It's a long way to the top

Today I had to do a cardiovascular examination on a Standardized Patient (a.k.a. a bored actor). It's a pretty straightforward examination but, unsurprisingly, I managed to stuff up a couple of bits of it quite badly.

The reason I wasn't surprised by this is that I only did one practise examination over the weekend, on my Smaller Half, and even that was only a pretend one because the weather was cold which meant that my hands were like hand-shaped blocks of ice so I just stood there and rattled off the list of things I would do. I had very good intentions of reviewing my notes the night before but ended up spending the evening in the company of some disreputable friends, so my homework went right out the window.

This morning I decided I needed an extra pick-me-up because I stayed up late reading my current book ("Perdido Street Station" by China Mieville - it's excellent!) so I vastly increased my caffeine dose. Perhaps this is why, despite not feeling nervous beforehand, as soon as I started the examination some gland deep within in me squirted out litres and litres of hoppy juice into my blood and I basically went nuts for about 5 minutes.

I was talking really fast, I was making strange jokes and laughing inappropriately at them, and to top it all off I skipped the entire first section of the examination: the hands. There's a bunch of signs you look for in the hands and since they hang right out on the end of the body they are an obvious place to start. But I lunged straight past the hands and latched onto the patient's arm and started on pulse and blood pressure.

I was just fitting the blood pressure cuff when I noticed that the patient was trying to catch my eye and was wobbling his hands around like Al Jolson. He was trying to remind me to look at his hands! Hooray for the patient - he always pulls me through! I went back and did the hands, then returned to the blood pressure cuff.

Unfortunately, I wasn't hearing anything at all through my stethoscope, so I had no idea what his blood pressure was. Now, at this point, although I just buggered up the process entirely, I am the only person in the room who knows this. Furthermore, I have already watched someone else take this patient's blood pressure, so it occurs to me that I could just repeat what they said, maybe fudge it up or down by 4 for effect, and move right along.

However, in the spirit of World Youth Day, I decided to confess. I explained that I hadn't gotten a good reading, readjusted the cuff, and started again. And once more, I couldn't hear a thing and got no reading. A cold chill broke out across my back. This is starting to get embarrassing. This patient has been examined by hundreds of medical students every year. My tutor is watching me and assessing me. My classmates are also watching me and pushing me a little further down that internal bell curve of competence that we all deny that we maintain on each other. Once more I am tempted to announce a made-up measurement. Once more I resist, and make a fool of myself by admitting that I couldn't get a good measurement.

Back to square one. Remove blood pressure cuff. Re-apply. Check stethoscope - am I wearing it back to front? (You never know with me!) I offer up a prayer to Saint George, the patron saint of ER. And this time I could just barely make out the sounds I needed to hear - phew!

The rest of the examination went smoothly enough. I thanked the patient for reminding me to examine his hands and for being so tolerant of my blood pressure disaster. He said, "You know, if I had a doctor who did what you just did, I would think he had no idea what he was doing. But I think it's great that you persevered and did it right". What a great guy! I think HE should be the doctor. More specifically, a psychiatrist.

He also complimented me on my percussion technique. Maybe he was just trying to make me feel better after I made such a twit of myself, but even so, I was happy. Maybe I can get a job as a drummer.