Dragging myself through today was rough. I usually look forward to afternoon small group, because we generally have a patient come in, and god knows we are starved for clinical wisdom. However, today we had written cases to discuss. Decidedly less exciting, but somehow, the conversation turned from hypothetical patients to tips in conflict resolution. Instantly useful, maybe more so than the standard interview-differential format.
There’s one patient encounter I remember very vividly from my fall clerkship of first year.
I was up at a small hospital at the very tip-top of the island, a satellite branch of the Big Hospital down here. It had a quaint, small-town-y feel that was quite unexpected in New York City. The nurses’ stations were the hub of every floor — far more people than available chairs, and everyone chattering away so loudly that the hospital actually installed a traffic light-style warning system to keep the noise down. Everyone promptly tried to set the hospital record for Most Warnings in an Hour.
Even small hospitals are not sweetness and light, of course. About midway through the semester, there was an extremely belligerent patient. I don’t recall why he was in the hospital. When I met him, he was about to be discharged, but he didn’t want to go home. (That should have been a tip-off.) He kept demanding to see the attending physician, upset about being fobbed off on a lowly intern. He treated the nurses like gum under his shoe.
One evening, when I was waiting at the busy nurses’ station for my supervisor to finish some paperwork on another patient, Mr. Bellicose lumbered up, dragging his IV pole. He started cursing out the poor clerk, so the nurse manager, an elegant, soft-spoken Caribbean man, came out of his office to deal with the situation.
“I want to speak to the guy in charge.”
“Sir, I am in charge of the nurses on this floor. Is there a problem I can help you with?”
“No, I want to speak to the doctor in charge.”
“Dr. Osler has gone home for the day, but he will be back in the morning. I can leave him a note to come speak with you as soon as he gets in.”
“Sir. If you continue to call me boy, this is going to become personal.”
Total silence at the nurses’ station.
The intern on the case showed up and asked the patient if he could do anything.
“You want to discuss my case in front of everyone?”
“Well, sir, let’s go back to your room.”
And the intern led the patient back down the hall.
Actually, I pulled a lot of this — especially the dialogue — from the journal I used to keep with interesting patient stories. No names or diagnoses, just descriptions of the personalities. Maybe I’ll use them in a story one day. Or maybe not. In any case, they are fascinating to remember. I can’t wait until third year, when I’ll be doing this full time.