I have to be honest. I was not looking forward the starting this rotation, mainly because the patients are older than 18 years old… but so far, its great!! I wanted to use this time to get better at antibiotics and the art of use them, and I am already learning so much!
By the time a patient needs an ID consult, they have been worked up by the primary team so the one that end up in our hands are usually the particularly odd or extremely cool cases. Each patient I’ve had has been a bit of a puzzle, one that is admittedly hard to figure out. Alot of my Step 1 / Pathoma knowledge has been flooding back (Brucella anyone?)
One down side though is that most of my patients are very old and many of them are very sick (having been around kiddos for most of this year, the idea of being present at an adult Code is pretty terrifying). I’ve seen quite a few septic IVDU users as well as end-stage HIV/AIDS patients. Such a change from the Pedi wards!
I’m looking forward to Friday, when I get to go to the microbiology lab and see the behind the scenes would of the millions of cultures I’ve been sending out.
A typical day looks like this:
8:00 am – arrive the the ID fellows office, hopefully with a coffee in hand. I chart review my patients that I need to follow. Check to see in their cultures have grown or the susceptibilities have return. Plan any antibiotic changes or further testing that may need to be done. I usually have 3-4 follow up to see in the am.
8:00-10 ish – See my patients. Make sure they’re not having adverse drug reaction and whatever infection we are treating is improving. Do my exams (it is during this time in particular that I miss my cute/cuddly baby patients). Then I’ll head back to the fellows room to write my progress notes.
10-11:30 – Check in with the fellow, who’s awesome.(I didn’t mention this, but there is no resident on this rotation this month, so I get to play resident.. such good practice for next year!). He’ll give me a new consult to see. He’s good at letting me see the more exciting/interesting patients. Chart review, start my consult note, go see them.
11:30 – Rounds with the attending! This is a super educational part of my day. I present all of my patients and we talk alot about antibiotic choices and stewardship. An ID pharmacists and pharmacy student join us for this portion of the day, and they have a ton to teach me. As you probably know, bacterial resistance is becoming a problem, so much of our conversation take this into account. After we talk, we usually go see the new consults as a team.
12 – I should eat lunch, but admittedly only get a granola bar in because the fellow has already given me my next consult! Which I then read up on and go see. I also reach out the the primary hospitalists taking care of my patients with any updates or changes to our care plan, form the ID perspective.
2:30- Meet as a team again and round on the new consults, as above. The ID surface is super busy, so there are always new patients to see!
5 is- finish up notes, send them to my attending, head home! I’m finding that I need to go read up on new topics every single night… I’m learning so much!!
In other news, this past weekend I had the most amazing time celebrating my bfs birthday with he family/cousins at the beautiful Equinox hotel in Manchester, VT. This including a sleigh ride, out door hot tubs in 10 degree weather, saunas, breweries, and amazing food. Getting back into the swing of things today was a struggle.
Check out my instagram for photos (including me petting a pig!!) : )