Reflections on Cardiology

I got off to a somewhat shaky start on this rotation because my assigned cardiologist had apparently never been told that I was going to be working with him. ( ;_; ) His office manager sounded pretty pissed at me (I’d had absolutely nothing to do with the scheduling for this) when I called in the week before, so I approached my first day rather cautiously.

It probably didn’t help that I was sick with a cold/the flu/the plague for the entirety of my 2-week rotation. :O I often felt like I was in a brain-fog of sorts and couldn’t think straight, but I tried my best.

Reflections on Cardiology

1. Be adaptable and always, always bring something to do in case there’s any downtime.
   The cardiologist I was assigned to work with was actually gone for ~40% of my rotation because he’d had a vacation scheduled and had never been informed of my existence. As a result, I worked with two of his colleagues while he was gone. There was a lot of downtime in sporadic bursts, and I often got there way earlier than the physician I was working with that day, so it was a good things I had all my books/notes with me! I’d try to catch up on reading while they were still arriving. When he had paperwork or meetings to attend to, he’d send me off to round with his PA in the ICU and for all the cardiology consults.
2. I would probably really like working in Geriatrics, but…
   I’ve actually known this for a while, but because of the inevitable depression that I would fall into, I wouldn’t actually pursue this. Cardiology has a great mix of inpatient and outpatient medicine, as well as procedures (e.g. heart caths), if you feel so inclined. (I still enjoy outpatient the most.) My cardiologist’s patients were an absolute joy to work with–I loved talking with them, and they had such interesting stories to tell. I think I have all the patience in the world when it comes to older folks, but at the same time…most of his patients were 65-100, and he followed them for years and years (basically until they moved elsewhere or passed away ._.). To me, it’d be like continually losing my grandparents over and over. :[
3. As with all things, you improve with practice.
   I was absolutely terrible at reading EKGs in the beginning, and also really unsure of myself even when I was fairly certain about my interpretation. Throughout the course of this 2-week rotation, I got about 5-15 EKG’s to read each day, and as a lot of them liked to put it, it’s like another language–practice it often and you’ll definitely improve. Put it away and never work on it again, and you’ll get rusty. I definitely managed to get a lot better with reading them by the end of the rotation! Likewise with hearing some heart murmurs. :]
4. This should be a given, but bedside manner is extremely important.
   All the cardiologists I worked with were continually running late because different things would tie up their time more than they’d anticipate, but their patients didn’t mind the wait because they adored their physicians. (All three of the ones I worked with had amazing bedside manner.) To that end, how smoothly your office runs and how well you treat your staff also makes a huge difference on your overall efficiency. Plus, if where you’re rotating has residents, befriend them! :D Neil was doing cardiology at the same time as me (he probably thinks I’m stalking him because I had ER with him earlier too, and snuck in one night to volunteer–he still thinks I’m crazy for doing this), so he let me see patients and do the history/physical + write the progress note when we teamed up on patients together.
5. If you don’t know the answer to something, it’s not the end of the world.
   As long as you try hard and show that you really do want to learn, they usually won’t give you a hard time about it. One of the physicians I was working with asked me about an extremely simple concept during the first week, but I could not, for the life of me, remember the answer. (It was all I could do to stay standing that day. ‘Twas a bad one. :[ ) I read up on it that evening and discussed it with him in detail the next day, and all was well! (I hope.)

One of the patients made his PA’s new baby a blanket!

Memorable Cases

• An elderly lady who’s been in depression ever since her spouse passed away several years ago :[
• An elderly man who had a heart attack and asked if it’d be possible for us to let him go home over the weekend so he could take care of his wife (she has Alzheimer’s)
• The daughter of one of the patients who’s lost >60 pounds in the past year just from making healthier dietary choices! <3 She cut out fried/sugary foods and stopped drinking soda/pop (depending on what region you’re from), and has a lot more energy + self-confidence now! :] She no longer has to take her meds for diabetes and is down to just 1/2 a pill/day for her cholesterol. We were all super proud of her. :D! She says she hasn’t felt this great in decades, and is going to start exercising next!
• A sweet elderly lady who made candy for us + a baby blanket (picture above!) for my preceptor’s PA’s new baby!

Notable Quotes/Conversations

• S: She definitely has a gentler touch than you!
  Dr. R: Yes, she’s much more timid than I am!
  F: (Nooooo… ;_; )
• Dr. R: I was just telling my student what a nice lady you were.
  J: I can tell she’s very nice too. (reaches out to hold my hand) You’re going to be a great doctor. You’re very caring.
  Dr. R: Yes, she’s a very compassionate young lady!
• “We’re going to miss you! You’re so sweet! Come back and visit us!”
• (I overheard this one as I was leaving the office. <3 ) “She’s going to do well anywhere she goes.”

She also made candy for us! And why hello, stack of EKGs. These are a couple from the first day. You should see my EKG collection now! :O

Resources (Amazon links = affiliate links!)

• UpToDate
• Rapid Interpretation of EKG’s (Dubin)
• Boards & Wards (Carlos Ayala, Brad Spellberg)
• SkillStat ECG Simulator (recommended to me by a guy in the cath lab who was trying reallyreally hard to set me up with the only single guy in their department)