My First Patient

Somehow I managed to never write about her...but this story is a must. This happened way back in May on my first day of Internal Medicine.

So....

Scene: 1st day. My resident tells me to go into room 19 in the ED and take a full H&P on Violet. He's smirking a bit to the ER nurse, who (nicely) pulls me aside and gives me a quick heads up on what to expect.

Nurse: (to the side) So she's um sorta naked in there and a bit out of it. Just to warn you.

Me: Ok.

Resident: (laughing)

Me: Ok, seriously, what is the deal?

Resident: Nothing. Just go.

Me : (FML)

So I suck it up and walk in. And I'm met with....

VAGINA. LEGS UP IN THE AIR. NAKED. SPREAD EAGLE.

(and add a few hemorrhoids...)

Add to that she can not even speak.

I mutter an uncomfortable "Oh I forgot something. I'll be right back" to the husband.

Me to my Resident: You know this is my first day, right?

Resident: She's crazy. I'm calling psych. Just go. Do your best.

Round 2: I take the H&P. I do the physical. I ignore the vagina.

After an hour of all that, I actually make my first diagnosis. Which happened to be correct. Hepatic Encephalopathy. The legs up in the air? Posturing. Clinical sign of encephalopathy. She wasn't "crazy" and got better after 2 days of lactulose.

That, folks, was pretty much my one and only day of feeling like a complete rock star. Kinda been downhill from there, lol. But, great none-the-less.