Monday, February 26, 2007


The pleasures of heaven are with me, and the pains of hell are with me,
The first I graft and increase upon myself....the latter I translate into a new tongue.

One of the frustrations with this rotation has been the fellow on our service. He has had little positive to say about my performance through the entirety of my time here, which would be fine if his criticisms were on point. But he will spend five minutes lecturing me on improving the organization of my presentation, just moments after interrupting me for the fifth time to ask the attending, or another student, about the last patient we saw. Now my speaking skills are not bad, but Demosthenes himself wouldn't be able to remain organized in this environment. At least the sea didn't change the subject of its interruption.

So today was awesome. We had a new attending, so we were going through a more complete presentation of each patient than normal. And one of our patients has elevated liver enzymes unexplained by any of the workup done so far. My (perhaps excessively thorough, for the ICU) classmate was presenting and threw into his schpiel a recent travel history to southern Asia, and the patient's doxycycline prophylaxis for malaria. The question was thrown out to the group. As the fellow scratched his head, I piped up "doxycycline can cause the elevated enzymes, or he could be demonstrating hepatic malaria infection." Both fellow and attending looked at me with new eyes, I felt. A "that's exactly right, excellent thought" comment later, and I didn't even mind knowing the next patient was mine and the interruptions would begin again.

In honesty, he is a solid clinician, certainly more experienced than I, and in a way, his odd manners are forcing my own development as a physician. I am confronted with the problem of how best to present a patient clearly, concisely, and (most important) quickly. His off kilter questions require me to really know every lab value and its significance. While some of the residents are nicer, they can actually hinder that development without meaning to. A new tongue indeed.

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