Well, that last post is a mess, and I don’t know how to fix it. We had class this morning, at which it turns out that in spite of the fierce letters sent to us a month ago about absolutely not missing any lecture days or anything, they really don’t mind if we go to interviews. Which is only reasonable, to avoid an inimical relationship with the students, because at this point the inborn medical student competitiveness and passion about grades is completely gone, and even I am only concerned to pass the clerkships. Interviews are far more important than grades now; that much triage I do know. They could give us all a zero for class participation, and as long as the attendings liked us reasonably well on our clinical evaluations, we’d pass. So we were all happy to hear that they don’t mind us going to interviews on class days.

Last night was fairly quiet. We had another couple elderly ladies complaining of vague dizziness, nothing related to chest pain or breathing difficulty, who turned out to be having ST changes that resolved with nitro – thus buying themselves a quick trip to the inpatient floor. I’m starting to be familiar with at least the battery of tests the ER doctors want for patients who might potentially have heart problems, and hopefully in another week I’ll have a better grasp of the resulting medications.

I got a copy of Cope’s Early Diagnosis of the Acute Abdomen from the medical library the other day; and being surgically inclined to start with, I was trying to diagnose appendicitis all evening yesterday. One was a pregnant lady, and after I had decided her symptoms didn’t sound at all like miscarriage, I figured she had right lower quadrant tenderness and rebound. Yeah right. The surgery interns would laugh at me. I’ve heard enough times by now not to call something rebound unless you mean you want to operate within the next hour. Dr. Dimant got out the trauma ultrasound, and we looked at the baby, and the appendix, and then the liver-kidney, spleen-kidney, and abdominal view of the heart windows (which in trauma patients you check in a FAST exam to look for fluid in those spaces; 250cc present will show up on ultrasound, and indicate that there is free fluid in the abdomen, either bleeding or ruptured viscus, which either way calls for a laparotomy). After the patient’s pain spontaneously resolved (intestinal colic is the fancy word, I think), we discharged her. I picked up another young woman with abdominal pain, and tried really hard to get a significant history from her, but it was just a UTI.

Later, there was a young man complaining of excruciating back pain radiating all the way down to his toes. I went to see him, and he sold me a good one. I ran back to get Dr. Dimant to see him so she could give him some pain medicine and figure out what neurological emergency was causing all this. She was highly amused. During her history and exam, she took pains to make him move around, and distract him into telling a story, in the course of which he waved his arms and bent his back and legs freely, completely different from what he did when she was examining him. Okay, so, he was a good actor, and earned at least one dose of good medicine, before we palmed him off with a muscle relaxant and told him he was cured. One good sleight of hand deserves another, right?

The best patient (from my limited viewpoint) was a guy who was playing with his dog, and underestimated how high he would jump to grab his toy back. Thus, dog-bite to the hand. It was gaping so much that we decided, after washing it out very thoroughly, to put two stitches in to hold it together. While I sewed, Dr. Dimant and the young man entered into mating negotiations for their dogs, since she has one of the same breed and age. Maybe it was the location on his hand, or Dr. Dimant’s calm attitude; but those stitches went in very nicely, and we had a good laugh about whether the ethical boundaries between patients and physicians extend to their dogs too.

That’s my last night with Dr. Dimant. Most of the rest of the month I’ll be with her partners. I’ve enjoyed working with her tremendously. She treats me almost like a resident, pushing me to make decisions, and name specific doses for the drugs I do manage to think of, and then acts as though it’s my plan, when she actually had to help me make it all up. She says she’s been talking to the others (uh-oh), so maybe they’ll keep making me write on the chart.

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