Sunday, November 4, 2007

Like Being in the Ring with Mike Tyson

That is what it's like on the wards for a 3rd year medical student.

You step into the ring and KAPOW!!! You're reeling, you try to shake it off, but before you can JABJABJAB! BODY BLOW! You hit the canvas, they're counting, you stagger to your feet and KABLAM!! Lights out.

What I mean here is, it's tough on the wards for people like me, still trying to figure out what the hell is going on. As soon as you recover from one mistake, you make a complete ass of yourself in front of your team and possibly trip over an IV on your way out. One time I dropped something on a patient's leg, right where she had just had a skin graft. She cried. It was horrible.

Dumbass Moment 1: Presentations during rounds
I swear to God, it doesn't seem to matter what time I get to the hospital to prepare, how much reading I do about my patient, how carefully I write out what I need to say. I cannot seem to get through a single presentation without making some mistake. I wish I could say that I make a new and different mistake every time, but sadly, that is not the case. There is a set of mistakes that I make over and over and over again, forcing the attending to ask things like "So why is this patient here?" and "Are you sure their heart exam was normal? Because that child has a murmur you can hear from Mars." In addition, I'm generally spastic and strange throughout most of my presentations (see "Medical Tourette's" below). You are supposed to go in a very specific order, and sometimes I'll make it the whole way through the presentation, but then people are still looking at me, so I'll just kind of yell "LASIX 30mg PO BID" for no reason.
Yesterday I presented a new patient. I had a particularly bad day the day before, so I worked very hard to shake it off and make it my best presentation, and when I finished, I felt great... for about two seconds. Then a fellow pointed out that I had said "lungs clear to auscultation, except for some scattered wheezes". That's like saying "patient is doing well, except that he is dead". Last week I was actually given a very complex patient to follow, but after one horrible crash-and-burn presentation they switched me to a patient just saying overnight after a percutaneous cath. It was like "There, there. Give mommy the power tool. Here is a nice soft plastic block with rounded edges."

Dumbass Moment 2: Totally off-base answer to pimping question
This happens to me a lot. They'll ask something like, "What is something in your differential diagnosis for lower abdominal pain?" And I'll just blurt out "CHEST TOAD!" It's like I have Medical Tourette's. I say completely idiotic things, and I say them loudly. It's horrible.

Dumbass Moment 3: Flubbing the Interview/Exam in Front of a Patient
I have done this plenty, but my favorite example is actually something a fellow medical student said. He was interviewing a patient's mom about her daughter's vomiting, and he actually said, "Any pets? How about a beaver?"

These are just a few examples of classic Ward Dumbass Moments. There are many more. What makes is hard is that these are inevitably scattered throughout every single day, and you have to find a way to immediately recover from the humiliation and shame so that you can go back to making the next mistake. It's very exhausting. So far Mike hasn't gone for my ear, but I'm sure it's just a matter of time.

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