Wrecking Ball

Working in the community health clinic makes me feel like I am on one of those Japanese game shows where the contestants attempt to navigate an impossible course of physically challenging and utterly embarrassing stunts. Here is how the sequence of events went today. Got out of lunch meeting late, got to the clinic late, nurse hands me a chart the second I walk back to the doctor offices, seconds later I am sitting down with a 52 yr female patient and her husband trying to go through the thick, cluttered PAPER medical chart while listening to her in Spanish as she rifles off a litany of symptoms, writing down what I deem pertinent, asking questions I deem relevant, and listening to her husband in English as he talks to me and to the patient.

I, myself started to feel a little sick trying to process all of the above. The first five or six minutes of the visit were almost completely lost. I did get some helpful information, but I felt so out of control that it was hard for me to recognize at the time that the information was salvageable, that it was actually telling me anything. With the rash and the fever I was thinking about the microbiology I studied on Saturday. The issues of vertigo had me thinking back to HSF and the inner ear complications. Her uncontrolled diabetes was working like a wrecking ball destroying the city of organization, the city of understanding that I desperately hoped to erect in my mind.

Then, after I accepted that the first five minutes was a loss, I observed the damaged city and was able to sift through the rubble to move the visit forward with an albeit tenuous plan. Some patients I present to my preceptor having a pretty good idea that my exam covered the right bases and led to the right diagnosis/plan. Then there are visits like this one where I report a weak hypothesis, essentially a white flag, to the preceptor and hope that he or she will look upon me with compassion. Today felt like there were only white flags, but now that I think about everyone I saw, I realize I forgot some of the simple, stress free victories of the day.

One reason why I might feel like there were no victories today was because before I leave the office in the evening, my preceptor and I sit down to go over any questions about the day's cases. I usually ask a couple, and then I have to answer her questions. It is a fun game we play, doctor vs student, and I actually like that I never win! I better get out my anatomy text already.