Type B-ness in the Clinical Setting

Poster: Jesse

So my HPS with Stan the human patient stimulator…fuck, no, simulator… encounter was so good today that I thought it deserved a posting.

We always have no idea what we’re doing in these things. Standing around outside, waiting for them to take us back, one guy, let’s call him Todd for now, Todd starts talking about how awesome it is that we never have an OTM lab again, and now he can rejoice in the fact that OTM doesn’t matter anyway. I tell him I’m going to report him to the OTM police. Female student number 2 shows up, we’ll call her, um, Lucy. Todd pounces on her, because she has brought her reflex hammer to the HPS encounter. And while Stan has a lot of things, he doesn’t have reflexes.

I chime in about how I brought my Bakerman’s, the little blue book with all the lab values in it, because I’m sick and tired of them giving us a patient’s chart and it meaning absolutely nothing to me because I haven’t memorized a million different normals. David, the course coordinator, and an awesome person, coughs under his breath “BS”. He clarifies that whenever a student goes in a starts racking off what they interpret normals as, more likely than not, it’s BS. This makes me in my type-B-ness feel a little better, because I just thought I was the only stupid one not to know the values, turns out I’m just the only one with balls enough to admit I don’t know the values.

Then Todd starts calling Stan a robot, which is a major no-no (They’re patients, not mannequins). First year it would have gotten you asked to leave. But I guess Todd is man enough now and is so ridiculously cocky that they put up with it and ignore it. He then asks David if we get to kill the robot today. David says no, but he’s now questioning Todd’s career choice.

Anyway, they get ready for us to all go in to the room. I’m thinking “fuck, somehow I was the first one to walk in to the room, now I’m going to have to act like I know what I’m doing.” I’m going to spare you the details of the exact case, no one who isn’t a med student really cares and I probably don’t remember enough of it to write it all down. But it is at this point that our true med student-ness starts coming out.

The doctor running the case is a hypertension-nephrologist specialist. Kind of like a person who specializes in using a salad fork, but only when its warm outside, a little too specific. He starts asking a bunch of questions, and everyone’s trying as hard as they can to get a word in, so they won’t have to answer something we have no idea about. Todd tries to answer everything, he eventually ends up being told to be quiet, some of the other students might actually have a clue too. I get excited when I get one (”What’s the best way to evaluate his renal functioning?” “BUN/Cr”), but like most of these labs are, I get pissed off because I know the answers to far more of them than I answer, I just don’t trust myself enough to say it quickly enough.

Dr. asks a question about what would cause a 20 year old to have elevated upper extremity pulses, but normal to low lower extremity. At this point, random Indian boy chimes in. Random because I have been in class with him for almost 2 years and have no idea what his name is. And have probably never heard him talk before this either. “Renal artery stenosis?” random Indian boy says. Major mistake, never answer a question with a question mark at the end of your statement. Dr gives him a slightly weird look. “No” Oh well, good try random Indian boy. The correct answer was aortic coarctation, which I of course thought of but wasn’t brave enough to say out loud.

Dr goes on to ask what would cause the same symptoms, but in a 70 year old. Random Indian boy uses a classic med student strategy, that his answer has to be right sooner or later, and this doctor is a nephrologist after all. “Renal stenosis.” Dr gives him a total wtf-who-are-you look. “No….why would you think that? Anyone else?” Random Indian boy says nothing else for the rest of the 45 minute lab. Todd gets the answer, aortic dissection. I almost start laughing because I think of Michelle saying “aortic dick-suction.”

Todd recommends we do an opthalmic exam, and of course that is exactly the correct answer. They put up a picture of what it would look like, and I want to punch Todd because he shouts out “papilledema” before I get a chance to. But then, Dr asks why papilledema, and I am the quickest to say “because the margins of the optic disc are blurred,” trying as hard as I can to sound confident and like that is the most obvious answer in the world. I get a very approving nod and repeat of my answer by the Dr. Take that Todd.

A little later on, we start talking drugs. I am a drug retard. I’m offering absolutely nothing to this conversation, except repeating other people’s answers and trying to act like I knew if to begin with. “Oh yeah, alpha 1 antagonist” etc. I’m almost afraid that I’ll look like the worst person in our group, but then I remember random Indian boy, who is now basically hiding in a corner behind me.

We leave the room and Todd complains about how we didn’t get to kill the patient.