End-Stage

One of the things about being at Santa Clara Valley Medical Center is that due to the patient population, we see a lot of end-stage disease. The patients often do not have regular medical care, and so they only come in when they are extremely sick. As a result, we see a lot of terminal cancer, heart failure, COPD, liver disease. I found that during my time at the Valley, I was able to focus on end-of-life care and discussions. I had several patients with terminal disease, and I think that physicians have such an important role during this time for the family. The demeanor, attitude, and engagement of a doctor at the end of a patient's life can make the experience meaningful or awful for the family, and I try so hard to achieve that essence which they never teach in medical school. The severity of disease also reminded me of the importance of fundamental and routine access to primary care. Those patients who do not have regular physician contact are so much sicker at a younger age.

Medicine at the Valley is also a great experience because we do everything. There is no primary neurology service, and so I admitted and managed stroke patients, racking my brain to remember how to localize the lesion. I was able to do several paracenteses on patients with liver disease. I saw overdoses of the widest array of medications. It was a really good bread-and-butter experience and a reminder of how wonderful it is to take care of county patients.