10 October 2010

Chimeric med students.

I was out partying this weekend, and people always want to hear patient stories. And I've got some good ones, as does almost everyone in my class. Even better - attending stories.

See, when you first start out, the simplest things seem fucking cool. When Bala first described a case where a woman started losing her peripheral vision before her central vision, leading Bala to instantly diagnose a pituitary tumor, we all felt like part of an episode of House. And that was fucking cool.

But now, decreased peripheral vision would easily elicit a differential of a pituitary adenoma or a craniopharyngioma. Instantly. Not only that, most of us could give a differential of what kind of a pituitary adenoma to look for, what symptoms to ask for, etc. etc. All this has become standard. But do any of actually believe we have achieved some miniscule level of Bala-greatness? Not in the slightest. Often, we'll ascribe that to someone else. That wasn't D, that was V.

A few weeks ago, when a elderly gentleman collapsed on my American Airlines flight, I had to assess his slight chest pain and syncope. If you asked me to describe that episode in excruciating detail, I'd probably stammer and 5 minutes later, come up with a half-hearted differential. But I knew then. I knew to look for the deadly chest pains and keeping in mind that common things are common, that he was probably dehydrated and fatigued. But that was someone else. All I do is mostly eat and sleep and occasionally crack open a book. Who was that delivering babies and performing CPR or explaining the side effects of FOLFOX to the patient constantly in denial? When the need arises, he better be back. The fear is, that he might not.

Not the Attendings. They don't have multiple personalities or the fear. They've got this. The white whales flee at sighting an attending.

Wikipedia says:

an attending physician (also known as an attending, or staff physician) is a physician who has completed residency and practices medicine in a clinic or hospital.

I guess? That definition is for the layman. 'Attending' means something else altogether.

And you always wonder if you'll actually ever get there. Even in middle age, you see yourself pilfering coffee and muffins and using silly mnemonics and stammering after every inquiry and running to UpToDate to look up everything.

But really, the point is, to never actually feel like you're there. One of Bala's favorite stories is the one about Type 1 diabetes, where upon administering exogenous insulin, a severely malnourished young boy regained his appetite and was back on the curve to good health. And you think, I could read, and listen to my patients, and not treat medicine like a game, I could be there.

Well, yes and no.

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