A nurse offers a medical student sage advice

Last year I was assigned to complete a history and physical on a patient in the hospital. Stifling my excitement to be doing this on a weekend night, I walked to the operator’s desk and paged the on-call intern, who — I’d been assured — knew I was coming. “You’re who now for what?” she stared blankly back at me after I’d explained my task.

My patient (we’ll call her Betty) rested comfortably in her bed. Her husband stood at her side, arms folded tightly against his chest, at once protective and authoritative while apprehensive and concerned. He eyed me as I knocked and entered the room to introduce myself. Betty had just been admitted from the emergency department, and I was to collect all of the information I could about her past and current conditions.

Betty has been a nurse longer than I’ve been alive. She humored me as I stumbled my way through the beginning of the exam, but her tenacious traits quickly surfaced, and she stopped me.

“No, no, no. Don’t ask that. You should just say ‘Who’s your psychiatrist?’ Everyone my age sees one, and if they tell you they don’t, they’re lying.”

As I began my exam, she offered pearls of wisdom. “What the hell are you doing? Do it like this.”

It took over an hour. Every time I’d completed a task, Betty made me do it again, but this time explain to her husband (obviously for my benefit, not his) what I was doing and why I was doing it. Despite my reluctance to lay her supine, she demanded I do so, otherwise my abdominal exam was “crap, just crap.” She laughed when she saw the school-mandated tuning fork in my bag — “don’t be ridiculous!”

But as Betty taught me, it was clear that she was worried about her condition. What did the chest x-ray look like? I told her what the intern and I had seen. How did the blood gas come back? I didn’t know. CBC? CMP? I answered what I could, and assured her that the real doctor would be in as soon as possible. We spoke for a few more minutes as Betty offered advice for the path ahead. “Respect the nurses. Remember to get a pregnancy test on every woman you see. Don’t date the nurses.”

When I exited the room the intern looked up from her computer screen. The bags under her eyes told the story of a long day, and she winced as her pager cried out again and again. Still, though, she kicked out the chair that rested next to her. “Grab a seat.” As phones rang and a steady raucous din filled the ward, the tired young doctor took the time to review my work and walk me through Betty’s condition. She pointed out the opacities on the plain film, pimped me on leukemoid reactions and differentials, and helped me understand the Winter’s Formula magic that I’ve learned and forgotten more than a few times now.

When she signed my paper, proving that I hadn’t fabricated my patient encounter, I went home. Betty still lay in her bed, and she’d be there for a few nights more. The tired intern picked up the phone and moved on to the next task on a never-ending to do list. I had been just a moment in their night, but the time they’d both taken to help me along was irreplaceable.

Rick Pescatore is a medical student who blogs at Little White Coats.

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