(One from last year that never made it out)
Its amazing how quickly one can forget.
I had the opportunity to spend a year working as a Scribe in two twin cities’ ER’s over the “year-off” between school and…well, more school. As you can imagine, hours spent with these patients gave me a different impression of the value and place of healthcare than some of my more…educationally streamlined (?) classmates. Drug addicts? no sweat – My sheltered suburban eyes have been opened. Blood? no more off-putting than re-gifted fruit cake. (sorry – only pun in my arsenal today.) Mental disorders? A reality of life, as was the rest of what we had studied in class.
You see, today we began “Preceptorships”. That wonderful period of time spent
shadowing playing Doctors, our first real change to see patients, take their vitals, their histories, and their relevant physical exams before presenting all (in a not-so-concise fashion) to the attending physician. Admittedly – I’ve been looking forward to this part of Med-school for AGES; because didactic learning has been…well, brutal.
Ours was at the VA (Veterans hospital – 50 minutes out of town)
I mean, FINALLY, a chance to flex a lil’ scribe muscle and show these newbies how a real doct…med student does it. Bring on the patients – those ailing masses who seek my caring touch! With a word my orders shall be carried out, yielding nothing but healing and wholeness for all!
Or so I imagined.
After the countless hours of class, “small group learning” and studies, (not to mention the skills practiced on fellow students (yeah…one of the better part of school, testing the reflexes of that annoying student. relax, his bruises eventually healed.) I was pretty confident walking into our first patient of the day, an Ex Vietnam vet with “Ascites” on his chart.
As a quick heads up – Ascites is basically fluid collection in the abdominal cavity ( yo’ – belly) that starts when the liver begins to slack in its duties, (whether due to alcohol, injury, cancer, hepatitis etc. etc.) The proteins that normally help keep all your squishy bits juiced up (yes. medical definition) don’t exist, and so fluid collects freely and expands the abdomen.
The textbooks all show a reasonably normal white male with a uniquely large and rounded stomach, and what child hasn’t teased their father after thanksgiving meal? Big stomachs are one of those realities of first-world life non?
Our patient, no taller than me, had what appeared to be an exercise ball stuck in his stomach. An almost cartoonishly impossible, taut, bulging stomach large enough that his XL hospital tunic, which had given up attempting to cover it, merely drifted to the side.
The poor guy hadn’t slept in a week.
Dear lord, a week?
And this was his, (gasp) third time coming in with this severe “abdominal distension”?
Like three timid little lambs myself and the two other students assigned to our hapless patient stood on either side of his bed – white coats little more than a symbol of our ignorance – and started firing off questions.
Firstly – When did I suddenly lose the ability to talk to humans? Here I am talking to a patient with a hearing aid, and an uncomfortable condition, and suddenly words escape me. Those that I do find are clumsy and overly-technical.
I had to take a moment and literally shake it off. Our patient, ever gracious – answered each question, despite our spending nearly an hour to finish off a complete history and physical.
“Oh, the physical exam, how did it go?” you ask.
Thank God I don’t have be treated by me (yet). Scratch verbal stumbling, we actually tripped over ourselves trying to examine our patient appropriately. The United States Medical Licensing Exam (USMLE Part 2) tests clinical skills, and docks points for unnecessarily repeating painful examinations. I can’t believe what this guy must have been going through as we “gently” poked and prodded his stomach to identify the boundaries of his liver, etc. Every time we insisted on waiting for the attending physician, our patient encouraged us to continue the exam. (Whadda-guy) I will admit, the moment I first touched his FIRM stomach ( I mean…it was tighter than a water balloon at capacity) I forgot the entirety of my medical knowledge.
There is simply nothing like touching a real person. And there is nothing scarier (or more exhilarating ) than knowing that his condition isn’t a test question.
An Attending and some Third-year medical students came in shortly after us, examined the patients (in seconds) and proceeded to puncture his stomach (“Paracentesis”)
Eleven (11) liters of fluid were released from this patient’s abdominal cavity.
Dear sweet snow…Eleven liters. This patient was sleeping with five two-liter sodas strapped to him, with a seltzer water on the side.
It barely made a dent.
Fifty years of 10 drink-per-day living will have that effect.
War is hell.