My third year of medical school is finally drawing to a close. To end the year I have two elective rotations, the first of which started last week. I chose the specialty of Infectious Diseases, and I am LOVING it. Hands down my favorite rotation thus far.
There are so many things I love about Infectious Diseases. For starters, this specialty is kind of unique because instead of focusing on one specific organ or body system, the focus is on infections, which can happen absolutely anywhere in the body. This means we get to see a huge variety of cases which always keeps things interesting.
Sometimes we know our patient has an infection, and we don’t even really know where it is. For instance, we had a patient this past week who had a bacteremia – meaning that a sample of his blood cultured a bacteria. It wasn’t clear what was causing the bacteremia, and the bacteria we cultured usually affects babies! So we really had to be detectives. This patient had a cough/fever – possibly indicating a pneumonia; he had a new onset of hip pain – which could indicate a septic joint; and he also had very red, swollen legs and a history of recurrent infections in his legs. It was a really interesting case.
Probably my favorite thing about this rotation is that every patient we have is very sick. I have always preferred working with very sick patients. We only get consults on patients with bad infections – such as sepsis, c.diff colitis, osteomyelitis, MRSA infections, necrotizing fasciitis, Valley Fever, and every other week we even get to go to a Tuberculosis clinic!
It’s only been a week but I’ve gotten to participate in some really interesting cases. We’ve encountered some bacteria that even my attending hasn’t heard of before! And right now we’re trying to get fecal bacteriotherapy approved for the FIRST time at our hospital for one of our patients with c. diff. (Fecal bacteriotherapy is literally a poop transplant! I know it sounds weird, but it’s a very effective treatment for patients with recurrent c. diff that is unresponsive to traditional antibiotics. It could be life-saving for this gentleman!)
There have been some challenges, though. We lost a patient over the weekend. And last week we had the very difficult job of telling a patient we had to amputate his foot. This poor man had a bad diabetic foot ulcer that had something called a “wound vac” placed to help it heal. He left the doctor’s office and removed the wound vac, only to contract a fever several days later. He delayed coming to the hospital for a week, and when he finally came in he had a MRSA infection that had spread to his blood – putting his life at risk. The only solution was what we call “source control” – meaning we needed to cut off his foot to stop the spread of his infection. When we told him how serious the situation was, he was devastated. He kept saying, “Why are you doing this to me?” But you could tell he realized that it was his fault, and that was really heartbreaking. I don’t think he understood how serious his foot ulcer was, and now it was too late. He said, “I’ve worked my whole life to retire, and now this?” Sadly, his first surgery was not enough, and he is having another surgery to remove more of his foot. It is likely he will need yet another surgery in the future as well.
Part of me really loves Infectious Disease. It is kind of nice to see patients and only worry about their infection and what antibiotic regimen they need. All the other problems they have can be managed by their Internal Medicine team. Sometimes we just say, “No it’s not an infection,” and then that’s all we need to do. But that other part of me still gets lost in the myriad of details of each patient. I am not satisfied to say infection or no – I really need to figure out what’s wrong.
It’s a very, very good rotation, and I am learning so much every day. I don’t think I will go into this specialty, but I will still get to manage a lot of infections someday as a hospitalist. And at least I get to have a ton of fun for three more weeks!