I am four months into house job and have completed my surgery rotation.
I began Internal Medicine rotation about five weeks ago and got posted to Nephrology – the aspect of Medicine that deals with the kidneys.
Toward the end of my Surgery posting, I started conversations with my friends who were in Internal Medicine at the time, discussing the likely units in Internal Medicine that I may get posted to.
Unlike Surgery where you rotate through various subspecialties and get to spend two or a maximum of three weeks in each subspecialty, in Internal Medicine, you spend the entire 12 weeks of a given rotation in one subspecialty.
It is essential, therefore, that you get a benign unit, or one at least that comprised mostly of good persons.
There were talks of Endocrinology, which I often rebuked for fear of the workload that accompanied the unit, and Nephrology which I outrightly rebuffed at its mention.
Nephrology is ill-famed for this saying among house officers in my hospital: ‘Internal Medicine is chilling except you get posted to Nephrology, otherwise known as Renal.’
So, when I showed up all glammed up that Monday morning with the post-holiday glow from my one-week leave, and the chief resident informed me that I was to resume Internal Medicine posting in Nephrology, I almost knelt down to beg him.
I almost cried too, and as I signed my name against Nephrology, it felt as though I was signing my death warrant.
I was sober and walked with heavy feet to the Renal ward to present myself for duty.
As if to confirm my worst fears, the registrar whom I first met looked me over pitifully, and asked, ‘Who did you offend?’
I actually gave thought to reply his question, but when I could not come up with a witty response, I merely gave an apologetic shrug.
A friend of mine in the unit candidly shared with me, ‘It is a wrong time to come to Renal, we are working up a patient for renal transplant next week.’
Later that evening, another friend texted me, ‘You will be fine. Renal is not that bad, moreover, there are nice people in the unit.‘ If nothing else, the text made me smile and attempted to lift my low spirit.
I thanked him and resolved to face my Internal Medicine rotation in good spirits.
My first week had a lot of my Renal colleagues saying stuff like, ‘This is Renal,’ ‘Don’t you know that you are in Renal?‘ ‘Welcome to Renal!‘ almost at every turn that I began to find it somewhat irritating.
I mean, I had just come from Surgery, and however much stressful Renal could be, I did not think for a second that Internal Medicine could be more stressful than Surgery – Renal or not.
So many times my seniors looked me over and when I still looked like I had my acts together, they commented, ‘You have not started Renal. When you start we will know.’
My fifth week in Renal. On a random day at work.
I felt like I was being watched intently and waited upon to crumble under the demands of the unit. Maybe this made me stronger or only unveiled my inner tenacity. I would choose the latter.
For different reasons the renal transplant that was supposed to be the bane of my Internal Medicine posting kept being postponed, that I thought to myself and perhaps aloud on one occasion, ‘I am the Jonah in their ship.’
‘Throw me out and the transplant will hold!’ I would add amidst laughter.
I would go on to flatter myself saying, ‘God does not want me to be stressed.’
If you are wondering if it is the medical team that carries out the transplant, and how it would stress the renal physicians, let me clarify that the pre-transplant workup and post-transplant care that form the bulk of the work to be done are largely supervised by the medical team.
The work of the Urologists – that is, the surgeons – is essentially to harvest the organ from the donor and transplant the recipient with it, after which most of their work is done. Of course, they assess the patient post-transplant, but the renal physicians literally sit with the patient.
Besides the fact that I have three consultant ward rounds a week – Mondays, Wednesdays and Fridays – putting me on my toes every other day, and a host of investigations per patient, what we term ‘A Full Renal Workup,‘ and having to chase investigation results, and make sure that each patient’s investigation chart is up-to-date, Nephrology is not so terrible.
Now that I think about it, that seems like a handful in itself. But when you think about the fact that you are exempted from medical ward covers and medical team casualty calls as a house officer in Renal, you have to admit that you have it lighter in a way.
I found myself reflecting on a certain day, ‘Renal is sweet, na CO spoil am.’
CO is short for casualty officer – the position house officers assume when they are on casualty or accident and emergency calls for a period of eight hours. This is different from the medical team casualty calls.
Every house officer, aside from those in Paediatrics, take these calls, and it is usually said that casualty calls override unit calls. That is, your unit is compelled to absolve you of all unit responsibilities for the eight hours you are covering the accident and emergency unit as the casualty officer.
The casualty officer is usually paired with a medical officer, who is a more experienced doctor that is either fully employed in the casualty or merely doing a rotation in the casualty.
In the accident and emergency, you are exposed to a wide range of medical and surgical cases. It is a good ground for learning if you are interested and not too fatigued.
My friend who told me that there are nice people in Renal was right. Also, it happened that the majority of the senior registrars in the unit were my friends beforehand. So, asides from the infamous stress associated with Renal, it was more of a homecoming for me.
So, it was on one of the night calls with one of my senior registrars, while working up our patient for renal allograft transplant that he said to me, ‘Don’t worry, it is when you see Mrs K making urine that you will be happy.’
You see, this patient had End Stage Renal Disease – the indication for the transplant – and has not been making urine. She has been on maintenance hemodialysis while awaiting transplant.
It was upon hearing those words from him that my focus shifted from the stress associated with the transplant to the joy inherent in the outcome.
Every other day since then, as I check her blood pressure each morning, and document her previous day’s fluid intake and output – the output always nil – I look forward with eagerness to when I will document, 50, 100, 500 and who knows 1,500 millilitres of fluid as her previous day’s output.
Nephrology has not been a walk in the park, but as the other house officer in my unit admitted a few days ago, ‘I am happy I got to do Nephrology in Internal Medicine.’
When we can intervene and patients have the wherewithal to foot their medical bills, it is always a thing of joy to see patients go home with smiles on their faces, thankfulness in their hearts, bellies, feet and faces less bloated than they came with, and most importantly, making good urine.
Of course, there are bad cases. In fact, I have signed the most death certificates since I came to Internal Medicine. The nurses sometimes tease us about how bad our patients can be, but all of that makes me appreciate life and good health the more.
My partner once said, ‘Since I came to Renal, the only thing I trust is water. Not even alcohol, because once you come down with a kidney disease, it is almost like the end of the road for you.’
So, guys, watch what you drink, eat, and even the drugs you take. Avoid analgesic abuse. Desist from excessive and chronic alcohol consumption. Run away from ogogoro and the likes. Know your blood pressure, especially if you have a family history of hypertension, and get optimal control of your blood pressure if it is higher than normal. Know your blood sugar level and get optimal control for that too from your doctors.
It is my sixth week in Internal Medicine. I am halfway done. I celebrated two weeks into the posting, four weeks, and I am looking forward to celebrating the end of the sixth week. If it keeps me going, why not?!
Did you know a house officer left Nephrology after two weeks of being there?
Oh, yes, I am not failing to learn. Focusing on the destination without enjoying the journey is not the goal. So, yes, l am all for the experience – the good, bad and bland.
While I go back to helping people make urine, please, leave me your thoughts and responses.