November 11, 2011

first encounter

     "I have a patient for each of you.  One," the doctor pauses here, "I'm not so sure about but we'll see how it goes.  The other is straight forward."
     He knocks on the door and introduces me to the patient as doctor which strains against any humble nature I have because it just feels cool.  I figure I've worked hard enough to get to this point that I can enjoy a bit of brief vanity, even if I'm technically not a doctor yet.  We're given nothing about the patient other than the last name.  That's it.  We're supposed to take a full medical history and give a full physical flying solo.  We then report back to the doctor overseeing us with our findings.  He takes us back to the patient so we can present our findings, shreds (deservedly so) our technique, educates us on a better way, and then we're on our merry way.  Repeat about weekly.
     Given his pregnant pause, I went out on a limb and guessed that I got the "not so sure one".  The daughter is in the room and I wait for her to finish up.  Then an occupational therapist goes in and I move further toward the back of the line.  As a med student, I think we're somewhere above the faucet but below the coffee machine in the hierarchy.  I wait about 45 minutes which is not really any big deal for me at MD Anderson.  I'm quite used to waiting here and I joked with my dad that they even keep their trainees waiting. 
     I finally get the green light and I'm in the room introducing myself to the patient.  One quick glance and I now know that I got the difficult patient.  She has a nasogastric tube emerging from her nose.  I look at the tube and notice the green fluid in it.  It's obviously not to feed her.  The green is the stomach fluid which is being emptied.  Her stomach is swollen to the size of a large watermelon and as hard.  I begin to gently question her and after many long pauses, her eyes focus on the window.  She slowly raises her hand and begins waiving.  I query as to whom she's waving.  "My daughter," as a half smile erupts on her face.  Keep in mind we're on the 10th floor of the hospital wing and absolutely no one is out there.  It's more than a little heart breaking to see a cancer patient in poor condition who is hallucinating but I cordone off that part of me, at least for now.  I do have a job to do.  I recover my senses and conclude the interviewing part isn't going to work so I try to salvage what I can and move to the physical exam.  After a very few quick parts, she says to the entering nurse, "I need to spend more time with you, and less time with him."  And with that, my first patient encounter lasts about 5 minutes and is over.

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