how's DKA doing?

i did it. referred to a patient by their disease. immediately hated the sound of my voice, and the attitude i don't want to wear.

since i can contribute essentially nothing to patients' care when i meet them, it's easy to feel a bit frustrated by the things that seem inhumane. so i argue when i'm told to kick families out, and sometimes do examinations a little more gently than i'm supposed to, and in the end feel a bit conflicted about what it means to be training to be a doctor.

but today reminded me of something that i can offer: here and there, and more and more as i learn, i can answer simple questions - the ones other people might not have time for, or that patients might not want to ask their busy care-givers. today the question was just about what it was that i was listening for when i press stethoscope to chest and ask for "deep breaths in and out through your mouth." something i can explain, and he seemed to feel much better for having found a way to get the answer.

three things to remember: 1) giving good explanations of what's going on never goes out of style, 2) being an audience for peoples' stories - having the time to listen and really hear - is good for me and good for many patients too, and 3) time and empathy lead to trust, which leads not only to questions that i might be able to answer, but also to revelations (like what recreational drugs he's taking, or what she thinks of her husband, or whatnot) that i carry around with me as reminders that it's people that are patients, not the other way around.

mother: "so, I hear you're going to emerge. today?"

me: "hmm."

mother: "emerge from what?"

indeed!

someone remind me, when my turn comes, that i don't really believe i'm a locus of control in the mortal events of this world!

DRE day today. just another orifice, non?

A far better storyteller than shall ever be we.

so what i figure is that experienced clinicians walk around with a database of 'typical' cases in their heads. it's easy, then, to compare each new presentation against these, and quickly identify what's of note (typical presentation, atypical, etc.). i, on the other hand, use each new encounter with a patient to construct my database, and as such, each tiny little detail remains painfully important.

just thought i'd share.