case presentation rant

you can never know how bad it can get until it gets that bad.

and it always hits you hard. in the wrong places if you're really unlucky.

i presented a case today and it was awful, oh so awful. by far the worst of the 3-odd i've done. here's how it went:

Students crowded around three sides of a cramped bed, staring down at poor-young-little-patient who has had the bad luck of suffering, since birth, from a fairly interesting disease. which basically condemned him to a life of torture at the hospital.

the kind that involves brazen staring, strangers moving their hands on you like they own you and not to mention trying to cut off the blood supply to your arm completely and permanently by using, over and over, an instrument called the sphygmomanometer.

trust me, the patients prefer the needles and knives kind of torture.

i maintain, however, that the students themselves are victimised (read: terrorised) into this sort of behavior, so its not really their fault.

so anyway:
students crowding around. doc (D) walks in and silence ensues. nothing can be heard apart from the steady drip drip from the patient's iv. D stands at the head of the bed, frowning at us. he has scary, bushy eyebrows.

D: Who's presenting?
MD: (waving hand from somewhere at the back of the crowd)
D: (looking extremely displeased) you know you're supposed to be by the patient's bedside if you're presenting!

so i pushed and shoved my way through. ended up standing right under his nose. i'm not exaggerating:

i could count his eyebrow hair now (and nose hair, but thats irrelevant). while in the middle of contemplating how to tactfully suggest an eyebrow plucking session every once in a while to this kind gentleman (i would have even given him the number of my favourite place, see i'm SUCH a nice person), i heard him thunder from above me:

D: begin!
MD: (jumps) oh, uhhm. The patient is a 19 year old male student from Kerela...
D: (interrupting) who told you all this?
MD: urm, the patient did, sir

(like, duh! i wasnt dreaming up fairy stories, you know)

D: does he look sane to you?
MD: (justifiably taking a moment to analyse whether or not that was a serious question)
D: do you think he's alright?
MD: (thinking: well he's in a hospital. so he IS what they call 'sick') he seems to be fine, right now...
D: you think he's fine? then why's he in the hospital?
MD: um. Thats why I took a history. so we could figure out why he came to hospital.
D: (smiling smugly) continue, continue

WTF?

MD: ok. 19 year old male, student, from kerela...
D: (interrupting again) no. say it properly. you're telling me his history in points, like its his biodata or something. a good history should flow.

("flow" ??)

MD: uh huh. Our patient, on this fine morning, is a young man of 19 years. he hails from the neighbouring state of Kerela, where he spends most of his time studying for a BCom degree.

(I had half a mind to go on and list what his likes, dislikes and hobbies are; i think that was the only thing that could possibly make it worse than it got soon after)

MD: Patient presents with the chief complaints of fever with associated abdominal pain. His fever began a week ago...
D: thats enough. give me 10 differentials for fever with abdominal pain.
MD: um. hepatitis. ureteric colic. basal pneumonia.

(by now, im running out of ideas, and i'm nudging frantically the person standing by me) (but, oh no! person standing next to me is patients' mother, and she's looking extremely indignant)

MD: pancreatitis. appendicitis... peritonitis?

my silent cries for help fell on deaf ears. my batchmates had been completely overwhelmed and their collective presence of mind amounted to a little more than absence.

but it was good in a way. every three words i said, D would take it as a cue to speak upon my inadequacies for ten minutes or so.

we got through the history fairly quickly, because i figured out that skipping entire symptoms made no difference to D's ranting. so i read three words off every third line of my notes, and we were done only half way through our lunch break.

yeah isnt that great? usually we're let off twenty mins before afternoon class.

dirty looks were exchanged before we dispersed though. most were directed at me, but you'll be pleased to know i deflected them expertly in the general direction of D.