Note: What a typical day looks like is more or less similar for most specialties in Internal Medicine, so for a nice overview you can read my post on A Day in the Life in Internal Medicine.
This one’s a bit longer? If it’s too long just skim over the details haha, or you can let me know in the comments below or in a private message if less rambling would be better.
Monday
As usual, the day begins with morning rounds. Hepatology is actually a combined department with Gastroenterology. So more accurately, it’s Gastroenterology and Hepatology, although we were attached to just the Hepato team.
Again, ward rounds = being a space-occupying lesion. I arrived early before the start time (7:45am) but there were no patients to clerk. The first thing the MO (doctor) told me was, “We go very fast.” And apparently the teams just changed and it’s their first day taking over these patients, so the doctors will be completely absorbed in rounding and documenting and have little care for anything else. Literally need to self-study stuff (but there’s no time to study—a recurring theme, if you read my previous post on Nephrology Clinical Rotation).
Everything was proceeding along routinely with the team rushing from one ward to the next. It was our first Hepato day, so again we were listening quite intently and trying to understand and pick up learning points along the way. But there wasn’t much out of the ordinary.
That is, until we saw a patient our age with a not-very-common condition.
At one point the Consultant was listing the risks of a certain procedure and had to explain to the patient’s mum that in very occasional cases there may be catastrophic bleeding. I have no idea what was going through the mum’s mind in that moment, but you could just see the pain in her eyes.
I wish I could take the words back, somehow. “It won’t happen,” I wanted to say. “It will be alright.” The risk was so minuscule that I was certain it would not happen. But—and this was something I’d learn through the rest of the week—with every procedure, when obtaining consent, doctors must inform patients of the potential risks of the procedure—no matter how unlikely.
As we were walking away from their bed I whispered to my friend, “It’s so sad.” But that doesn’t encompass it. How could it ever?
When ward rounds ended the Hepato team went to get drinks. It was our first day so none of us ordered anything. Instead, we just sat at the side drinking plain water and trying to figure out an ECG, until we had to rush off to a tutorial. (This was actually already lunchtime (12pm). But we love learning so…)
In the afternoon we had two more tutorials. One was quite late so somehow we ended up staying in the hospital till 6pm. That doesn’t seem so bad until you realise that there was no time to study during the day, therefore some studying must be done now, right? But we have to wake up early the next morning to be at the hospital again. So where does sleep (and sanity) fit into the picture?
Tuesday
In the morning, my friend and I went to the Emergency Department to clerk a patient with ascites. We managed to present during ward rounds to the Registrar and the MO.
We were supposed to have a tutorial in the afternoon, but it was rescheduled to 11am+ instead. It was a Neurology topic (weakness) which I hadn’t really studied yet, and my sleep-deprived brain was half-disintegrating.
When we ended, it was only 12pm+! How on earth is that possible. This is surreal. Anyway so my teammates headed right home. I stayed in the hospital. All of us have to complete certain procedures (e.g. taking blood) under observation during our postings. So I thought I could help my teammates find out too how we might get opportunities to try. I tried to be thick-skinned and randomly approached nurses and phlebotomists to ask about this. Many “so sorry for disturbing!”s later, I ended up getting nowhere.
Then I tried to study but after a few minutes I was dozing off with my laptop perched on my lap.
After which I practised history taking with the patient our age (who very kindly agreed, even though their mum was there). My brain was non-functional. I sort of went on autopilot and did it the Year 2 way. It didn’t help that I already knew the case so I wasn’t thinking well along the lines of systematically ruling out other possible conditions. After self-reflecting on the encounter to the Registrar, I said that I will fail myself. He agreed.
Maybe I should have gone home then. But I couldn’t. The Registrar had said, “You should find a case that you don’t already know.” I headed down to the Acute Medical Unit (AMU).
So at 5pm, I was still at the hospital, now speaking to another patient. The patient was very chatty so the whole encounter lasted much longer than expected. Plus the doctor gave me a very detailed debrief, which really made me realise how much I’d overlooked. But still, an improvement.
I’m not sure when I left the hospital. I just remember that when I glanced at my watch at 6:15pm, I was still there.
Wednesday
The unique thing today was that before our usual ward rounds, we had Grand Ward Rounds at 7:30am over Zoom. It seemed to involve several teams, and our Registrar was the one presenting. He presented on a rare condition that our Hepato team was seeing.
At ward rounds, this was the first patient we went to see. Suddenly another team arrived, and there was a whole flock of more than a dozen doctors gathered outside her room.
That’s really the only mildly interesting thing that happened. After rounds, the Consultant bought us all drinks and everyone insisted that we cannot decline. So we upgraded from our plain water days.
We had another tutorial at lunchtime. My teammates headed home right after, while I went to a library. There was a Zoom tutorial with our Core Tutor in the afternoon on falls in the geriatric population.
Thursday
In the morning, I dashed off to another part of the hospital to chat with a newly admitted patient who was here for an elective procedure. It was quite intriguing as the condition was not the usual stuff we were seeing (in Hepato, that would be mostly chronic liver disease and cirrhosis).
Wards rounds was even busier than usual. Towards the end of rounds, we were at the Emergency Department. Suddenly the MO announced that we needed to take blood from this patient. Right there and then.
With zero forewarning, I found myself attempting my first venepuncture. (I didn’t get any blood. The doctor tried at the same vein and couldn’t either. It was difficult but she managed to access a different vein.)
Then we ran to another ward to obtain consent from one patient for a common procedure, and break the news of a new diagnosis to another patient. It was a very fast-paced and busy day. We ended past 12pm.
After lunch we had a bedside tutorial with our second Core Tutor. We saw two cases, one respiratory and the other cardiovascular. Then we were supposed to have a tutorial and examination of Parkinson’s disease. But something happened in the AMU. There was quite a bit of drama, and security was called. So we didn’t manage to have our tutorial. But still the day ended late at 5pm+.
Friday
Before ward rounds, we went to clerk a patient in the Emergency Department. Midway as my friend and I were asking questions, I quickly pulled out my notebook and scribbled, “possibly psych???”
I couldn’t put my finger on it—perhaps his tone and the way he was describing his illness, I don’t know. It was more of a gut instinct. That’s really not to discount his physical illness, but only that it might be compounded by psychiatric factors. Afterwards I checked his case notes and—almost to my own surprise—saw that he’s already known to the Psychiatry department.
To maintain our sanity, we decided not to pack every day with tutorials. So the day ended with lunch.
I stayed for a chance to take blood. (Long story short: I failed. And this time I felt really bad.) I then tried to study. By this time, my productivity levels had dropped to zero. So I ended up not doing much but still leaving the hospital at 6.30pm+. And that’s how the week ended.
For patients’ confidentiality, all details and identifiers are omitted. I’m unable to tell each patient’s story (though they’ll definitely be rich and meaningful). For more on my personal experience and struggles as a medical student, you can read about my Med School Life.