Last night, over the period of three hours, we went through the last OSCE, a clinical skills examination involving a scenario with a simulated patient.
As usual, I began quite nervous with butterflies fluttering in my stomach. From station to station, I became more confident and more relaxed, as the differential and the questions flowed through more easily through my mind.
At my last station, I was met with a scenario I had never encountered before in practice. I struggled at the door, scratching my head as I read the scenario. The bell rang and, without any solid grasp of what I wanted to ask or what physical exams I needed to perform to find the cause, I went in.
My struggle was obvious. I had elicited a passable history that helped to point me in the right direction; however, my focused physical yielded no findings. I was stuck.
I paused for a moment, and excused myself as I gathered my thoughts. Ding. One minute remaining. Think Tom. Think! Hastily I added a few extra tests. Again, no findings. Ding. Your exam is now over.
I looked to the doctor marking me, whose eyes asked with disappointment: did you study this topic at all?
No. I guess I probably should.
It was an unusually busy shift in the emergency department. There was no time to rest, no time to sit, and no time to catch our collective breath. The patients kept coming and the wait list kept growing.
Between me and the only physician on the ward, we were heavily outpaced and outmatched to meet demands. The teachings were suspended as I helped deal with the easier cases as my attending tended to the sicker patients.
As the clock struck noon, we finally had another doctor on site to help us with the growing stack of charts. Tensions eased. We could finally go for a break.
In those few short hours, I had seen a few fractures, dislocations, diabetic crises, electrolyte disturbances, chest pains, and acute abdomens. I had an opportunity to insert foley catheters, reduce shoulders, intubate a trauma patient and assist with a central line.
It was a concentrated shift of experience.
“You earned your stripes today, kid,” said the exhausted doctor as our shift together came to an end. “Go home and get some rest.”
I typically try to stay away from coffee if I can. In any given week, I might have one or two cups - pick-me-ups for a busy or sleepless night. This is fairly consistent.
Today alone I had three cups of coffee.
Conclusion drawn? I need more sleep.
I stood there and did my best to explain what we felt was going on, our impression of the possible causes, and our investigations around them, some of which simply could not be done tonight.
The family was not satisfied. “We want answers. Now.” From there came the questions. “Why must it happen later? Why is this test being done? Why will you not take our complaints seriously?”
I reassured everyone that we were checking every avenue, that there was a method and reason behind the tests and explained as plainly and thoroughly as I could. More importantly, I tried to address their concerns up front and with honesty.
Nothing could appease my audience. I could feel the growing dissatisfaction in their tone, the tension that my presence brought to an obviously well meaning and concerned family.
However, standing there, the focus of every pair of eyes in the room, I began to feel the churning of my stomach, the pounding nudge in my chest, and the burning flush of my face. I had become an enemy in the room, an obstacle between the vocal family who wished to be heard and heard by none other but the doctor himself. It was time I excused myself.
I returned quickly to my attending and explained the situation: I had attempted my best to alleviate their anxiety and answer their questions but I had failed. I needed help.
When he arrived, even then the discussion presented challenges. It took a lot of work to come to an agreement and understanding.
The communication channel is open both ways. The solution to defusing a situation like this is always to make people feel that they have been acknowledged, that their concerns have been understood, that they are not an afterthought in this already complicated system of care. Even with that in mind, the discussion can be challenging. It really takes a lot of patience, perseverance, and thick skin to build up the rapport needed in difficult situations.
Perhaps with time and experience, I can find a way to finally manage this myself. For now: please do not shoot the messenger.
Were you ever involved in a confrontation? How did you deal with it?
Over the past year, I have noticed a young man attending the barbershop I frequent. A tall and well-dressed adolescent who bared some resemblance to my barber, he initially started off with the scut work: sweeping the floor, greeting the customers, and watching. Always watching intently as my barber trimmed my hair.
Slowly, over time, he had begun to learn the tools of the trade - the different scissors and the brushes; the straight razor and the strop - and began to practice on the dummy heads.
Today, I went to the barbershop to find him cutting what must be his first set of heads full of hair. All the while, he was receiving pointers and tips from my barber, his father.
His eyes were focused, his body was tense, as he trimmed the weight from the man’s temple. Snip. Snip. As the locks fell to the floor, he re-examined his work. Was it too little? Was it too much?
“Remember to angle your brush up. It’ll give you more room to work with,” his father would say, and he would oblige and try again, with more angling of his left wrist. In the end, the older man seemed satisfied with the young man’s work. A sizeable tip came the trainee’s way, to which he hurriedly returned to the man.
“The cut is free. I’m still practicing.”
“You’re always going to be practicing. Besides, you’ve earned it. Keep the change.” The customer gathered himself and took his cane as he thanked the barber in training yet again. The young man was pleased.
“Next?” Of all the people waiting in the barbershop, no one took a second glance.
“Does your son know what he’s doing? I mean it’s a rookie cut,” came one snappy customer. No one moved. They wanted the expert, the experienced barber, the man who knew every bump under every patch of hair on their heads. They wanted his father. The brilliance of the man’s eyes that a moment ago seemed so alive, dulled. He put down the gown and reached for the broom.
“Sure, I’ll go,” I said, taking up his offer. He gave me a smile and motioned me to the chair. “Have a seat.”
I understood his plight. We were all in the same boat together. As learners, we depend on the good will of the people we see for us to gain experience, to be better, to become professionals. The process must start somewhere. It was time I returned this favour to another student.
“Caesar trim. Sides short. Front long,” his father called out.
“Thanks for giving me the opportunity.”
“No problem. We all have to start somewhere.”