When I started Internal Medicine, I thought it was just about treating adults.
My ignorance deserved ICU admission. ๐๐
I was there thinking,
"You listen to the complaint...
Run a few tests...
Give the diagnosis...
Prescribe medicine...
Go home."
Internal Medicine folded its arms and smiled.
"Oh sweetheart..." ๐ญ๐
The first patient arrived.
Chief complaint:
"I'm just feeling weak."
Weak.
That's it.
No location.
No duration.
No clue.
Just... weak. ๐๐
The consultant looked at me and asked,
"So what's your differential diagnosis?"
Differential?
Sir, I'm still trying to differentiate the patient from the relatives. ๐ญ๐
Then the history started.
Past medical history.
Drug history.
Family history.
Social history.
Dietary history.
Occupational history.
Travel history.
Sexual history.
At some point I felt like I was interviewing someone for a passport. ๐๐
Then came the examination.
General examination.
Hands.
Face.
Eyes.
Mouth.
Neck.
Chest.
Heart.
Abdomen.
Legs.
Back.
The patient came complaining of a headache...
But somehow we ended up examining their toes. ๐ญ๐
The consultant asks,
"What do you see?"
Me:
"A human being, sir." ๐๐
No.
He wanted clubbing.
Koilonychia.
Janeway lesions.
Osler nodes.
Splinter hemorrhages.
Xanthelasma.
Acanthosis nigricans.
Apparently every body part has been dropping clinical hints while I was busy blinking. ๐ญ๐
Then investigations arrive.
FBC.
U&E.
LFT.
RFT.
CRP.
ESR.
ABG.
ECG.
CT.
MRI.
Echo.
By the time you've ordered everything, you've basically rebuilt the patient from scratch. ๐๐
Then comes the consultant.
Looks at the patient for twelve seconds.
Touches the pulse.
Listens once.
Then confidently says,
"This is infective endocarditis with early heart failure."
Sir...
I was still deciding whether the patient had malaria or stress. ๐ญ๐
Ward rounds are another level.
The consultant asks,
"What's the diagnosis?"
You answer.
He asks,
"Why?"
You explain.
He asks,
"Why not the other diagnosis?"
You explain again.
Then he asks,
"What if the potassium was 2.8?"
At that point you're no longer treating the patient.
You're defending your PhD thesis. ๐๐
Then exam day arrives.
Question:
"Discuss the approach to a patient presenting with shortness of breath."
My brain:
"Breathing is important."
The rest of the answer went into cardiac arrest. ๐ญ๐
After submitting the paper...
Every diagnosis returned.
Every investigation.
Every management guideline.
Even the contraindications.
Apparently my memory had been admitted for observation and was discharged immediately after the exam. ๐๐
That's when I realized Internal Medicine isn't just about treating disease...
It's about proving that one symptom can have 147 possible diagnoses.
And somehow...
The consultant expects you to know all of them before breakfast. ๐ญ๐
Internal Medicine taught me that patients don't read textbooks...
But examiners definitely do. ๐๐
I refuse to believe humans were designed to wake up, sit in traffic, stare at Excel for 10 hours, eat dinner exhausted, watch crazy news, scroll through Tiktok then do it again for 50 years.
At this point, we urgently need a statement from KMPDU, KUCO & KNUN to assure us chronic pre-interns that MoH is finalising the posting process ๐คญ