It's my call night. I got sent home early (9pm) to study and read up on my patient, which is what I should be doing, but I felt inspired to blog. I just read Bender's entry about his thoughts/feelings on these last few days of internal medicine. I'm on the same rotation, though we're in different hospitals right now, and though I have to say I have felt just as he feels --"in waves"-- a few times already on this rotation, I am at this moment having remarkably positive thoughts about internal medicine.

It is a rollercoaster ride. We are being drained dry, and it is terrible and amazing all at once.

I have never learned more, I have rarely in my life worked harder, I have never neglected all other parts of my life as much, I have never met so many amazing and memorable people, I have never been so surrounded by sickness and death. Trauma surgery was comparable, but it was exciting, it was immediate, it was impersonal. Internal medicine is demanding - mentally, physically, psychologically - but it is also constant and gradual, so that you suddenly find yourself drained.

And despite all that, despite feeling on occasions just as Bender describes feeling right now, I still want to do it. It is mentally invigorating. It can even feel holistic and complete. You take the entire patient in and you break them down into indvidual problems and then try to put those problems together into interrelated patterns. You then try to fix the big picture with all the little ones - and in the process, you get to know your patients, their fears, their needs, their humble or unrealistic hopes and wishes. And though you can't make them perfect, you try your best and they appreciate it. The frustrating patients are frustrating, but it's never personal. In a way, they make you even more grateful of everyone else...and, if you happen to have the energy that particular day, you remember that they all have their reasons.

And patients die, or they get sicker and don't recover back to baseline, and that is always devastating and sad. You take it home with you every day and when strangers ask you how you are doing images of your intubated patient, or their metastatic tumor, flash in front of you, and you realize that that is sometimes all that you have become. But then on the good days, you take a step back and deep breath and you remember that this is just all part of life. That the tragic alcholic with liver failure or the smoker with end stage COPD have been dying for years, and there is nothing you can do to change that. What you can change is their experience during this final process of their lives. You can make them more comfortable. You can treat them with dignity. Just by walking into their room and looking happy to see them, you can remind them that their life still matters.

Yeah, anyway. It's complicated. It can be miserable and it can be amazing. If it wasn't for the ridiculous hours we have to work, it would probably be one of the most "human" experiences one can have. (Being a workoholic society, we've managed to even pathologize the practice of medicine ...but that's a different blog entry.)