Sunday, June 11, 2006

Destined to be a Flea

Internal Medicine docs, like I'm going to be, are called "fleas" because both are the last things to leave a dead body. That's obviously a derogatory term, but like "yankee" the term has been embraced by its targets. Fleas can be a pretty nerdy bunch, so I tend to fit right in.

I was reminded of this Friday. I saw a patient, whom I was convinced needed a colonoscopy, because her symptoms were strongly suggestive of cancer. My resident didn't want to order one. So our conversation went:

Well, if you don't want to get the C-scope, I don't know how sensitive the test it, but you could just culture her blood for Streptococcus bovis, since that's associated strongly with colon cancer.

Wow Nathan, you are destined to be a flea.

See, that's a pretty insubstantial footnote in the average medicine text, and an almost ludicrously wild shot in the dark, but I was trying to surmount obstacles with knowledge.

I love it.

My attending agreed with me though, and the patient got the C-scope. Good thing residents don't write my grade.


Zwerver said...

It's certainly more derogatory than "diagnosticians", which is an old-school term that used to be applied -- rather aptly -- to internists. But as long as you've embraced the label, it's all good.

TMU said...

(hmmm... this didn't seem to work the first time.)

so... what did the scope show?? Were you justified? Did your resident ever mention it again?

anyway, if you're gonna be a flea, be a good one.

Nathan said...

Well, no results back yet. The problem with being a medical student is that you are never in one place long enough to follow a given patient. Her scope is scheduled for later this week, by which time I'll be gone.

And I fully intend to be a good one. I think, in internal medicine, I've found the best place to use the vacuum cleaner mind G-d gave me. I remember all the bits everyone else forgets.

But as far as the patient is concerned, I'd be very surprised if she doesn't have cancer. You're a nurse, right? So this patient's unprompted history included a 40lb unintended weight loss over the past 6 months, night sweats at least twice a week over the past two months, a decrease in stool caliber to "pencil thin" and a family history of cancers. Surely that deserves a C-scope, right?

TMU said...

Si, si! or Hai! hai! (depending on what language you prefer)... not that a nurse who wants to retain her license would ever dare to diagnose.

one wonders why the resident didn't think this was necessary!

medstudentitis said...

Oh man, internal, better you than me! Oh, and yeah, good call on the scope... what idiot wouldn't do a scope with b-symptoms and evidence of a partial obstruction?

Nathan said...

I think family medicine docs are overly cautious. My resident actually wanted to give this lady laxatives and iron and see her back in a month.