Why they don't let me teach certain conferences.

Carlos D. dropping that knowledge in Kokko Conference

Today after rounding on the wards, I grabbed some lunch and slipped into the residents' teaching conference. I go often, but especially on days when I don't have too much work to do or when one of my friends is slated to do the teaching.

On this day, it was my friend, Carlos D. 

Now. It's actually kind of funny to refer to him as "my friend Carlos D." Not because he isn't my friend because he absolutely is. As my friend, he is thoughtful, funny, and supportive. Celebrates any accomplishments I have and even rearranged out of the country travel just to be at my sister's homegoing last December. So, yeah. He is my friend. But see. . .  I think it feels weird because he's a friend that I look up to a great deal as a colleague. 

And today? I was 100% reminded of why.

So Carlos was teaching this particular conference that is usually reserved for our most seasoned senior faculty. And rightfully so because those folks do a justice to those cases that takes time to develop. Yeah, they do. See, the thing about this session is that the teaching faculty member is presented a case that they haven't heard before. Not even a heads up. 

Yup.

So today Carlos was presented this rather cryptic case filled of all of the things that could be attributed anything and everything like fever and weakness and dizziness and being a little bit confused. Uhhh, yeah. Super nonspecific pretty much. Then all of the tests were mostly negative-ish and even the fancy-shmancy MRI yielded a whole bunch of nothing. There were some super subtle things in the physical exam and really not much else. 

This dude (the "dude" being Carlos D.) listens to the case and jots down the pertinent things with a dry erase marker on the board in front of the seventy some-odd residents in the room. And he would ask questions and clarify little pieces of it and take tiny steps through the case. He dissected each little piece of information and pointed out those super subtle things that were partly gleaned from his extensive reading and unbelievable breadth of medical knowledge but also the kind of gleaning that just comes from years of experience. 

So I swear to you he picked that case apart until he had knocked a bunch of things off of his list of potential diagnoses. And eventually he had whittled it down to one thing. So he put the cap on the marker, looked over at the presenting resident and said, "This is what I think it is."

And you know what happened next. That's what it was.

And he just sort of sat there with a smile on his face like, "Hey, cool case!" when me, all I could do was fight the urge to jump up out of my chair on the back row and yell: 

"WHAAAT? WHAT!!!! WOOT! WOOOT!!!"

Which is clearly why I am not the person giving this conference. Ha ha ha. I wanted nothing more than for him to just throw the marker down on the ground hard, hold his hands up and just walk out of the room without saying a word. Because he ANNIHILATED that case, do you hear me? KILLED it. And see, you need to be at a certain level of bad assness to not want to do the Cabbage Patch Kid dance when these kind of things happen.

Oh, you don't remember the Cabbage Patch Kid dance? We must fix that.

Yeah. So me? I'm not there yet. I clearly have some growing up to do. 

Because had that been me today? Me who broke that case down until it could no longer be BROKE? Chile, please. First, I would have been all like:

"It was positive? I'm right?!?"

Then, I would have been so hyped that I would have started doing a little of this:

and if I really felt good, I would have done this:

 

Now if that didn't quite convey my feelings, I would have done this while the chief resident just stood there watching and waiting for me to stop like this:

Oh, and if there was any trace of hateration in the room, I would have been all like:

"Wait, did you just nail this case or did I?"

"Yeah, that's what I thought."

Ha ha ha.

 THEN after all of that, I would have thrown the dry erase marker down and just did this until everyone left the room. Ha ha ha ha.

That or just walked out while chucking a deuce over my shoulder with a pair of Raybans on.

Mmmm hmmm.

Which is precisely why they don't have me cracking a mystery case in front of all of our residents and medical students. Because in the chance that I would be as spot-on, ridiculously right as Carlos was today? It could've gotten real, real ugly. As you can see, I still have some senior faculty maturing to do before I get to that point. 

As one of my students said to me the other day via text: "OBvi."

Ha ha.

But seriously though--some of the best learning occurs when we let our learners see our wheels turn. Even when it doesn't turn out as pretty as Carlos' presentation today, it is still good for us to show that to our students and residents. In fact, the literature tells us that this is what they want. They want to see us thinking and to have a front seat in the clinical reasoning process. 

So yeah. 

Some day, I'll get there. But until then, don't be surprised if you walk by me on rounds at Grady and see me doing this after that test comes back as what I thought it was from the very start:

Carlos D.? Tell the truth. You just had to want to do this a little bit. . .  . .come on, buddy. You can tell me. . . .

Ha ha ha.

***

Happy Late Monday night.