The first week of my Renal/Nephrology rotation has already been more intense than the entire cardiology elective combined. First and foremost there are about 723,645 things that can go wrong with a kidney and each one of them is dependent on a different set of parameters, each affecting a different part of the kidney. The heart is much simpler. It's function is pretty simple, linear. It either works or it doesn't, and most of the problems can be observed by simply following the conduction. The kidney...not so much. Electrolytes that we were never asked to pay attention to in Basic Sciences (oh how long ago and far away that seems) can wreak havoc on the kidney with even the smallest changest. It's interesting, but a real challenge to keep it all straight. Potassium, magnesium, phosphate, sodium, BUN, creatinine, albumin...and the beat goes on.
This week was particularly intense as it is the first week. I haven't been asked to write a progress note or do any sort of real physical exam in months (since OB). The first morning I had to rock my brain a bit (anyone smell smoke?) to remember how to go about it! Then I had to figure out which lab values were more important to focus on (all of them, and none of them are important, completely dependent on the patient), and then I was brought face to face with an attending who can remember about forty-six sets of lab values per patient. I, personally, have difficulty remembering phone numbers unless I've used them more than twenty times...Wednesday my partner couldn't make it, and of course that would be the day we had our highest census. I had to round on, and note eleven patients, and then get pimped solo by the attending. All in all a busy day! I didn't get home until rather late (I left smack in the middle of rush hour traffic, oh goody), and then had to do a presentation. It was a bit of a tiring day and definitely will be a more intense rotation but I am liking being busy again.