Yeah, I think It's Medicine I want

Internal medicine is what I mean. But am I cut out?

That was a recent topic of discussion when I went back to Texas over Thanksgiving, the place where I was raised. My aunt asked, "Are you a good diagnostician?" somewhat too candidly. The question floored me because she really hit the heart of the matter. Becoming an internist takes a great deal of analysis and diagnosis. In honesty, I couldn't answer unequivocally "yes." I have no idea if I'm a good diagnostician. How would I know right now as a third year medical student? I know I'm logical, thorough, and resourceful. But plenty of times during my medicine rotation, I was astounded by the doctor's diagnostic skills.

For example, one evening in the ER, one of Dr. Afsari's patients (Dr. Afsari being my preceptor) came in with an acute abdomen. She was vomiting coffee-bean-like substance, had an acute, diffusely tender abdomen, and leukocytosis. Dr. Afsari said "Looks like ischemic bowel." Huh? I really had no idea. Yeah, she was in the age range, but I was thinking PUD or diverticulitis. Those were on the differentials, but guess what? A few days later, she was diagnosed with acute bowel. Damn. I was slackjawed.

What does it take to be a strong internist? If I were commissioned to write this story, I'd probably research this topic. But I'm not. So I'm moving on to my next, most internally (get it?) pressing issue during this rotation...the experience.

Fantastically mesmerizing. Buoyantly intriguing. Deeply haunting. Mindblowing. No, I'm not giving a movie review. This is what medicine with Dr. Afsari was like. He's an infectious disease specialist and an incredibly straightforward teacher and stable, understanding, and thinking doctor. Most days, we rotated with him for 3-4 hours, then researched the cases, visited our own patients, prepared for our presentations, and caught up on school work.

Most of the patients were really sick or had chronic illnesses. And many, many of our patients died. Not because Dr. Afsari is a poor physician, but because Doctors Medical Center serves a destitute, underserved patient population. Examples: the IV drug user with cirrhosis. The obese male with ischemic bowel. The handyman with pancreatic cancer. The rheumatoid arthritis patient with rheumatoid lung. Death to many of these individuals was unwelcome and shocking. Many weren't ready. And many finished out their lives on the gurney in Doctors, some alone, some with loved ones, and some with loved ones ready for their death.

I bring up the subject of patients who died because it pained me to watch. And I keep those feelings close to me. I want those feelings to stay close to me, to live with me, and to be uprooted again and again during patient encounters.

There's so much to say about internal medicine. Dr. Afsari methodically works up each patient, spending hours reviewing patients' charts, consulting with other practioners, and talking to the patient. His way is thorough and thinking, heartfelt, and real.

On my last day, I nearly buckled. I wanted to stay with Dr. Afsari and continue to learn from my patients. He said his farewell over a glass of champagne, calling us his colleagues, and the future of medicine. I'm humbled by this thought.