Running Out the Clock

I’m running out of time. It was right there on the vital signs monitor clock: 30 minutes left to finish the patient’s history and do her physical. And here she was, a real talker, expounding on the pros and cons of Obamacare. I pressed ahead with my questions about her health, not rushing her, but taking advantage of her pauses to steer the conversation in the direction of the information I needed to present in less than an hour to my supervising doctor.

A classmate and I had been assigned to this patient–I’ll call her Mrs. G.–as part of our course on the physical exam. She lay in her bed on the inpatient cardiac ward, frail under gown and blanket, an IV dribbling into her arm. We worked systematically, with lots of ground to cover. At this stage of our medical education, year two, nothing we do is for the patient’s benefit. Not the barrage of questions, not the poking and prodding for findings we’re only just beginning to understand. It’s all for our training. We find our patients catch-as-catch can. Sometimes one of our physician teachers will ask a patient to let us perform an examination. Other times the nurses tell us which of their charges that day are the nicest, and we ask those patients to put up with us. Invariably, they do. Though sicker than sick, they generously act as guinea pigs so we can learn the skills to help our future patients.

Mrs. G. was hoarse but still chatty as she answered our questions about her heart problems. “Have you experienced any palpitations?” I asked. “Only twice. Right before I came to the hospital, and the first time I saw my husband,” she deadpanned. They’d been married, she said, 63 years. As my classmate and I prepared to move from taking the history to doing the physical exam, it struck me that Mrs. G. was doing me a favor—allowing me to learn by practicing my budding physical exam skills on her frail form. And she was even entertaining. But I couldn’t repay her with the open-ended listening she was clearly hoping for. It’s starting, I found myself thinking. This is why everyone says doctors are always in a rush.

She was still talking. “They say I may go down in days,” she said. “I’m just hoping to get to Christmas with my grandkids.”

It was a mental slap on the wrist. I’m running out of time? I thought. My cheeks warm, I contemplated how few hours she could have left on this earth. A few hundred, probably. If she was lucky. And yet, here she was, spending one of those hours helping me grow into a doctor.