This trimester officially marks the beginning of my clinical internship. For the next year, until graduation, my colleagues and I will be working with and treating patients under the license and supervision of various clinicians. It’s a time to hone our skills of exam, diagnosis, and management. It’s an exercise in understanding, in empathy. More importantly, it’s a privilege to build a relationship with patients from all backgrounds, to be allowed into their personal life and history. It’s a sacred experience — and a humbling one.
Suddenly, all the classes taken over the past few years seem overwhelmingly crucial. Worry sets in. What if I’ve forgotten something crucial (and believe me, it seems like you forget a lot); what if I miss something? A whole slew of questions flood in. There’s good news, though! All the stuff you thought you’ve long forgotten is still in there, laying dormant until circumstance calls upon it.
The first patient I was with, on my first day at the Salvation Army clinic, showed up severely out of breath. The patient immediately stated a history of COPD and complained of an intense, severe left sided headache. My colleague and I immediately took his blood pressure and recorded it to be 200/90. There was a moment of disbelief, followed by rationalizations, reasons why this man couldn’t, shouldn’t, have blood pressure that high. We tried a larger cuff. We let him relax for a few minutes. Finally, there was no other rationalization. We had to face the music. These combined factors constitute a massive stroke risk, so we had our clinician call an ambulance.
Sure, it’s the cliché medical story, but the point of this story is to demonstrate that, even though I didn’t have those factors involved in stroke risk consciously available while going into that patient appointment, when I saw the red flags, the answer came to me, seemingly out of thin air. The things we learn stick with us, and the more work we put into learning the science and the pathology, the longer they remain. Don’t fall into the fallacious belief that simply because you don’t plan on treating a condition, you don’t need to know about it. You will be a doctor, regardless of whether or not you are in acute care, patients’ lives will be in your hands.