I have my clinical skills exam this weekend, which should be fairly interesting. It's being held at the Morchand center, made famous by an episode of Seinfeld, you all know the one
Student #1: And are you experiencing any discomfort? Kramer: Just a little burning during urination. Student #1: Okay, any other pain? Kramer: The haunting memories of lost love. May I? (signals to Mickey) Lights? (Mickey turns down the lights and Kramer lights a cigar) Our eyes met across the crowded hat store. I, a customer, and she a coquettish haberdasher. Oh, I pursued and she withdrew, then she pursued and I withdrew, and so we danced. I burned for her, much like the burning during urination that I would experience soon afterwards.

Student 1: GONORRHEA!!!

Anyway, there's a a 100% chance that it will be nothing like that scene, but it should still be interesting...I'll make sure to report back. I survived my GYN exam with minimal emotional trauma. The ladies that ran the session were great and even though I was forced to desexualize the vagina, which was not an easy feat for me, they made it a very professional and educational experience. I am still afraid of the cervix though...it's one of the scariest organs that I've encountered.

Failure to Communicate

I've written a string of posts relating to my adventures through my oncologist preceptor's practice, and I think my experience came to an apex today. My classmate and I were telling our preceptor about what we thought we needed in terms of getting ready for our clinical skills practical and how we would both like to run through a H&P today to make sure we have everything down before the exam. So our first two patients were follow up visits, the first a schitzophrenic who was so gorked out on anti-psychotics that he cannot communicate and the second was a patient that we had already dealt with in the past who needed some theraputic phlebotomy.

Patients 3 and 4 didn't show, so we went out to the floor to do a consultation. We get to the patient's bedside, and my preceptor tells me to go ahead and do the H&P. Slight problem, the patient HAS NO LARYNX and has a GAPING TRACHEOSTOMY FISTULA without one of the tubes that you usually see. (PS-Don't smoke.) Ok...how to communicate with a man who cannot speak...

Bostonian: How long have you been hospitalized?
Patient: Gurgle gurgle gurgle... (mouths November)
(this is going to be easy)

I took about as complete of a history as I could have, got a general idea of what was going on in terms of what needed to be done and did as painless a physical as I could, because they poor guy was wasting away and had several exquisitely tender points on his body. I've never seen such a pitiful site. The skin was just hanging off of his leg bones, he had no muscle mass left just bones with some skin hung on them. Pretty sad. It was also my first physical on someone in bed...not my ideal way to practice, but a good experience none-the-less.

To make things even more happy, it turns out that he was MRSA positive and the only notation was in his chart, the nurses didn't mention it, there was no warning about contact precautions...nothing. So if I disappear from the interweb, it's because I'm hospitalized with MRSA pneumonia

1 comment:

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