A medical student’s first patient encounter

This is an account of my first encounter with an in-patient from a little while back — I have provided only minimal details about the patient to maintain compliance with HIPAA.

After a firm handshake with each of us, our preceptor embarked purposefully up two floors to our first in-patient encounter. As we walked, I peeked into the rooms with the door left ajar and wondered what brought each individual to the hospital. I absorbed the environment full of harsh fluorescent lighting and the doppler effect of whirring machinery. As long white coats hurried past, I admired how they could make that swoosh sound of purpose that mine lacked.

Prior to meeting with our mentor, my partner and I discussed who would conduct the interview — he agreed that it was his turn [being the go-getter that I am, I offered to go first during previous patient encounters] and admitted to feeling nervous. Even without the pressure of being in the spotlight, I still felt like this was a test. An assessment of whether I truly possessed the humanistic, yet deductive ability required of physicians.

We walked up to the room and our preceptor grabbed the chart to secure a name. Before entering the room, he asked about the vital signs and I remember mumbling, “temperature, blood pressure, pulse, respiratory rate and sometimes pain.” At this point, I felt my own vital signs conveying my anxiety over meeting our first patient. Even though we were only charged with recording the history of present illness, it still felt like a tall order to fulfill. After all, many patients present with numerous chronic conditions, mounds of prescriptions and an extensive medical history. Since anything from the past could have contributed to precipitating the present condition, it didn’t seem like an hour was nearly enough time to gather every piece of the puzzle.

I don’t quite remember the rest of the conversation outside of the room, but I remember walking into the double room to greet our patient. Our preceptor introduced himself, then my partner, then I did while extending my hand to shake hers. Upon walking in, I was taken aback by her look of helplessness and how uncomfortably out of place she seemed — I envisioned that her life outside of the hospital involved young children and rosy cheeks from a slight chill in the autumn air. Her hand felt warm when it greeted mine, but I cringed slightly when my thumb brushed against her IV lines — I was scared that I might have grasped her hand too firmly.

My partner settled to the right of the patient while my preceptor pulled up two chairs for us to sit at the foot of the bed. As I opened a blank Word document to take notes, I heard quiet sobs from the other side of the curtain; I felt like we were unwelcome and intruding on an intimate moment. The “interview” commenced, but it was more like a guided tour of how to obtain important information. Our preceptor mentioned countless tricks he employed while he was still practicing [he’s currently retired] and by the time we were halfway through the interview, I already felt like I was only absorbing fragments of information. It was like a disorganized concept map in my head. I heard familiar and unfamiliar terms, but the lines connecting the ideas stopped appearing after a little while. By the end of the interview, I only really understood the diagnosis, but not the logic that brought us there.

Before leaving, we had to record the patient’s vital signs [minus temperature]. My partner went first, then I went ahead. Although we had practiced taking each other’s blood pressure, it wasn’t nearly enough practice to feel comfortable. I fumbled to put the cuff back around her upper arm and pumped it up to some large pressure value then listened carefully for the distinctive “lub-dub, lub-dub” Korotkoff sounds until they faded into oblivion. She sounded like she had a strong heart and I confidently reported a value similar to my partner’s. As I started to remove the cuff, our preceptor came over and noted that we had placed it on the patient backwards.

We thanked our patient profusely on our way out of the room. In the hallway, we discussed the interaction then parted our separate ways. At that point, I don’t remember anything else from that day besides the feeling of floating in a cloud of contentment. Despite the little mishaps during the encounter, that hour temporarily put the magic back into medicine and reminded me that someday the endless hours of studying and stress will pay off.

Amanda Xi is a medical student who blogs at And Thus, It Begins and can be reached on Twitter @amandasxi.

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