Cut loose like a deuce, another runner in the night...
It's funny how we sometimes seem to dwell on the one negative thing amidst a sea of good. I just finished my 1st rotation in Pediatrics, got an excellent End of Rotation write-up from my supervising doctor, completed all the necessary paperwork for both my Continuing Medical Education as well as my required Clincal Master's projects and thus was ready for the random paperwork audit that day, attended my 1st Clinical Assessment Day, and scored rather well on the computer exam in Pediatrics. So all-in-all, not a bad wrap-up of my 1st rotation. However, the Practical section didn't fare as well. I went in feeling nervous but fairly confident, but then it blew up in my face, David Lo-Pan-style...
What am I talking about? Well, the Practical part of our Assessment Day requires us to interview a standardized patient, complete a Physical Exam, order appropriate diagnostic testing and interpret the results, formulate a presumptive diagnosis, recommend a plan (medication, lifestyle changes, education, etc) and then present the entire case verbally as if we were reporting it to our supervising physician. Of course, there is no pressure ... other than the proctor in the room watching you and making notes on a clipboard, the video camera rolling in the upper corner of the room, and the knowledge that your professors behind the 1-way glass are most likely chuckling with glee as you stutter and stammer and clumsily fumble about and otherwise make a fool out of yourself.
I am of course exaggerating as always -- the staff goes out of their way to try to relax everyone and make it a low-pressure situation, but especially on the 1st one, it is simply not possible to be totally relaxed, and the tension and jitters in the air was palpable.
To get to the real point -- I blew the diagnosis. What presented as a possible migraine headache was actually an underlying temporal arteritis. There were sufficient clues present to tip you in that direction, but I simply missed them in my near-panicked state. The acute treatment for temporal arteritis is a high dose of steroids. Failing to do so could end up permanently blinding the patient. And so even though there will be a remediation process for me, and life goes on, I will forever have the knowledge that had it been a real situation, I would have BLINDED MY PATIENT (a fact my brother and roommate rammed home for my edificiation).
So instead of celebrating my successes, I am left with an unsettling feeling that I have a *long* way to go. But, I have to look it at this way -- my training is only 1/2 done, and the rotations are there for us to hone and polish our skills as well as to continue learning. I will say that it was a good "kick in the butt" and I plan on being better prepared for the next one.
My next rotation begins tonight -- Emergency Medicine and I'm in a ER down by the border. The shifts are 12 hours and I'm kicking things off this week with the graveyard shift -- 8pm to 8am. More on that later...
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