought that as a med student, I was slowing things down and making things harder on the residents, because they had to explain things to me. But really, I think med students bring enthusiasm. They bring a thoroughness, so they make us think about patients in different way or they get different information, because they spend longer talking sometimes. Okay, most embarrassing moment. So most of these services... Most of us communicate with Whatsapp and you don't put patient names or anything confidential down, but you know... 

Just saying where we're meeting or if you have a little question you put it in there. So we have a GI Whatsapp group, but I also have a family Whatsapp group. And you can start to see where things are going. So my mom and I went and did a bunch of shopping for clothes, so that I had new doctors outfits. So I have been excited about trying on different things in different combinations. I've been sending her pictures each day as updates and I was walking out of the bathroom, had a moment between patients and decided ''Oh, there is a mirror. I'll just snap a picture and I'll sort of make like a silly face.'' And I sent her, just being ''Oh here is an update on what I'm wearing. What do you think?'' So super girly, like sending to your mom. And of course I sent it to the GI team! Oh my gosh, I was so embarrassed. The minute I clicked send, I just knew what had happened. 

I tried to immediately go back and delete and say ''No, come back!'' But I couldn't... And after I deleted it on my phone, I realized that I had only deleted it on my phone and they didn't delete it to anyone else in the group. So I sort of had to face everyone and make a joke about it, like ''Oh, haha yeah. I can't believe that happened, so funny.'' But actually inside I was just like ''Oh my gosh, it's so embarrassing.'' Oh boy... Craziest thing. Ehm well... We had this totally healthy guy who came in and it turns out that he had this gigantic piece of steak just stuck in his throat. So we actually had to go down there with a scope. Well, not me, but it was my staff who did it. And had to take little pincers and try to pull the steak out, it's actually pretty dangerous for him. So there was a really good reason that our parents always told us to chew our food. 

Well another really cool experience is getting to do paracentesis. So that's basically when people have these really big abdomens, and they are full of fluid. Usually when the liver is not doing so well and fluid sort of seeps out into their abdomen. Sometimes we actually have to drain it. So you put in a needle and put in a catheter and that drains the fluid into these big bags. And it's crazy, I drained off one man 15 liters of fluid. So he was walking around with 15 liters on him all the time. And he was just so thankful, he said he could breathe so much better and move so much better and even stand up. It's satisfying to be able to do that, but honestly I was shocked that there was that much in his belly. 

Okay, serious talk. One thing that really shocked me coming into med school and residency was seeing how chronic alcoholism could really, really hurt people. And I know it sounds obvious, we know that it's not good for your liver, but you don't really see what it's like for people when they've destroyed their liver. And it's not just alcohol that can do this, but that's the main thing that we see in the hospital. And they become cacechtic. So so skinny and this huge big bellies that are just full of fluid, that I was saying that we end up tapping, and it's an image that we don't see. On cigarette cartons they show us teeth and they show you what cancer looks like and they show you pictures and dissuade you. But no one talks about what happens when someone really abuses alcohol, so anyway, okay. 

Off my Soapbox. So you might ask, what's coming up next? I'm actually super excited, because this weekend I'm moving to a new condo, brand new. First people to be living in there. And then I'm also starting a new block, so I'm starting a rotation, which is outpatient internal medicine. Not really sure what it's all about yet, but I'll keep you guys updated. I think it's patients who aren't quite sick enough to get admitted to hospital get sent to this rapid assessment clinic, so we can try to help them before they get sick enough to go to a hospital. But again, I'll let you guys know a little bit later. So for now I just want to say thank you so so so much for all of you who subscribed, who commented, who sent me private messages and who've just been part of this journey so far. 

I love that it's making me be reflective and think in the moment. And I just feel so much support in this crazy transition, a new time. So thank you, thank you. It really means so much to me.
FIRST MONTH as a DOCTOR: Gastroenterology Rotation FIRST MONTH as a DOCTOR: Gastroenterology Rotation Reviewed by Reaz blog on July 10, 2020 Rating: 5


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