Those who have suffered through internship, any internship, can attest to what I like to term the “Attending affect”. An embarrasing event which happens after taking a thorough history from a patient. Initially you may have believed that he/she may have extremely worrisome disease but based on the answers the patient provided you’ve managed to rule out most of the more dangerous pathology. The next morning you give a great presentation to the attending pointing out how you’ve asked all the appropriate questions. And then everyone as a team, including the Attending, comes to examine the patient.
The entire story suddenly changes. Every lethal complication you’ve managed to rule out on the basis of history the patient manages to rule back in and all of your hard work goes out the window.
“What? Sure I had crushing chest pain and a very difficult time breathing. Of course I did!”
“No, it only happened to me one time before, you know, before I had that emergent cardiac catheterization I forgot to tell you about”
...As you feel the blood rush to your cheeks and the neck suddenly loses all ability to continue holding up your head.
How the same story changes overnight I’ll never understand. I can sympathize with the poor intern, just another victim of an undefinable phenomenon. This adds yet another challenge to the first year of doctoring. A year filled with unexpected obstacles.
No lesson, though, is more embarrasing than that of the “pleasantly demented” elderly. And every intern, on one occasion or another, will fall pray at the hands of the pleasently demented.
This newly demented individual is so slick that they can obscure this fact quite well, especially if a deeper investigation of the fact is not taken. Usually, the morning presentation is smoothless. The patient is “Alert and Oriented times three”. The intern rejoices in his own glory.
Later, when we find that the patient believes it’s 1969 and that the Mets are actually a good team, all accounts of the story can be filed along with the recycled trash being picked up in the basement. All the hard work for not.
When you “assume” you make an….
Once again, the intern has fallen pray to the adorable forgetful, the pleasently demented. And such a fall from glory, especially when your peers are watching, is always fun to watch.