Hi guys! A few weeks ago I shared some of my thoughts on the first week of my internal medicine rotation. A lot has happened since then, including finishing my first month.

The first month has been all inpatient medicine, that means it has all been in the hospital. I spent the last two weeks on the inpatient Hematology/Oncology & BMT (blood and marrow transplant) services. I was getting pretty tired during my first two weeks of general inpatient medicine since the schedule was a grueling 6am-6pm (might have been harder since I was fasting) with only one day off each week, but the Heme/Onc and BMT services both featured an amazing 7:30am-5pm schedule with weekends off - gasp! I started with a week of Heme/Onc and then switched with the other med student on the service and finished off with BMT.

HemeOnc. Transitioning from patients with a seemingly endless list of problems on general inpatient medicine to patients whose main problem is their cancer was interesting, and it also made presenting to my attending surprisingly more challenging (in medicine, interns, med students, residents and fellows are all expected to present their patients to their attending during morning rounds). Whereas I was presenting a bunch of problems on general medicine, my Heme/Onc patients have a very specific problem for which they've been admitted to the hospital - this is usually for induction chemotherapy (the first part of their chemotherapy), management for side effects, or other problems that general medicine teams feel more comfortable referring to the Heme/Onc service. In order to understand my patients, let alone present them, I had a lot of learning to do in a short amount of time. This is because Heme/Onc is a vastly research-based field where new treatment regimens can come into practice at any time. Therefore it's crucial to read up on the latest chemotherapy treatments for each patient, as well as other treatments like radiation that may be helpful in their overall management and comfort. Even though the hours were more relaxed, Heme/Onc was really intellectually challenging. More importantly, the patients themselves were also extremely special people. All of the patients on the service were so wonderful to work with - it says a lot about a person when they've been handed a difficult diagnosis yet they stay kind, cooperative and easy-going. This service was also a sad one, however. My most memorable patient of the week is one I probably won't ever forget. The patient was for pain secondary to metastatic esophageal cancer. It felt like a routine admission for pain control; one that would surely be discharged in a day or two. He was so kind even while he was in so much pain. I also got to know his wife, a hopeful woman who loved her husband very much. He quickly deteriorated and what seemed like a small problem on admission spiraled out of control just days later. It was heartbreaking, and I can't even begin to understand what it would feel like to be in the shoes of any family that has experienced something like that.

My week on Heme/Onc was great. Morning rounds were usually done by 11am and the rest of the day was dedicated to orders and management of whatever came up during the day, which generally wasn't much. It was a pretty quiet service. Some days, however, the Fellow and I would venture down to the pathology department where we would discuss certain patients or odd diagnoses with the Heme Path team - that was pretty fun. Overall, I learned that although Heme/Onc is very intellectually stimulating and a scientifically pioneering specialty, it is also very emotionally demanding.

BMT. Getting comfortable with the jargon (there are SO many acronyms in oncology!) and work flow of the Heme/Onc service made my transition to BMT a little easier. The BMT service is dedicated to treatment of "fluid" cancers like leukemia, lymphoma, myeloma, etc. In many ways it is more specialized than Heme/Onc. BMT also involves some pretty cool procedures like BMT harvest, biopsy and transplant. As a med student on clerkships you're pretty much useless after rounds (when you present to your attending) so the rest of the day is usually what you make of it. Since the BMT service had significantly less patients to take care of I got to know them all pretty well. While my Fellow and the PA on our team fielded orders and other nuances, I had the option of either studying or going to see patients. Most days I chose to study (third year is basically working on top of the same study load I had during MS1 & MS2), but other days I would visit patients and just sit to talk with them. They seemed to enjoy the company, and I really enjoyed getting to know them as a person instead of just a patient. Oftentimes it's easy to see a patient as a set of problems, orders and scheduled procedures since that's what keeps you busy, but I feel lucky to be a med student with significantly less responsibilities than the interns/residents/fellows because I can use my time to get to know the patients. It always amazes me how interesting patients are once you're able to chat with them. Unfortunately I know that I won't always have the time to spend with patients like that so I'm taking advantage of it now!

All in all, Heme/Onc and BMT were extremely interesting and I learned a ton. While this wasn't my first exposure to BMT (I volunteered in the pediatric BMT unit in high school), it was my first exposure to Heme/Onc, and my first time seeing adult patients in either field and I enjoyed it more than I thought I would! Also, both the Fellow and the PA on my BMT team complimented by presentation style and said they both wish they could present more like me - which obviously made me feel so cool lol.

Tomorrow I start my month of outpatient clinics. I'll be working in our cancer center, as well as the infectious disease, pulmonary, and endocrinology clinics. It should be more laid-back than inpatient medicine, and I'm excited to be able to study more often for our Internal Medicine Shelf Exam coming up in September which is famously difficult.

Have a great week everyone!

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