Image of the Day, January 20: Q&A

We have an amazing culture of teaching at Emory. The best part, though, is that not only do the faculty get really into it, we also pour an incredible amount of time and energy into building the most junior of our learners into teachers, too.

This photo was snapped during our resident conference yesterday. This particular session is a unique monthly lecture series where resident physicians are coached by faculty members to deliver  high level, evidence-based lectures--but here's the kicker: They can only be 8 minutes long. We started doing this last year and it was an immediate hit. I think part of it has to do with young people just enjoying the inspiration of being taught by their peers. But also there's something to be said about somebody only talking for 8 minutes and that's it.

Of course, I had to come up with a witty title for the conference. We call it "BST Mode" (pronounced BEAST MODE)--short for "Bite-sized Teaching." My diabolical plot--of which BST Mode is a part--is to get us to a point where nobody ever lectures to anyone for more than 20 minutes. Okay, thirty minutes tops.

*insert wicked laughter*

The four residents were answering questions from the audience when I took this snap. It got me thinking about how critical of a skill the question and answer period is after a lecture. I've found that it can really make or break someone's merit at the end of a great talk. This fab four did great with theirs. That said, the nerdy teacher in me sees this as a great opportunity for some future focused teaching-learning-growing exercises. I like to think of it as "The Art of I Don't Know--But Here's What I Do Know."

Ha.

I love my job. And this is one of the main reasons that, even if I had won the Powerball, I'd be right here at Grady. (That is, after being dropped off by my personal Uber driver.)

Yeah.

***
Happy Humpday.

Our Emory Medical Student Teaching Competition is TONIGHT!

WA-hooooooo!!!!!

I am so excited that I'm about to lose my mind. For reals.  Here is our our "elite eight" student presenters and their faculty "teaching coaches" for the event--makes up our "sweet sixteen" --well, technically sweet seventeen--one of our coaches had to leave town and, in true Emory form, another great teacher took the baton and ran it in for the final coaching sessions. How cool is that?

 Clockwise from the noon position:

• #teamabhi: Dr. Ryan F. and Abhi K.
• #teammike: Dr. Girish K. and Mike E.
• #teamyaanik: Dr. Danielle J. and Yaanik D.
• #teamchristian: Dr. Julie J-M. and Christian M.
• #tagteamariella: Dr. Wendy A., Dr. Lisa B. and Ariella D.
• #teamvinnie: Dr. Francois R. and Vinnie L.
• #teambyron: Dr. Bhavin A. and Byron C.
• #teamkelly: Dr. Kimberly M. and Kelly A.

This? Now this is a clinician educator/medicine nerd's dream.

*thump*

Just fainted from nerd-tacular excitement.

O.M.expletive.G.


More on this soon, okay? (As soon as I stop hyperventilating. . . . )

***
Happy Thursday and MSTC Day!
www.emorymstc.com
#emorymstc

Goodfellows.

Last Thursday

Rock steady, baby
That's what I feel now
 Let's call the song exactly what it is
Step'n'move your hips with a feeling from side to side
Sit yourself down in your car and take a ride
While you're moving, rock steady
Rock steady, baby

~ Aretha Franklin

_______________________________________________

Sigh. 

So much excitement this past week. As if match day weren't enough, last week also included one of my favorite events of the year -- The Fellows Teaching Competition!

What's that, you ask? Okay. Let me explain from the beginning. . . .

First, since a lot of non-medical people read this blog, let's just digress with a recap of who all of our usual suspects are in teaching hospitals, shall we? Yes, we shall. Okay. So you already know that I have finished my training and I supervise medical students and residents as an ATTENDING physician, right? I also know that most of you recognize that those who are still working toward earning medical degrees are our MEDICAL STUDENTS. We number them by year--M1 through M4--first year through fourth year, respectively. You with me? I figured you were and that you're yawning right about now. But stay with me because this is the part where I think people who aren't in medicine get confused.

And a few people in medicine, too. Uhh. . .yeah.

Okay, so check it. Our academic calendar runs from July through June. Most medical students graduate in May and then start their post-graduate training in late June. Sometime during your third and fourth year of medical school, you declare your chosen career path and that's what you then interview for as a senior student. Match day is the day where you find out, through some crazy computerized game of card shuffling, where you will be spending the next several years shaping yourself into a sho' nuff and bona fide member of whatever specialty you want to do.

Whew.

So that FIRST year when you first start in late June fresh out of med school commencement, you are an INTERN. That lasts for the academic year until the following July when the next crop of bright-eyed bushy-tailed neophytes arrives. After that, you become a RESIDENT. This pretty much lasts until you finish your training. And just in case you weren't confused, let me quickly rectify that by telling you that we collectively refer to all of those people, interns and residents, as "residents." I think it's because the official verbiage from the graduate medical education governing body uses the word "resident" to describe specialty trainees. And guess what? We also refer to them all as "house staff," too. That dates back to the times when residents lived in the hospital which, hallelujah, I never personally experienced. (At least not in an official capacity.)

Yeah, but there's more so stay with me. In most specialties, a program selects a few standout residents to serve an additional year as a CHIEF RESIDENT. This is usually an honor given to a select few who stay on beyond the final year of training to serve in a year of administration and teaching. The caveat is that in some surgical fields and training programs, the Chief Resident is any person in their final year. (But hell, getting to your final year of a surgical residency is often an honor given to a select few all the same.)

Alright. We still cool? Good. Okay. So let's just say you have chosen to train in the best specialty ever--Internal Medicine. You've done your first year (internship) and also your last two years as an upper level resident. At that point, you are eligible to take your specialty boards, hang your shingle and start to practice. But you also have another option, which many people take. You can go and get some ADDITIONAL training in a subspecialty so that you can narrow your expertise to one area.

Such as:

• Cardiology
• Infectious Diseases
• Hematology and Oncology
• Endocrinology
• Pulmonary and Critical Care
• Rheumatology
• Geriatrics
• Hospital Medicine
• Nephrology
• Gastroenterology

Or something else if you happened to train in a specialty that isn't the best specialty in the world.

Mmm hmmm.

So IN ADDITION to our teaching hospitals being filled to the brim with house staff and medical students, we also have a whole cohort of wonderful trainees who have finished their residencies but are now getting an additional three + years training as specialists. We call these folks FELLOWS.

Whew. I know that was an awful lot to put you through just to set up what I'm about to tell you. But you know? I think all of your medical folks need to bookmark this post for your loved ones so that you won't have to keep fielding these kinds of questions:

"So, are you still in medical school?"

"No, ma'am. I'm doing a fellowship in Rheumatology."

"In who?"

"Rheumatology. We see people with things like lupus and bad arthritis."

"So are you a full-fledged doctor that can write a prescription?"

"Yes, ma'am."

"So when do you graduate?"

"Next year."

"Damn, ain't you over thirty?"

"Beg Pardon?"

"Medical school sure do seem like it last a long time these days."


 And I know that somebody somewhere is nodding their head HARD to this because they just had this very discussion with someone last week.

Mmm hmmm.

So what was my point of all this? Oh. The fellows. Yes! The fellows. Okay. So our fellows are such a huge part of patient care in the hospital. But not only that--they do a TON of the clinical teaching. That said, fellows don't often get much . . . how can I say it. . . shine. . . for all they do. Those guys work very, very hard and provide so much to us yet there aren't many opportunities to shine a light on them. Last year, with the help of a great committee, we set out to change that.

Enter the "Demonstration of Teaching Excellence" aka "The Fellows Teaching Competition."

So, a few years ago, I was asked to serve as a judge for a similar event held by the Department of Pediatrics at Emory. They'd been holding their fellows teaching competition for quite a few years and when I participated as a judge that year, I fell in love with the idea. Later that academic year, I pitched a similar event to our Department of Medicine leadership and they gave the green light. Because the Internal Medicine Department has a lot more people and trainees, we set out to build on their wonderful ideas to make it a HUGE signature event.

And the best part? Our unsung heroes--our FELLOWS--would be at the center of the attention. Yes!

Last year was our first year doing it and man! It was a smashing success. People had no idea what it would be but our fellows made it into something special. So special that it became a "don't miss" event just one year later. So yeah, this was our second year and all I can say is . . .wow. It was unbelievably awesome. Recognize that I'm a medicine nerd, so these kinds of things excite me in ways that aren't really normal.

Yeah. So the official name of ours is "The J.Willis Hurst Demonstration of Teaching Excellence: A Teaching Competition Between Fellows." Nine of our subspecialty divisions get to nominate one of their fellows to represent them in the competition. We make it very clear that it is a distinct honor to even be asked to participate and, truthfully, everyone sees it this way. Kind of like being asked to be chief resident. Kind of.

Anywho. The fellows are allowed only eight minutes to present a topic of their choice. The focus is on delivery, intonation, enthusiasm, use of learning materials and all of the things that set good teachers apart from exceptional ones. Because the focus is teaching methods, there is no question and answer period--just applause. Now how sweet is that?

We select a panel of esteemed judges from across our Department of Medicine and also one from another Department. (This year it was my buddy Jaffar K. from Neurology.) That group also includes one medical student and one of our Chief Residents--because these learners are important judges, too.

After a MAJOR PR blast to the whole of Emory (sorry, y'all--I just get excited), last Thursday our nine fellows showed up and BROUGHT it to a full house. Really. A full house! Here's my favorite of our email blasts featuring Cardiology fellow and former Chief Resident, Akram I., who was a super good sport.

I was so excited, y'all. When we pitched this to our leadership, the exact vision was an event that would celebrate teaching in a packed room buzzing with excitement. That's precisely what it was. There were division chiefs, program directors, fellows, house staff and students of all levels. And all of them were buzzing with enthusiasm about excellent teaching--and all focused on our fellows.

Yay!

It's so cool to see something come together. Our fellows were amazing--both last year and this year. Oh, and I almost forgot--the part that I'm most proud of is that the judges name one winner who gets a substantial cash prize. I love that our Department of Medicine put our money where our mouth was. Last year our winner was Eddie S. from Infectious Diseases and this year it was Randy H. from Pulmonary and Critical Care. But the real winners were all of us who came to the event because we learned SO much.

And to all you medicine nerds out there reading this, let me just go ahead and read your minds: YES, it was EXACTLY as awesome as it sounds and YES, you would have TOTALLY enjoyed it had you been there. And YES, you should TOTALLY try to do something like this at your institution and YES, we are TOTALLY going to write it up for publication so that more institutions will.

Eddie S., 2012 winner

Randy H., 2013 winner

What can I say? The flyer worked so nice, we used it twice. Ahem. (Don't judge, people. I was on wards.)

Anyways. Another neat thing was to see the innovative tools the fellows used for their presentations. Last year's winner, Eddie S., was the lone person to use a presenting tool called Prezi, and it was fun to see how many more people used that interface this year. Also lot of them used videos and sound and all sorts of cool things. And they did all of that in just EIGHT MINUTES.

EIGHT. MINUTES.

And would you believe that NOT ONE of them went over time? Not a one. Man. Imagine if all lectures could be limited to eight minutes? Hmmmm.

So at the end, our committee members snuck off to a secret location, tallied up the scores and named the winner on the spot. People were cheering and the energy was awesome. And all of the fellows who were in it and even there felt that spotlight and some love, too. Yup.

So shout out to our fellows. And also a HUGE shout out to our awesome planning committee that included what is quite possibly the most easygoing bunch of busy clinician-educators in our entire institution. Yay for drama-free and non-"extra" people to work with! And double-yay for people coming through and doing what they say they will which is what a great planning committee is all about.

You know? The whole thing was social, too, which was also a bonus. It was fun to see students talking to full professors and residents hob-nobbing with division chiefs. So much to talk about and discuss (especially since we wouldn't allow any questions. . .ha!) But seriously. . .all of it was full of the very best spirit and the climate for learning was like the clearest, most perfect spring day you could ever imagine.

Yeah.

The thing is this: "Not enough time" is never an excuse to ignore learners and not teach. Whether you're in a teaching hospital like me or just talking to a patient in the clinic. Once you make up your mind to do it, it can happen a lot faster than we realize. I've even started giving my ward teams fifteen minute chalk talks instead of 45 minute or 1 hour sessions. I learned from organizing that event that lots of rich teaching can happen in a more condensed period with some preparation.

Yup.

So that's the other super cool thing that happened last week. And yes, all of this went down while I had a ward team, kid responsibilities and butterflies in my stomach about the match. But more than that, it was also another one of those things that makes me love my job so much. I'm surrounded by lots of really cool, smart people who love sharing ideas and realizing visions. And that's a really cool place to be in.

A rock steady one, even.

Man. I know I've said it a million times before . . . but me? I'm just glad to be here.

***
Happy Monday.

Now playing on my mental iPod. . . ."Rock Steady" by Aretha Franklin -- the theme song for our intro video for the 2nd Annual Fellows Teaching Competition. These are our awesome fellows who demonstrated their teaching excellence. Enjoy!

Fellows Teaching 2013 - Rock Steady from Emory Medicine on Vimeo.

Full of it.

as texted to me today: two ticks chilling on rounds

Medicine Nerd Textapalooza, today at 2:23 PM.

Her:  "Check this out!


Me: "DUDE! Full as a . . . .tick?"


Her:  "A deer tick!"


Me: "Holy cow! Is that real?"


Her: "Yep!"


Me: "Whoa. So cool."


Her: "Oh yeah."


*moment of silence*


Me:  "Syphilis! Syphilis! Syphilis!"


Her:  *throws down phone and runs off screaming in glee with hands waving all over*
_____________________________________________________


Okay, okay! I admit --  Syphilis has nothing whatsoever to do with ticks and tickborne illnesses.  But. This multimedia text image I received today? It just shows you the kinds of things you might get randomly texted when your good friends just happen to be Infectious Disease medicine nerds. (In addition to heartfelt campfire discussions about syphilis.)

Ah hem. I'm just saying.

***
Happy Friday.

P.S. Remind me to tell you later about how much they also love tuberculosis. *cough* Yeah. Remind me.

This little light of mine.

"This little light of mine, I'm gonna let it shine. . ."

I was working in the clinic the other day with one of my favorite medicine nerds, Lorenzo D., which is something I always love to do. Mostly because, without fail, I learn something new when we work together. It embarrasses him when I talk about how frighteningly smart he is and how densely packed his brain must be with facts and figures. But seriously? It's true.  

I could tell all sorts of stories about Lorenzo D. and his ridiculous medical brain, but I won't because he'd be mortified. Nope. I won't tell you about the day that he was running the residents' favorite case conference where they try to stump the professor and how he went off into a crazy ten minute tirade on the inner workings of the clotting cascade and fibrin cross linking. I mean, I certainly wouldn't dare share anything about how, literally, all of the residents' mouths dropped open at the sheer complexity of the bombs he was dropping off of the top of his noggin like it was NOTHING.  Nor will I admit to sending him a text message somewhere during that whole soliloquy that said, "Dude. You're a BEAST."

Naaah. That would totally embarrass him, so I won't do any of that.

I love it when I see someone putting their best foot forward when it comes to medicine. I think it conveys caring, don't you? When someone looks at your actions and they can tell your heart is in something that's a good thing. The Grady elders would call that "letting your light shine." I like to think that a lot of my fellow Grady doctors do that every day.

Anyways.

On this day, I was talking to a resident who was seeing a patient that he thought might have sinusitis. He flashed a light from the otoscope onto the sinuses and looked through the floor of the patient's mouth for light to shine through. This process, called transillumination, helps with making a diagnosis of sinusitis--if you don't see the light passing through what should be air-filled spaces, chances are it's clogged with mucous or some kind of goom-bah consistent with a sinus infection.

"It didn't transilluminate when I shined a light."

That's what the resident said to me and I simply said, "Okay." I was impressed that the resident had even taken that step to check because transilluminating is kind of sophisticated and folks don't always do it. I told the resident that it was good that he'd checked and probed to see if there was other compelling evidence to support a sinus infection.

"She has facial pain and has been coughing up green phlegm for nearly three weeks. And decongestants haven't helped," my resident answered.

A few moments later, I overhear Lorenzo D. talking to a different resident about a nearly identical patient presentation. This actually isn't unusual--most physicians will tell you that conditions often come to the office in groups. Today seemed to be "sinus day."

Anyways. I hear Lorenzo D. spitting all kinds of sinusoidal pearls to this resident followed by him explaining that "unless you look with a transilluminator--you know the special attachment made for this--you might think a patient has sinusitis who doesn't."  That resident nodded in acknowledgment.

I decided to poke my regular fun at my friend--especially because I was hoping to rope his brainy goodness into the patient I was discussing at the same time.  "And I'd be willing to bet that you have a transilluminator somewhere in your bag." Because seriously? This is the kind of thing that a medicine nerd of this proportion would totally have.

At this point all of the residents looked over at him to see what he'd do. From the quick flush that came over his face, I knew I was right. I laughed out loud and so did he. He reached right into that bag and confirmed exactly what I'd suggested.

"I love working with such a medicine nerd!" I clapped my hands and reached for that little needle-nosed light-shiner from his hand. "You are like my most favorite medicine nerd in all of Grady-dom!"

And I meant that because I was deeply impressed by the fact that he did indeed have this special device that I had not seen since my third year of medical school. Why? Because he knew he could achieve a more accurate examination if he had it. Then he explained to all of us that the focused light emitted by this attachment (when replaced on the otoscope base) makes all of the difference. Next came a few percentages and teaching points to boot.

Loved it.

So the resident and I went into that patient's room with that transilluminator and you'd better believe we used it.  And Lorenzo was right, it did make for a better examination and a more clear treatment plan.  We even shined the light on my resident's sinuses to show our patient how things should look. She seemed to like that a lot. (So did I.)

As always, on this day my fellow medicine nerd Lorenzo D. didn't disappoint. This time, it was in the form of some obscure piece of medical equipment. And yes. Having a transilluminator attachment thingie on your person makes you a bona fide, full-fledged, top-tiered medicine nerd beyond any shadow of a doubt.

But it also means that you care. A whole, whole lot.  Which, if you ask me, is really, really great.

"Let it shine, let it shine, let it shine. . . ."

***
Happy Sunday. Oh, and set your clocks back.

The Power.

 "You always had the power!"  

~ Glenda the Good Witch

My office is next to that of one of the smartest people I know.  My friend and fellow Grady doctor, Lorenzo D., is the kind of scary-smart that makes your eyes narrow and your head hurt at the same time. But the thing about it is. . .he's not obnoxious-smart or annoying-smart at all. He's just a medicine nerd that gets all wild-eyed and foaming at the mouth when a patient comes in with a real puzzler.  And, trust me.  This dude can almost always come up with something very close to striking distance of the diagnosis, and in most instances, he hit the bulls eye.

I like knowing that his office is next to mine because I always learn something when I lean into his doorjamb.

Today I did just that.  I stopped in the doorway and propped an elbow on the frame.  He looked right up and gave a big, boyish smile. Then, he said what he always says.

"What's up, Kim Manning?"

The way he says that always makes me smile--especially the way he runs my name together such that it sounds like "KIMMANNING." 

"Nada mucho," I answered, which is what I always say whether there is something going on or not.

I asked a few residency program related questions and we both commiserated a bit about how behind the eight ball we both were with regards to resident orientation.  Next we got on to the favorite discussion of all medicine nerds -- patient care.

"I saw the most AMAZING case in the clinic yesterday!" Lorenzo exclaimed. "Like, seriously. . .  it was really amazing, KIMMANNING. I almost fainted."

Okay.  Let me just digress for two seconds to mention something that just popped into my head.  No matter who you are, you never, ever want to be the subject of a "great case."  "Great Cases" usually signal badness. . .or such rare and scary things that, by definition, the outcome just can't be good.

Now, interestingly, Lorenzo chose the word "amazing" instead of "great" which immediately made me wonder if it meant that it was not necessarily horrible but more of a stumper.  Looking at Lorenzo's giddy, medicine-nerdy smile I knew I was about to find out.

Fellow medicine-nerd Lorenzo D. today in his office

Lorenzo went on to describe this unusual complaint in a very young immigrant gentleman.

"It was weird. . . . he was seen in a few emergency rooms, and each time they discharged him home. No one could get to the diagnosis. But the why of the story just didn't make sense to me."

He explained that he kept asking the resident physician questions but was having trouble making sense of it all.  "I decided to go in and just repeat everything," Lorenzo said shaking his head.

Next, he told me that the resident seeing this patient was excellent.  I'm sure this (excellent) resident was quite frustrated with his barrage of queries and downright annoyed with the twenty minutes he was about to spend duplicating the entire encounter.

"Has this happened before?" Dr. D asked the patient.  The patient nodded and shared that once or twice this problem happened in his country.  Hmmmm.  After a few more questions he then discovered that this man had lost some sixty pounds--without trying. Not normal.

Next came a careful physical exam.  Then more careful historical questions.  And BOOM!  The light bulb came on in the medicine-nerd light house. He was waving his hands all wild-like as he walked me through the moment when he figured out what was wrong with this patient.

"Man! It was AWESOME!"

He said "awesome" in the Teenage Mutant Ninja Turtles kind of way, or better yet, in that way that is almost always preceded by "totally."

"Dang. I don't think I would have known that, Lorenzo."  And I meant that because this scary-smart friend of mine pulled this diagnosis from way down deep in the cob web part of the senior resident board review section of the brain.

"But you would have been bothered enough to wonder what the heck a twenty-something year old dude was doing with such horrible weakness and unusual labs, for sure.  And then you would have dug deeper and asked questions until you figured it out."

I stepped into his office and sat on the end of the chair across from him and thought about what he was saying.  The more I thought, the more I realized that he was right.  Even if that obscure answer wasn't in my fund of knowledge, I probably would have found it after doing a literature search for things causing this constellation of symptoms, findings and lab values.

Dorothy: "But why didn't you just tell me?"  

Glenda the Good Witch: "You had to learn it for yourself."

When I was a resident, I was rounding with one of my medicine-nerd heroes, Dr. Rick Blinkhorn.  I'd just presented this patient who had fever of unknown origin and a bunch of nonspecific other complaints.  I knew that Dr. B was pretty hard core at the bedside, so I had tried my hardest to come up with a working diagnosis for this patient, but no cigar. I felt like a failure when I finally finished up the presentation with "Assessment:  Fever of Unknown Origin."  Because this otherwise healthy young woman did have a fever, and as for the origin of it, I had no idea.

Now check it.  Dr. Blinkhorn strolled into that room all suave and debonair-like. . .white coat starched so hard it could cut you bad and salt and pepper hair in a signature military buzz. . . .and commenced to show me how to do a sho' nuff and bona fide history and physical. This dude asked questions I never even thought of asking and next did a head-to-toe examination on her that was so fluid and thorough that it made my head spin.

"Let me ask you," Dr. Blinkhorn said to the patient with a furrowed brow, "do you have any pain in your legs?" 

And I remember that this lady prepared her mouth to reply but before she did he added, "Specifically, do you have pain in your thighs?"

And she widened her eyes and said, "You know WHAT? As a matter of fact I do.  It's weird. I told that man in emergency that I had this weird ache on the front of my thighs, but not the back!"

Blinkhorn looked over at me, in front of my whole team of interns and medical students, and said, "Dr. Draper, if I say 'anterior thigh pain and fever,' what should be the next word out of your mouth?"

I squeezed my eyes shut and google-searched my brain for something, anything.  "Influenza? Wait, no that's calf pain. Umm. . .rhabdomyolysis?" I shook my head knowing that it wasn't that, either. "But Dr. Blinkhorn, her muscle markers were all normal so it can't be rhabdo, right?"

He stared me in my eye without flinching.  "Bilateral anterior thigh pain and fever," he repeated.  I held his gaze and shook my head. I had nothin'.  Dr. Blinkhorn knew I was a medicine-nerd so he wouldn't give me the answer.  Instead he turned back to the patient and began inspecting her legs some more.  He removed her socks and studied her feet.  Closing one eye he glanced over his shoulder and asked, "What happened here with your toenail?"

The woman explained that she'd had a pedicure technician that was a bit overzealous while pulling hangnails.  "It was bleeding and everything," she said with a shudder.  "But it's fine now."

After a few more words with the patient, Dr. Blinkhorn put his eyes back on me.  "Anterior thigh pain and fever in a patient who had a distortion in the skin's integrity."

I sighed hard and shook my head.  "I just don't know."

"Find out," he replied matter-of-factly. "Better yet, go check her labs again and you will know the answer."

I knew he had just heard of this patient for the first time less than ten minute before.  What did he mean by, 'Go check the labs?'  I kept staring at him for a beat and then escaped to the nearest computer to recheck the latest labs.  After a few key punches the screen popped up.  Nothing new.

I held my hands up and mouthed, What the hell is he getting at?  Before I could say another word, the area clerk handed me a slip of paper with a "critical lab value."

"Preliminary Result:  Blood Culture two out of two bottles growing gram positive cocci in clusters."

I couldn't take it. I needed to know what he was talking about.  Searching the pre-Google internet, I went to PubMed to enter the search term:  "Anterior Thigh Pain", "Fever", "Bacteremia."

Up popped the answer.  "Anterior thigh pain as an indicator of bacteremia."  Published right there in the Archives of Internal Medicine.

"Damn!"

I immediately covered my mouth, forgetting that I was in earshot of my attending.  Then I said it again as I skimmed the abstract to that article.  The second time, I didn't even bother covering my mouth. This "damn" wasn't a "damn, I should've known that!" kind of "damn" either.  It was a "damn, this dude knew what was wrong with this patient just from the bedside."  Or better yet "damn, when I grow up, I'm TOTALLY going to roll up on a patient's bedside and nail a diagnosis just like this." 

When I went back to Dr. Blinkhorn and told him what I'd learned, he smiled and put his hands on both of my shoulders.  "You're a very good doctor, Dr. Draper, because you're curious. Medicine isn't about knowing everything. It's about being so curious that you hunt until you find the answer."

I nodded and smiled, respecting the Mr. Miyagi and the Jedi Master all up in this moment. Then he added these words of wisdom:

"Stop. Look. Listen. If you do that, you will almost always get to the bottom of what is going on with your patients."

I never forgot those words. Ever.


Turns out that Lorenzo's "AMAZING" case was something completely treatable and reversible.  It was also something that could have been life threatening if someone hadn't stepped in and used the power that you get long before medical school:  To stop. To look. To listen.

***

"Curiosity may have killed the cat, but it saved the patient."

~ A Medicine Nerd (me)