Being a first-semester medical student feels a little like playing a doctor on TV. There are lines to memorize: we say “axillae” instead of “armpits” now, and “epistaxis” instead of “bloody nose.” There are props: the stethoscopes, engraved with our names, that we tote around but have yet to use to examine a patient. And of course, wardrobe: the short white coat that to me still feels a bit like a costume.
Some of the first “patients” we see are, in fact, professional actors, trained to mimic the symptoms of a seizure disorder or the aftermath of a suicide attempt. And we do some acting of our own, particularly when patients know more about their symptoms than we have yet to learn: “My IgE is off the charts,” one man told me as I shadowed his doctor during his visit. I frowned and nodded, showing no sign that the clinical significance of this fact was a mystery to me. (I looked it up later.)
So I was eager to move on to the real thing. I took a medical history recently for the first time–from a young Indian-American woman just a few years older than I am–and a real patient. But the fact that I was no longer playing a part didn’t hit me until later.
“What brings you here today?” I asked. A painful lump in her armpit, she said. Two weeks earlier, the doctor had examined it and determined that it was probably nothing to worry about, but had asked her to return for followup.
Running through a mnemonic in my head, I walked the woman through the major questions necessary to flesh out the chief complaint and history of present illness, the components our professors had tasked us with eliciting that week. (OPQRST, the memory trick for pain goes: Onset. Provocation/Palliation. Quality. Radiation. Severity/Symptoms. Time.) I didn’t interrupt the patient; I spent time with her; I even made her chuckle. I listened to what she said and wrote it down.
Afterwards, my supervising doctor took over, asking the woman to lie down on her back. Palpating both sides of the patient’s chest, she asked where it hurt. At first, as the doctor pressed, the patient looked confused. Then her face brightened. She started pressing on her own armpit, looking down and then back at the doctor. “There’s just some tenderness,” she said. The pain had gone, and there was no lump. What she thought was a cancer scare was no longer. The temporary pain, and the lump, had gone away on its own. Whether it had arisen from too much salt intake, too much caffeine or something else entirely, it wasn’t cancer. We three parted ways, shaking hands, all smiles.