Housejob Chronicles|| Rounding up Medicine4 mins read

4 of 4!!! Can you palpate my excitement through this post? You should be able to.

I’m officially done with Housejob; no longer a house officer, now a medical officer. 😁😁 #Justlikeyesterday

I’ve documented the journey so far here on the blog. I’d share a post on my overall experience and lessons throughout this year in a different post, shortly after this.

Internal medicine is a sub-speciality of medicine which deals with the diagnosis, medical treatment and care of adults.

In medical school, medicine was actually my best posting. Not in terms of grades or ‘stuff’, but because things there seemed a bit more straightforward than other departments. You could almost always tie all the symptoms together neatly (this is true for every aspect of medicine but it feels truer for internal medicine). People view them as the stuff-moving peeps (no lies there) and you have to like and know stuff to thrive in it.

I didn’t expect that it would be my last posting, but in retrospect, I’m glad that it is. Firstly because most people presenting to the hospital have medical issues, not surgical or gynaecological. So, I feel it would help during my service year as a medical officer to have most of those medical details fresh in my memory.

Also because it seemed like the most likely speciality for me to branch into if I am considering clinical medicine. I feel it would be an interesting field to specialise in, so maybe.

(I wrote the above paragraph in my first week of the posting and put a strike through it in my fourth. Medicine posting was actually a lot more than I anticipated – more work, more time-consuming. It’s also a pretty depressing posting; I probably saw more morbidities and mortalities in the past 12 weeks than in the previous 36 weeks of my Housemanship year. So no, it’s no longer my most likely speciality. Maybe this is just a Nigerian factor and things might improve in ‘the abroad’, but for now, it’s a no no.)

It’s typical for most HOs to lose the fervor and just slug it through the last posting of the year but I made a deliberate effort to avoid that. I did my best to be more active than normal.

I would have loved to be posted to the Endocrinology unit (because I like Endo) but I got posted to Cardiology (I was still happy because the doctors here seemed nicer, which is key to having a good posting experience). Unlike my surgery posting where I got to move through all units, I was stuck with cardiology for 12 weeks. It sounded hellish when I found out but I made it through. The activities revolved around morning reviews, ward rounds, clinics and seminar presentations.

Cardiology clinics are always full – cardiology cases are prevalent in society. During one of the clinics in my first week, we had over 160 patients to see in the clinic only 6 doctors manning the clinic, so it wasn’t a surprise that the clinic was rowdy and so long. While waiting to be seen, one of the patients became unconscious, the clinic immediately became an emergency room. Several attempts were made by senior colleagues present to access her veins in order to administer resuscitative fluid and meds but it was proving difficult.

The veins in the elderly are usually tortuous and can be really hard to get. I didn’t think to try since others were there. As soon as I noticed the woman getting worse, I decided to try and I got a patent intravenous access on the first attempt! I felt really good. Necessary medications were administered and the patient got better, after which she was admitted to the wards.

Remember that part where I talked about people slugging it through the last posting and how I wanted to be better? It was a real struggle for me to do better. It also didn’t help that I was doing a daily countdown. I had to give myself constant pep talks, reminding myself about how I had to be present in this phase (I regularly recalled a quote in my mid-year review) and not be in such a hurry to leave it (not like I could hasten time or anything). I think this is a thing that happens to almost everyone at the last stage of anything – school, projects and all.

This posting also shed more light on the constraints in the practice of medicine in such a country as Nigeria, both in the patients part and the doctors. For the doctors, there’s only so much you can do for a patient without having the results of necessary investigations which the patients sometimes cannot afford. In the rare cases that they can afford them, there could be one or more ‘logistic’ problems – faulty equipment, no equipment at all, no electricity amongst others. You then have to just make do with what you can get.

For the patients, there’s the lack of awareness which causes late presentations. Apart from that, sometimes the costs of investigations can also burdensome. There are also the costs of drugs to deal with. A good number of people still pay for health out of pocket which can be draining on anyone. It’s really sad that we have to deal with all these challenges. That’s possibly what made me enjoy the posting less.

Towards the end of my posting, we had medical students come around. Watching them clerk and do all the regular medical students’ stuff transported me back to my med school days. It was actually a welcome experience. It reminded me that there are times and seasons for everything – there were things I saw them struggle with which came easily to me. They were things I had struggled with in school as well, but with months of hands-on experience, I have gotten better. I also recalled how naive and unprepared I felt at the start of housejob. It’s a long ways away from the confidence I have as a doctor now. This also affirms something I tweeted a while back – degrees are static, skills are dynamic. Yes, I have a medical degree, however, without practice, it would very easily become redundant.

Degrees are static, skills are dynamic. Click To Tweet

I have now come to the end of this one year journey. I’ve had a lot of emotions going through it – from thinking I’d be in LUTH to having to work in an entirely different environment. I’m grateful for it all, for the experiences and friendships formed.

As a way of rounding up the housejob chronicle series, I’ll be sharing a post compiling my experiences working in two different hospitals in this housemanship year. I will also be sharing posts featuring other interns sharing their experiences interning away from ‘home’ and also balancing having a life during housemanship year. Make sure you subscribe to the blog so you don’t miss any of it!

It’s been fun sharing my experiences and getting feedback from y’all.

Cheers to the close of a chapter and the start of a new one!