Hello! I'm Kyle Rattray and I'm on an Internal Medicine rotation with the UW School of Medicine. The rotation is a 12-week clerkship, and I'll spend six weeks each at two different locations. My first six weeks are on inpatient/hospital medicine at the VA Puget Sound Health Care System, Seattle Division (which I'll call "the VA" herein). My next six weeks will be on outpatient/clinical medicine in Soldotna, Alaska–a town of about 5,000 residents, approximately 150 miles south of Anchorage.
The most refreshing part about beginning clinical years (instead of didactic years) is that the days can be so widely variable. On any given day, you never know what to expect, and that variety helps to keep you fresh. Once you begin clinical rotation, there is no such a thing as a typical day, but here is how my day today broke down.
05:30 – I awake and read up on my patients from the day before while drinking my morning coffee. Then it's time to get my scrubs on.
06:00 – My ride is waiting outside. I hop in and off we go.
06:30 – Once at the VA, I read notes from the night before about how my patients did and I review their lab results.
07:00 – I visit my patients, do a quick exam, and ask questions about any new medical events overnight.
08:00 – Today, my team for morning rounds consists of one attending physician, two first-year residents, one second-year resident, another student and me. We round on all the patients our team is taking care of. It is my job to know each patient well, which means knowing answers to questions like:
- What happened to the patient since we last saw him or her the night before?
- What does the patient's sodium level mean?
- Should we change the patient's medications?
- What are the barriers to sending the patient home?
- What are the five indications for dialysis?
10:00 – I attend the Morning Report, a morning teaching round. Today we have mini-lectures and "21-questions" on a patient with a mystery diagnosis.
11:00 – I go down to Radiology to persuade them to put a drain into my patient with refractory ascites. Mission accomplished!
11:20 – I write up progress notes on my patients.
12:00 – While eating lunch, I listen to a lecture on ultrasound.
14:00 – I discuss end-of-life care with a patient, his family, Palliative Care and the Pulmonary team.
15:00 – A new patient in the Emergency Department (ED) needs to be evaluated for admission. I do a physical and medical history and put in admission orders.
16:30 – I make the rounds on my existing patients to make sure that nothing has changed during the day. I do quick physicals and see if they need anything.
17:30 – I take a patient who wants to "go for a walk" outside in a wheelchair. He cannot go out alone without a M.D., R.N. or a third-year medical student. We talk about his terminal diagnosis, his 1967 Dodge pickup and what he used to do in the military.
18:00 – I start the note on my new patient from the ED, and present him to my attending physician. We work through my suggested plan for his care in the hospital.
20:00 – I'm out the door.
20:30 – Once home, I eat, read and relax.
21:30 – Bedtime.
This is how days go six days per week. Some days I'm done at 15:00 and in other rotations, the work is typically 9 a.m.-5 p.m., Monday through Friday. Each day is different and has something new to teach.