Schrödinger's Student

Third year of medical school. A time when a student can know nothing and everything at the same time. Meet Schrödinger's student.

Morning report. Second day in the hospital, my first day attending morning report. As I come in, I take a moment to figure out where to sit. A resident walks past me and mumbles "students sit in the back". I sit in the back. I am soon joined by my peers. A fellow student with vastly more experience than I (he has been at the hospital for a week) gives me the rundown. The seating is arranged based on medical expertise. The attendings sit at the head of the room. Senior residents sit closest to them, followed by residents and then interns. Then two poorly watered ficus plants. Then medical students. We share the back of the room with some dusty JAMA issues from past decades. I pick up a couple of volumes and place them in the chair in front of me. I know my place.

Morning rounds begin. Time to shine.

"A hypertensive, diabetic, pregnant lady with glaucoma, a history of seizures and severe depression comes to your office accompanied by her husband, after he read an article on the wonders of electroconvulsive therapy on depression. Which one of her medical conditions is the main reason why we should avoid treating her with ECT?" the resident asks me.
I have never met this person before, yet he is demanding an immediate answer. I take a moment to think about the question. It's 7AM and my 200cc of caffeine has yet to kick in.
"Hmmm... I don't know... maybe it's -"
"You are correct, you don't know!" the resident pounces on my lack of confidence. "If you had been paying more attention during last week's grand rounds you would know that there are no contraindications to ECT."
"Oh, ok. I don't think we have been introduced by the way. Today is my second day here at the hospital, so I didn't attend last week's -"
"Let's move on."
Resident walks away. The intern and two other medical students follow suit.

I know nothing.

Morning rounds continue. The attending has now joined us and is discussing a young patient who is suffering from vision loss. "What is the leading cause of blindness amongst children in developing countries?" She looks to her left. She demands an answer.
"Glaucoma."
"..." her eyes move to the right.
"Retinoblastoma?"
"No."
"Cataracts?"
She looks at the resident now. I have yet to see her blink.
"Retinopathy of prematurity?"
"Nice try."
She is looking at me now. I am last in line. I am the last hope. I think I know the answer. No; I know the answer.
"Measles."
"Good. So, as I was saying before, we should make sure ophthalmology comes by today to..."
Attending walks away. The resident, intern and two other medical students follow suit.

I know everything.

Morning rounds are almost over. We enter a room of a patient I know little about. Maybe I should consider switching seats with the ficus plant during morning report so I can better hear what is being discussed. The patient is sitting up on his bed, eating his breakfast. He mumbles what I assume is a "hey". The attending introduces herself and asks the patient how he is doing.
"I'm ok" he replies.
"Well, we looked at the results from your MRI from last night and it showed that you had a stroke. That is the reason why your left arm has been weak for the last 48 hours."
"Mmhmm." Takes another bite of the toast.
"Do you have any questions, sir?"
"No." Sips some coffee.
"Ok, have a good day."
"Bye."
I am confused. And this time it is not due to a deficiency in my medical knowledge.The patient didn't have any questions; but he should have. His doctor just dropped a medical bombshell on him. Yet he had nothing to say. I think about how I would have handled the conversation as a physician. I would have tried to invite a more helpful dialogue. Any dialogue.

Rounds eventually finish. I head back to the stroke patient's room. He is lying down in bed watching TV. Maury Povich is on. Although statistically not significant, my research has shown that Maury Povich's show is on TV at least 75% of the time I walk into a hospital room (p = 0.14). I ask the patient how he is doing. "Fine." He doesn't even make eye contact. Maury just announced someone is the father. The crowd goes wild. The patient smiles. I am confused. Not the first time today. I stand there for 30 seconds. Commercial break. Patient finally looks at me and asks "So, what's up?"
"I just came back to see how you were doing." I reply.
"I'm still ok."
"Do you have any questions about earlier?"
"No, not really."
"Is there anything we can do to make you more comfortable?"
"No, I'm fine."
"So... do you live locally?"
"..."
"I asked if you live in the area."
"Yes, I know. Anything else?"
"No, not unless you have any questions for me."
"I still don't."
"Ok, well do let us know if you do."
"I will."
I walk out of the room. At least I gave it a shot. I guess some patients rather not know what is going on with them. Or maybe they are not ready to hear the truth. Or maybe they are just jerks. I don't know. But there is something I now know. I know that I have to keep trying to get through to patients. Even if Maury Povich is on.

Next day. Morning report. I now sit next to the ficus plant.