Residents often ask me what is wrong with nephrology? Why don’t residents want to become nephrologists anymore?
I have a number of answers to that question, but explaining the reason means that I am explaining how other people think and make decisions. I’d rather talk about how much I love nephrology and why I find it a fulfilling career. It feels more honest and less presumptuous.
Last week I had a perfect day and it encapsulated what makes me so happy in the medical career I have chosen.
I woke up, walked the dog and headed into the hospital. I had a lecture. I hold a monthly electrolyte session with the fellows. It is scheduled for an hour but we always go long. Usually the lectures last 90 minutes. I start the lecture with a recent electrolyte conundrum that we work out on the white board. Last week’s lecture kicked off with the highest urine sodium I had ever seen.
And after discussing this case of hyponatremia we continued the potassium lecture from the previous month. The way I handle my fellow lectures is I use the slide set from my resident level lecture but instead of going through the slides in an hour, we spend three to four hours unpacking lecture. We discuss the papers and data behind each slide. The original presentation becomes a road map for a meandering discussion-based didactic session. They are among the most enjoyable teaching sessions I do.
After this lecture I went to the dialysis floor where I’m rounding this month. The full team is supposed to be a fellow, a senior resident, and three interns. But this month we don’t have a fellow, and on that Thursday the senior was in clinic and one of the interns was in his weekly lectures (he is an ER intern, not categorical medicine). So it was just me and two of the interns running the show. The service had exploded overnight so we had the work cut out for us. But we buckled down, triaged the list, saw the sickest ones first, got dialysis orders in for the new patients, and saw everyone on the floor. We even did some on-the-fly teaching and the interns got to see a fresh transplant patient who was making urine. This was great because the previous two transplants had delayed graft function and slow graft function. So this one completed the set.
At noon I had a lecture, but this time I was the audience. One of our fellows was presenting on an interesting case. This was his first time presenting the case but he is going to present at the upcoming intracity grand rounds so we essentially got to see his one point oh presentation. It was great getting to see his work because I know he had been working hard on it. How did I know he had done his homework? Because he had been discussing the case and his research on Twitter!
Then after lunch I had a meeting with the head of research and our biostatistician to go over three different resident and fellow research projects to see how they are going. This research isn’t moving fast but it is moving forward and it will be exciting. We have some good stuff in the pipeline.
After that I headed back to the ward, but got derailed by the transplant surgeon and spent 20 minutes trading hospital gossip with her. Truly one of the most enjouable diversions you can have. After that I met with my team, now joined by the senior and ER resident to card-round and make sure everyone was tucked in for the night with dialysis orders ready for tomorrow.
I then went back to my office, added a page to the NSMC.blog website for the NSMC interns.
Went home.
Went for a 5 mile run.
Dinner with my daughter and lastly worked on NephMadness until I went to bed.
Does anybody have it better than me?
What a day!