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Medical Internship Reflections!

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And yet another part of my medical career is over (not an April Fools joke). 1 year of internship; running around various hospitals in Jeddah, dabbling in different rotations, meeting and dealing with colleagues, residents, and professors; getting to experience actual work for the first time, yet still feeling as helpless as a 4th year med student most of the time. It all happened so fast. It feels good to finally be done, yet I do have a feeling that I’ll miss this time of my life in retrospect. Time for an entry in the diary of a wimpy medical graduate, wouldn’t you think?

My internship situation was somewhat special. Usually, fresh undergraduates start internship at around July or August, right after they finish finals. I, on the other hand, started at April of last year. The reason for that is because I repeated a semester in 5th year because of the dreaded Obstetrics & Gynecology and Internal Medicine. The subsequent ramifications involved me interacting with students who are actually younger than me in 6th year undergrad, and that ‘feature’ subsequently carried over to internship as well. Essentially, I’ve gotten to know students/interns who are up to 2 years younger than me. On one hand, I guess it feels nice mixing it up with other classes (2009, 2010) instead of sticking with my default friends (2007 graduates I believe?) who I’ve spent four years studying with until I flunked. However, you can’t help but feel lonely at times since you’re not really close with the younger generation (I realize that I feel old using that phrase).

Internship with KAU in Jeddah has been…interesting, to say the least. The basic schedule is as follows: 2 months of Internal Medicine, OB, Pediatrics, and Surgery, 1 month of ER, 2 months of elective, and 2 weeks of Radiology. Back when I started, it was an enforced rule to take two major rotations in our host hospital of King Abdul-Aziz University, something which I initially didn’t look forward to and rightfully so. You see, our University has this reputation of being brutally tough on students and interns alike. Additionally, it was just too depressing to start in a hospital that I’ve spent the last 5 years studying in. While there are always exceptions, I’ll have to generalize some things in order to paint you a pretty picture of the worst-case scenario; professors are bitter, residents are overworked and cranky, and interns are super-competitive and cheeky. It’s no Mona Lisa, unfortunately…in fact, it feels just as painful as admiring abstract art yet not understanding the meaning behind it.

I spent the first 2 months of internship in KAUH rotating in Medicine, which sank me into depression for the first two weeks then subsequently improved after. Reasons of depression: 1) other interns knew all, while I continued to suck, b) since I was new, I got abused by my resident (a female which has PMS 24/7), specialists, and professor…the latter of which ripped my head out and stabbed me with a proverbial spoon as I presented my first [clunky] history as a so-called intern. I still remember the barrage of questions he presented me after I finished my nails-on-a-chalkboard history on a COPD patient (under the respiratory team), “why didn’t you check the JVP? How about lower limb edema? What’s the grade of this murmur? Where’s your opthalamoscope? Why didn’t you buy one? It’s as essential as a mobile phone.” I must’ve looked like I’ve seen a ghost.

At times, I finished late (7 pm) because I was still getting used to the work environment and what the job entailed. Because of my depressed state, I looked at the glass half-empty all the time; I just couldn’t wrap my head around things and felt that writing progress notes and booking for CT schedules was just busywork, not contributions. Thankfully, I was blessed with some great colleagues who helped me get through the first two weeks. After that, things got slightly better as I worked under another professor who was focused in teaching me as I worked, something which I’ve been waiting for since I started.  Next month, I worked with Hematology. Great material, nice residents, cranky (and I do mean cranky) specialists, and cool professors who sadly didn’t have enough time to give us teaching and tutorials. The profs were thankfully appreciative, yet the specialists were like kids who got pissed off for the stupidest things. Scolding me because I went to the restroom for 5 minutes? Really? REALLY? Next thing you know, he’ll put me in a corner or something.

Thank God I started with the hardest subject in one of the toughest hospitals because subsequent rotations felt light in comparison. My one-month elective of Gastroentrology in King Faisal Specialist Hospital was AWESOME. Really comfortable environment with a lot of teaching behind the scenes. The professor I worked under was so cool. He used to invite us to the Starbucks inside the hospital to give us teaching sessions on things like Liver Disease and Failure. I’ve never experienced teaching in this type of environment. Next up, two weeks of radiology in the same hospital as well…I had been really looking forward to this because I’m interested in radiology, and thankfully taking this rotation got me more interested.

My OB & G rotation at August was awesome yet weird for different reasons. As I’ve mentioned before, August was the official start of internship for fresh undergraduates, so I met them for the first time during this rotation. They were a nice bunch, yet again I wasn’t close to them so I felt lonely. On the other hand, the hospital which had us, King Abdul-Aziz Hospital and Oncology Center, treated interns like students. We were mostly observers who had little responsibility. Essentially, we had the freedom to do anything depending on our interest levels…and I wasn’t interested much so I laid low during these two months. I know it’s wrong, but it felt like a nice breather to take. I am an introvert by nature after all.

I expected Surgery in KAUH to be terrible, but thankfully it went really well because I picked two cool teams: Vascular and Plastic. I steered away from general surgery because I felt uncomfortable with the professors. I’ve known them since I was a student and I really didn’t feel like dealing with those same faces again. I know it sounds like a bad decision because GS has cases that I have to see during internship (appendectomy, colesysectomy)…but since my interests aren’t in an all-time high and there were many other interns who really wanted to specialize in surgery, the environment was generally competitive. I would’ve done all the paperwork and seen or participated in little to no surgeries if I went with GS. This was obviously not the case with Vascular and Plastic. Aorto-venous bypass of the lower limb, removing varicose veins (a surprisingly very common case in Jeddah), AV fistulas, breast augmentation, cleft lip repair, fat injection, and the list goes on. What I found surprising with Vascular in our university hospital is that they didn’t handle cases of diabetic foot amputation. Instead, these are handled by the GS teams.

I took an additional month of Radiology after that thanks to the awesome two weeks I had before…in our university hospital. Despite not being my first choice, I surprisingly had the best time there. In fact, this is my favorite rotation throughout all internship thanks to the insane amount of teaching we’ve been getting, not to mention the relaxing environment and nice people. [EDIT: I just got a call from one of my best friends, who is coincidentally a radiology resident in KAUH…he read the blog and got upset because I didn’t mention him specifically in this paragraph. Indeed, he was part of why this rotation was really enjoyable. Hooked me up with some of the consultants and did a little teaching on the side. So Mattar, if you’re reading this, there you go. Even though I didn’t remember you firsthand, the only reason why is because you’re so integrated in my life it’s just natural to have you around. Maybe too natural…I would be too detailed if I even mentioned you here. Also, you suck at Marvel vs. Capcom 3.]

Ah, two months of pediatrics in the Maternity and Children Hospital (MCH)…a really weird rotation. On one hand, the teaching is really good. However, the majority of cases were respiratory in nature (bronchiolitis, pneumonia, asthma). I was expecting an abundance of SCA and Thalassemia cases since they’re so widespread in Saudi Arabia, but apparently they’re mostly rerouted to KAUH because I’ve seen a ton of them during my hematology rotation. Perhaps MCH wouldn’t have offered the same care as KAUH, since the latter contains bigger and more advanced facilities compared to the former.

Other than the focused cases, the attitude of our professors in MCH didn’t really help. I won’t take away the fact that they’ve taught me a lot during my stay, but they’ve been overly picky…getting upset for the dumbest things. It got really stupid at times, to the point where I had several of them gang up on me with crap I shouldn’t be taking. My colleagues noticed the same thing, too. Granted, the workload wasn’t heavy, but I never said no to anyone there, never raised my voice or talked back, but I still took a lot of flak for some reason. I expect that this relates to some of our ‘kiss ass’ interns who worked with me there. I’m sure you’ve heard of this breed of interns as well. You know, playing lovey-dovey with our professors by being extremely social with them just for the sake of looking good. Not actually being social for the sake of taking interest in them, but doing it to kiss ass. When the profs weren’t around, these interns showed their true colors; not interested in working, no knowledge whatsoever, and throwing work at others interns like me. I don’t like doing that unless I generally want to mingle and have taken an interest in making good conversation. Sadly, these interns got the job done because when they slipped up, it wasn’t a big deal…which in turn put the spotlight on people like me who worked and didn’t kiss ass.

My final rotation was ER in King Fahd General Hospital. Good stuff. A bit lonely since I was the only male intern this time around (the rest were females who were pals with each other), but to compensate there were I lot of residents there who I knew from my undergraduate years. KFGH is a trauma center so it’s ER is the most interesting of the bunch, getting various RTA cases and the like. Maybe interesting isn’t the best word to use, though. I need to correct myself and say unfortunate, try to block that medical student mentality. One memorable case was a teenager who got her tongue cut off by her brother. It’s sad to still see cases like this here…can’t believe that this extremist mentality is still rotting in our country.

Phew…talk about a long blog entry. I’m sure I missed out on a lot of other stories, which hopefully I’ll recall some other time. You truly are a trooper if you’ve kept reading. Keep it locked as I write about my plans post-internship. For now, I’m going to relax!!

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