So, there is a running joke about how the HMS med student on the team should refer to himself as the World Renowned Student Doctor when he picks up the phone or returns a page. We have patients…we don’t know anything and we have patients – that is kind of scary. Granted, we are always followed by interns/residents/attendings at this stage in the game so we never actually run free in the hospital (what a scary thought). Let me tell you about my patients…doctor-style.
76 yo male with a history of millions of ophthalmic problems and coronary artery disease (heart problems) comes in after nearly fainting during an ophtho exam. If you ask the resident playing with the eye what happened you get some story about no pulse for a ridiculous period of time. If you ask the patient – he remembers everything. Too bad the patient wouldn’t tell me that.
Yes yes, I started out my first rotation ever with the ominous “Difficult patient.” The kind of person you try so hard to get information from only to find out he hates you because 6 other people entered the room to ask the same things and you happened to be the last one. Initially I was bummed – unlike other clinical experiences, I didnt just get to talk to another patient instead. I was stuck. After seeing what other people got out of him plus what I managed to get, I made my way through my first diagnosis. One point Jainy. (For those that care, we think the oculocardiac reflex kicked in, although the patient had a history of these kind of episodes when he was younger so maybe vasovagal).
With diagnosis one out of the way, I figured my next patient would be that bad. We were on short call meaning we were getting new patients from the team that in overnight. What did I get, a class case of alcohol abuse and withdrawal…or I thought it was classic. Here comes the story of “difficult patient #2.”
63 yo male with an extensive history of chronic alcohol abuse, depression, Hepatitis C and cirrhosis presents with symptoms of withdrawal and intoxication. Something about having money stolen and an account frozen…then a lot of drinking…then eventually coming to the hospital. The patient has come to the hospital like this 9 times in the past year – just one year alone – for the same problems. I got my brief on the patient..I thought this would be so easy – he’s already experienced but boy, was I wrong. Difficult patient number 2 is the patient that really can get to the point of his story. If I were to ask “Do you have pain?” I would get back a convoluted story about nothing related to anything we have talked about. It would semi-answer my question but it really should have been a simple/sweet yes or no. What makes this better is that I was being watched during this whole interview. I just felt myself drowning the whole time. Eventually we uncovered a crazy past medical history of gender identity disorder for which he got implants (yes, breast implants) and a lot of cocaine/crack use.
Who ever thought that I would get slightly attached to these patients – but after the first day passed that I would grow to really like these people. Its true what they say about mean patients – most of the time they are normal, nice people dealing with the huge stress of being admitted to the hospital. All I can say is that I’m glad both of the patients are back to their lives with the second actually checking into a detox program for help. 2 points me? I think so.