Why, why God? Cardiology!?!??!

There are a lot of things in medicine that I'm pretty good at. They make sense to me, or I can reason them out with some thinking.

Cardiology and EKG's are not one of those things. In fact, I would easily call cardiology my Achilles heel. I just plain don't get it.

So of course, this morning I was asked to interpret R-wave progression on an EKG, as well as listen to an infant's heart murmur and describe it. I was completely wrong both times...not very impressive.

I arrived a 8am this morning and thought I was to go straight to computer training but the woman who was supposed to help me out had no idea about it. It turns out neither did the computer training people. The woman who was supposed to be setting this all up left on vacation a few days ago....it appears she may have dropped the ball on me a bit in her hurry to go relax.

Things turned out alright, though, as my preceptor was paged to come meet me. She is a short woman in her fifties with a pretty thick Eastern European accent of some sort (Ukranian?). We were quickly acquainted and off to do rounds immediately. We visited one patient on the general floor, and while she was dictating her note, another doctor came over and told me to go listen to the murmur in room 50. Before I could even get to it, my preceptor and I were off to do a stress test. This is where I failed EKG interpretation, but it was interesting to see nonetheless.

While I am running around behind my preceptor as she gives me the fastest tour in human history (she is on hyperspeed) she gets paged...turns out it is the other doctor calling ME to see what I thought of the murmur (that I didn't listen to). Shame, shame....call him back after I've listened to it.

Visit patient in psych ward, starting to get my legs -- get my preceptor to talk about her dogs and rescuing homeless pets. Bonus points. Finally go listen to murmur...it's a 7 month old baby! I've never even listened to an infant's heart, but luckily this murmur is easy to hear. Lub-whoosh-dub. I call back other doctor. I describe the murmur as "lub-whoosh-dub." He states that he would have described it as a harsh, crescendo-decrescendo murmur (cardiology failure #2). He asks me what that murmur means....oh dear god...I have noooooo idea. He says its a ventricular-septal defect, and a small one at that because it's so loud. Could have also been aortic stenosis...good to know. Finally he asks me what else I'd noticed about the patient. Luckily I had seen on the patient listing that this infant had Down's Syndrome, so I mention her big head. I couldn't remember the verbage for medically saying big head, so I sounded pretty dumb. Uh huh, he says, what else? CRAP - I just went in to listen to the murmur, I didn't study the little thing!!! Apparently I should have noticed epicanthal folds, simian creases on her hands, a protruding tongue and maybe even some space inbetween her 4th and 5th toes. FAILURE. He asks me what all that means. I say Down's Syndrome. "Bingo," he says, "next time look at the whole patient." End of phone call. (Apparently this guy really likes to teach, and usually has 3rd/4th year med students, so I am going to assume he is just pimping me old school...make the student look dumb and they will study harder. I appreciate his efforts, and just hope he doesn't think I'm hopeless).

So after all that, I was sent home because my preceptor only has half days on Mondays. I go back in at 4:30 for computer training, though, which will be helpful because my preceptor is so fast that I couldn't for the life of me figure out how she was accessing all the patient's labs on the computer.

Tomorrow I meet with my doc and the other internists at 7:45 in the hospital chapel (odd meeting space) before rounds begin. She is on-call tomorrow and Thursday because one of the other docs is on vacation, so it will be a busy day. She told me I wasn't required to do on-call with her, but I know that the right answer to that is always "I'm here to work and nothing else, so count me in." We will be doing hospital stuff from 8-10, then the outpatient clinic from 10-5:30, with an hour for lunch (although she mentioned there is always some "stupid lunch meeting to go to,") plus whatever on-call stuff happens.

This is going to be okay. I think. My only hope is that after my first day fumblings, they will have low expectations. I know that is terrible to say, but seriously...I'm trying to find positives here.

Jen