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SAN JOSE, CA – “Hi, Mr. Jones.  Tell me about your night,” said by the stupidest, know-nothingest, why-did-I-just-do-that intern, Dr. Austin.  Austin, a new intern at HarborHealth immediately regretted asking an open-ended question to his 98 year-old, mildly cognitively impaired patient admitted for dizziness.

Am I alive?  Is this nightmare going to end soon?

Dr. Austin froze in panic that he may not make it out of the room in time for noon conference, and they were serving tacos too.  Mr. Jones continued to recall seemingly interesting events past that took the form of a non-linear, vaguely goal-directed monologue.  Bargaining with any available higher power, Austin pleaded, God, I only ask that you have a nurse page me about anything right now.  I promise I will never get annoyed by another page if you just page me right now.  I even promise to renew TPA and restraint orders on time.  

Austin, often praised for his non-judgmental, unrestricted approach to interviewing standardized patients during medical school, came to internship ready to listen to patients, to hear their stories, to elicit an excellent history to cinch the diagnosis.  By the third patient of the first day with “a little bit of an AKI” complicating their course, that zeal began to fade away.

“Oh, that’s interesting and an important detail that your skin sometimes gets dry in the wintertime.  Remind me when you said this started?”  Realizing he only enjoyed medicine when reviewing patients’ vital signs and laboratory results on the computer screen, joking with coworkers, and sipping coffee.

“Gosh, it’s been a long time.  I’m not sure I’d say it’s been forever, but maybe almost as far back as I can remember.  My sister gets it, too.”  The good Dr. Austin pretended to listen intently, convinced he could feel his fingernails growing.  “I think it might be from my dad’s side of the family.  But then again, my mom’s side of the family is from Georgia.  Anyway, do you think this it’s related to why I no longer have a taste for Fig Newtons?”

“Great, Mr. Jones.  That’s an important piece of the puzzle for sure.”

Unsuccessfully trying to signal to patient Mr. Jones that his time with the young doctor was coming to a close, Austin began to quicken his automatic replies into terse, “Uh huh, that’s very interesting,” simultaneously closing his body language and edging his way to the door but the old man kept calling him over to look at spots in his hands that have been there for “over 30 years.”

At press time Austin was still in the patient’s room trying to convince the patient an Ambien might be the best approach.

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