Today I just had

Today I just had this weird physical exam test where you get observed performing specific exams on fake patients (real people, but acting as patients). It is a group thing, so each member gets to be the "doctor" for atleast one scenario, and the other group members watch, and then add in what the person missed at the end. An observer (a real doctor) is sitting in the corner with a clipboard, to which is affixed a long checklist of items, which must be completed (either by the student doctor or their team members) in the alotted time, which happens to be exactly 7 minutes. Oh, and we don't know about the scenarios ahead of time. Usually we have a pretty good idea (based on various med school spy networks), but you generally have to wing it somewhat.

Usually these experiences are pretty fun. Kind of stressful, but fun. Sure, they throw some crazy things in the mix, and yes, sometimes they do have obscure things on that checklist that noone has ever heard of, but usually it = good times.

But this time was a little rocky for student doctor Fiona M. Garlich. I had the luck of being in a small group, meaning that some of us were going to have to go more than once. That turned out to me. And not only did I have the pleasure of going twice, I was blessed to be randomly given the worst two exams a medical student could possibly imagine: The "Difficult" Patient and The Dying Patient.

Difficult came first. This was a patient with chronic pain and a long history of hostility to doctors who was pacing around the room when i entered and refused to sit down. She proceeded to give me vague, angry answers to all my questions, after which she asked how long I've been a doctor and why couldn't she see someone with more experience. I later found out that one of the things on the checklist was to ask her to take a seat once (which i did) and then ask her to sit a second time (oops - missed that one).

At this point I'm thinking, Cool. I got the talking one under my belt. They have to give me an actual physical exam next time cause now, after hours of studying, I know how to do a cranial nerve exam, a geriatric functional assessment exam, a infant exam, and a full mental status test. They wouldn't give me another counseling one, would they?

Oh yes, they would. Enter The Dying Patient. A more appropriate name might be The "Break the Bad News" Patient. He is a 42 year old man with a wife and kids. He had cancer which was treated successfully (he thought) and came back for further testing after some weird symptoms. My job was to go over the results of his test with him and tell him that the cancer had recurred, that it had metastasized to both his lungs, and that he would be dead within 6 months. Nice.

Even after talking about this sort of thing in class, and even knowing that this is fake - telling someone you don't know that they are about to die is suprisingly difficult (it probably didn't help that I was being observed by 5 other people while simultaneously being graded). It didn't go badly at all, but is was so painful and akward. Later the grader told me that I could have shown more sympathy. I missed points by not moving the chair to sit next to the patient instead of across the table.

And then, to top it all off, I kind of started crying at the end there, when we were getting feedback. I have this weird crying response to things that make me uncomfortable, and nothing makes me more uncomfortable than crying in front of other people, so there wasn't really anything to be done. It was very weird. It was kind of funny because what triggered my crying was the grader showing me how I could have helped the patient feel okay to express his emotions by handing him a tissue. It was very touching. Then, with puffy red eyes, I had to walk out in this skinny hallway packed with my fellow students hovering around nervously in their white coats. Yikes.

What a day. Everyone couldn't believe that I had both of those cases. They were very sympathetic.

One more week, and then I am done!! I can't believe it. I actually know stuff now. Just 3 more years to go.
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