The Mind of the Med Student: Might as well jump.

"I ain't the worst that you seen

Can't you see what I mean?"

~ Van Halen

Heart pumping. Hard. I bet you they can hear it. Do I look nervous? Don't look nervous. Relax. This is not that big of a deal. Just open your mouth and talk. Simple.

"You ready to present your patient?"

"I think so."

Shoot. I should have said something more definitive like, Absolutely! Shoulders back. Head up. Look confident. Even if you don't feel confident. You can do this. You totally can.

"Excuse me--sorry to interrupt your rounds--but is Mr. Albertson your team's patient?"

My senior speaks up first. "Yes, Ms. Johnson. Is everything alright?"

Dang. How does she know every name of every nurse? I think I will try to learn their names, too. Johnson. Johnson. Johnson. Got it. I think.

"He's a bit agitated. I haven't had him in a couple of days and hadn't seen him this way."

"Hmm. Let's go and check it out. Thanks, Ms. Johnson."

Johnson. Johnson. Johnson.

"Hey--push pause on that presentation for just two seconds, okay? Let's go see what's up with Mr. Albertson."

"Sure. I mean, absolutely."  Hope that didn't sound as dumb as it felt like it sounded.

In we walk. A whole big team of white coats and industrious expressions. The long coats with the surest footing. Me, I try to keep up. Mimic it all in my short coat.

"Hey there, Mr. Albertson! What's going on?"

Wow. My senior resident is awesome. So confident. I want to be more confident. Shoulders back. Head up. Like her. Yeah, like her.

"Nothing is up! I just need to go water my lawn!"

Lawn? Rut roh. Mr. Albertson is more than just agitated. He's confused. Or as my senior and everyone around here says, "altered." Short for "altered mental status."

My senior looks over his medications and through the electronic chart. The intern begins to ask him more questions and they examine him. I watch from the foot of the bed as Mr. Albertson writhes about with wrist restraints on and also against the ones on his ankles.

"My lawn! It's gon' dry out!"

"Where are you sir? Do you know where you are?"

"What? I'm at my house! 2733 Hopkins Place Decatur, Georgia."

Now I may be new but I know that this isn't his house. I stayed quiet as my senior and intern continued to discuss his mentation.

"I think he could be sundowning. He is eighty-four you know. No fevers or anything." Sundowning. Of course. The intern said this with that confidence that I wish I had so bad.

"That's possible. But that should be a diagnosis of exclusion." My resident scrolled through the medications on the screen as Ms. Johnson came back into the room to flush is IV. "Hmm. What about this Ambien? This could be the problem."

"He hasn't been getting that," Ms. Johnson replied nonchalantly.

So much for that. I stood there feeling. . .I don't know what I was feeling. Unhelpful? Nervous about still having to present my patient? Something. I felt something. I decided to keep quiet. Look interested and engaged. That wasn't hard to do since I think I actually am feeling both of those things.

The room is quiet. People are moving and checking and scrolling and doing. Me, I'm just standing there. Zoning a little bit but not really. I look at Mr. Albertson and feel bad about his lawn. I wish we were at his house, actually. So that everyone would stop calling him "altered."

I look at his arms and feel bad about those restraints, too.  My brow furrows every time he beats his wrists against those soft cuffs and this time, that nurse saw me.

"He yanked his Foley catheter clear out on Sunday. Balloon inflated and all." She said. I guess she needed to explain to me why we had him tied down. I had already assumed it was for his safety, but appreciated the fact that she actually spoke directly to me.

I jumped at the opportunity and asked her a question. "Ms. Johnson?" Johnson. Johnson. Johnson. "What was his temperature?"

She looked down at the sheet in her hand. "Excuse me, baby? Oh, it was. . .let's see. . . .35.4. That's celsius."

I love how everyone stops to interpret things for the new med student. I nodded and felt something happening. There were mechanical sounds in my head and I think that--just maybe--it was the sound of my wheels turning. Say something? Jump in with my thoughts?

"Could. . . " I thought about taking it back right after spoke. Everyone swung their heads in my direction. Alright. Now they're looking at me. Might as well jump.  "Could. . .um. . .like. . .maybe he could have like a urinary tract infection. . from, I mean, because he . . . well, he has a Foley catheter. So maybe a UTI? Or like, urosepsis since his temperature is low?"

There. I said it. Could be a dumb thing to say but it was at least a thought. And honestly? This was my first unscripted thought or statement so far. Deep breath. Shoulders back. Try to look confident.

"That's a really good thought." I looked at my resident and waited for the obligatory "but." It never came.

"The restraints could also be making things a little worse?"  That's what my fellow student said. And I remembered someone telling us that, actually.  I smiled at him and felt proud of us. Wheels turning and everything.

"You know what? You all have great points!" the intern exclaimed. "Our students are awesome."

That part sounded kind of patronizing but hell, I'll take any compliment I can get. Our resident was still focused on Mr. Albertson and his labs and his perturbations in mentation.

"Gram negative rods. Wow."  She opened up a screen on the computer that had just reported a new value from a blood culture. "Urosepsis. You're right. He's infected."

I could feel my heart pounding. Harder and louder than it had before. Guitars playing like crazy in my head. Want to drop to my knees like Eddie Van Halen.

"Let's get him some Ceftriaxone right away. I'm entering the order now, Ms. Johnson."

"Okay, baby."

The only sound was that of my resident typing that order into the electronic record. That and my heart pounding.

"Let's get him out of bed and into a chair, too. We can take off the hand and foot restraints and just use a soft Posey vest to keep him safe. And a one to one sitter."

"You got it," Ms. Johnson responded to my resident once again.

Wow. This is what it feels like to contribute. To help.

"Orders in, Ms. J. Let us know if you need anything else or just page us with any changes."

"Thanks."

"Thank you for letting us know, Ms. Johnson. Alright guys. Let's get back to hearing about this next patient." My resident waved her arm and we followed her sure footing once again.

For whatever reason, I was the last duckling to file out of the room. Johnson. Johnson. Johnson. "Um, thank you for your help with him, Ms. Johnson."

She smiled at me wide and genuine. "Thank YOU for yours."

My heart. Now? It might explode. My feet are lifted like a gust of air has been pushed under them. Team waiting for me in a semicircle. Looking. Watching. Waiting. For me.

I step into the group and my resident is standing directly across from me. Without saying a word she holds up her fist directly aiming it at me. She nods slowly and smiles in approval. All eyes on me. Me. Heart about to leap from my chest. Guitars wailing, howling, squealing at such a high pitch that I'm afraid a window will shatter. This was my celebratory fist bump.

*Bump*

"Hypothermia can be a sign of sepsis. Particularly in the elderly." My senior said this and then added in a few more teaching points that all hinged upon my wheels that had turned right there in that room. I listened and learned and heard things that I didn't know before. Feeling myself learning. Yes. Yes!

"Alright. You ready to present your patient now?"

All eyes on me. Shoulders back. Head up. Heart still pounding. Come on. You can do this. Don't be nervous. Go ahead. Jump.

"Ready? Absolutely."

***

Happy Wednesday. Go ahead--jump!

Now playing on my mental iPod. . . . .