2nd week into my 12 week internal medicine rotation and I'm definitely sure I don't want to work with old people. I'm doing 4 weeks at the VA hospital and I've seen way more old men with complicated histories than I want. Although everything is computerized now, it almost makes it less easy to flip through the chart to really get an idea of what's going on with them. Older patients tend to have a lot more health problems then kids do which means that are more likely to have a ton more meds which makes balancing the health problems and the meds hard, not to mention figuring out exactly what is the cause of their problem. For the most part I like my team and my patients. I just don't find working with adults as satisfying as working with kids.

Also, what is it with older men and icky toenails?? I think in this rotation I've seen lots and lots of feet and a lot of them have these strange piled up extra thick toenails probably from like fungal growth or something. I've only seen one gentleman with good footcare - probably because he's a diabetic and knows that he needs to take good care of his feet or risk losing them. Still, there must be something about not taking care of your feet anymore as an older man that must be common in this population. I guess I saw it a fair amount on my family medicine rotation with some of the older men but not as much as this. Icky!

I think the nastiest thing I've seen on this rotation though was a case of phimosis (look it up). Very very nasty. To relieve it, they had to do a ventral slit cut on the penis foreskin to stick in a foley to drain the bladder. I got to cauterize the wound (hooray) but made me glad I don't have a penis!