30 July 2007

Playing neurologist

I shadowed Dr. L in clinic recently and it turned out to be particularly eventful. The medicine itself is always interesting, but this time it was the patient's behavior that made it memorable. We saw a girl who was recovering from stroke for a routine follow-up examination. Throughout the exam she was staring straight at me and refusing to acknowledge a single question or command posed by Dr. L. After trying one last time to get her to follow his finger with her eyes, he sat down and looked at her. She finally looked him in the face, pointed an arm straight out at me and said "I want her to do it." Dan looked at me, nodded, and I walked over and stood in front of the girl. I have seen at least fifty basic neurologic exams performed and could describe it in lurid detail, but standing there performing it was absolutely nerve wracking. Dr. L was standing immediately behind me interpreting everything I was doing... I was in no way evaluating the patient; I was simply the body she interacted with.

The next patient was another female, clearly somewhat on edge. Dr. L introduced me and a visiting physician (also shadowing) and began a conversation with her. Three sentences in she announced "I know you don't think I'm going to discuss my business with all these people in the room." I promptly offered to leave to make her more comfortable, but she countered, "you can stay, but the other one has to go." The visiting physician left the exam room (I would later learn she was uncomfortable with men, as the visiting physician was male, it was simply a matter of gender). She began telling a (rather sad) story about recent events and while she was talking she curled up into a ball on the exam table. When Dr. L turned to get a pen from the desk, she hopped off the table, ran across the room to me, and gave me a bear hug. After a few minutes she released me and sat in my lap. The rest of the visit was conducted with her on my lap, one arm around my shoulders.

Most of Dr. L's patients have met me once, many of them at least twice now. Quite a few remember me when they come in and ask me how school is going, which is really quite remarkable to me. After all, I am silent most of the time, just watching and smiling. Apparently though, they are beginning to feel comfortable with me, which is a great feeling. I hope this carries over to my future career, that my patients feel they can trust me and be open the way these two girls were. The way all Dr. L's patients are with him.

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