While students on medical rotations rarely experience a dull moment, Joe Herba’s internal medicine rotation in a McHenry County, IL, hospital was adrenaline-filled from day one – or, for Joe, from his first night shift. Five individuals came in after being in a gun fight.
“That was the first time I’d seen trauma. It was jarring,” says the third-year DMU osteopathic medicine student and president of his class. “The first person was shot in the arm, but the next had two shots in the head. It was the first code I ever ran.
“The doctor felt kind of bad,” Joe continues. “He said, ‘That was a rough night – but you got some good experience.’”
He also gained unexpected experience when the hospital admitted a man who was the first human case of rabies in Illinois since 1954. The Illinois Department of Public Health said the man had woken up to find a bat on his neck. Later, the bat was captured and tested positive for rabies, but at that point the man already was experiencing symptoms.
“We study rabies a little bit in microbiology. The treatment is 100 percent effective if a person receives it before they have symptoms,” Joe says. “My team leader asked me to talk with the man to see if he had symptoms. Rabies victims are hydrophobic. He was thirsty, but when I brought him water, he didn’t want it. He knew he was going downhill.”
Joe says the man’s eventual death not only was very sad for his loved ones, but it also reflected a public health issue. Although rabies is exceedingly rare in humans, with only one to three cases reported each year, rabies exposure is still common. An estimated 60,000 Americans receive post-exposure vaccinations every year.
In Joe’s patient’s case, a bat colony was discovered in his home. He died.
“McHenry County has had a problem with rabid bats for a long time,” Joe says. “If a bat is found in a home, everyone there should get the treatment just to be safe. Without treatment, rabies is fatal. It’s important that public health officials explain that to people. Seeing such a rare case was an incredible learning experience in both medicine and public health.”
As tragic as the man’s case was, Joe felt fortunate that his rotation included daily didactic sessions during lunch; the week before the rabies patient came to the hospital, he participated in a session focused on taking care of and talking with patients and their families in difficult situations.
“It involves careful wording – not making promises but assuring patients and families that we’re going to be with them 100 percent and do all we can,” he says. “I was able to use that a couple of times later in the emergency room, including with a patient who’d had a heart attack. His family wanted to talk with someone, but there were no doctors available, so I talked with them. I think of it as what I would want as a family member in that scenario.”
According to the American College of Physicians, doctors in internal medicine are equipped to handle the broad and comprehensive spectrum of illnesses that affect adults and are recognized as experts in diagnosis, in treatment of chronic illness and in health promotion and disease prevention; they are not limited to one type of medical problem or organ system. General internists are equipped to deal with whatever problem a patient brings and are specially trained to solve puzzling diagnostic problems. They can handle severe chronic illnesses and situations where several different illnesses may strike at the same time.
“They’re sort of the jack of all trades,” Joe says. “They’re able to treat and control a lot of conditions until a specialist is needed.”
He enjoyed his four-week internal medicine rotation, including working with a surgeon who had saved his grandfather’s life when Joe was in kindergarten. In the months ahead, he’ll experience rotations in psychiatry, obstetrics, ophthalmology, family practice, endocrinology and pediatrics. His advice to other medical students: Keep an open mind about the specialty you want to pursue while having a couple ideas of where you want to go.
“And be nice to everybody on your rotation,” he adds. “You can learn something from everyone, including the people who clean the rooms.”