My internal medicine rotation consisted of being in the emergency room holding unit, as well as being upstairs on the ICU floors, doing 12-hour shifts three days a week for five weeks. The shifts were during the day (7am-7pm) and I worked during the weekdays. I really enjoyed my five weeks working in my internal medicine rotation. I saw many different patients with a plethora of different pathologies and ailments. I saw between 8-15 patients every day.

After patients were deemed that they needed to be admitted from the emergency room, they were placed in the emergency room holding areas. They consisted of many different areas that had colors associated with them. There was Orange, Navy, Red, Pink, Purple, Green and Gold. Patients would first be triaged by the emergency department at Green and then get sent to one of the color areas. That is where the Internal Medicine team comes in. At 7am the outgoing overnight PAs/NPs would sign out to the incoming group of providers. I would get the list of patients the incoming PA/NP had and I would start charting on them. I looked at why the patient came in that day and then looked at their vitals, labs, and what imaging they had and what they were slated to get.

There were many different types of patients that came in with a wide array of different types of medical conditions and diagnoses. After we looked through the patient’s charts, we would start rounding on them. Many patients came in with chest pain or shortness of breath. Others came in with ulcers, rashes and broken limbs from slips and falls. I asked the patient how they were currently feeling and I asked them what happened. I tried to get the patients past medical history, social history, brief review of systems, and do a focused physical exam. Then I reported what I heard and saw to my preceptor that day and we both went to see the patient together.

I saw many different types of patients with different comorbidities. I felt like I learned the most from this rotation because of the extensive list of different type of ailments that were on display. I learned that I needed to keep my differentials broad, even if I think I might know what the diagnosis might have been within the first five minutes of speaking to the patient. Internal medicine was the diametric opposite of the emergency department. The ED was for stabilizing a patient and making sure the patient was not going to decompensate. Internal medicine saw patients, generally, with chronic problems and how they were managed. Many patients came in with chronic heart failure, acute myocardial infarctions, anemia due to blood loss, liver issues, kidney failure, alcohol withdrawals, and psychiatric problems. IM ran the gamut of what the providers saw on a single day basis.

I was also elated to see how the catheterization lab worked. I saw how a watchman’s procedure took place. I also saw an ablation for a patient who had atrial flutter. I was also invited to see the endoscopy suite. I saw a few upper endoscopies as well as colonoscopies for patients who had GI bleeding. I also saw a bronchoscopy with a patient who had mucus in their lungs. That was such a joyful experience to watch.

Overall, I really enjoyed my time at my internal medicine rotation. I really learned about to read through a patient’s lab work and decipher the pertinent information from the irrelevant. I saw many EKGs, Chest X-rays and CT scans and tried to decode what was going on with them. I really enjoyed speaking to the patients and getting their stories and seeing how they were feeling and what we could have done to make their stay there better.