Stuttering

My preceptor used to really like me.

Let's back up. So I've met with my preceptor five times now. The first time we met over coffee with her other med student, and then she showed me around the hospital. She asked me what I wanted to be when I grew up, and not being a total kiss-ass like the other student on my team (whom responded that he too wanted to be a hospitalist, just like her), I truthfully answered that I wanted to go into pediatrics. Her face changed slightly, and she kinda ignored me for the rest of the visit. But after that initial visit, I met with her on my own and I think I was starting to win her over. She told me my oral presentations were fantastic, and I had really good bedside manner. In fact, I know I was doing better, because for our last two visits, she bought me coffee. Starbucks coffee.

And then, I had to go and ruin all of that.

So today at preceptor, I had to perform a complete history and physical on a patient. My patient turned out to by a very opinionated, but very sweet old woman (who used to be a nun!). I asked my questions and did my little exams (observe, percuss, palpate, auscultate), and went back upstairs to see my preceptor so I could give my oral presentation.

I was all over the place.

"Miss McEntire is 72 years old female with a past medical history of diabetes, presenting today with abdominal pain and lots of vomiting and nausea - five episodes max. Oh and transient ischemic attacks - four of them in May 2004, September 2006, and August 2008 - oh sorry, that was part of her pertinent past medical history. Anyways, um, this started two days ago when she, um, woke up to sharp pain radiating down to all three lower quadrants. She claims no alleviating factors, but says that lying on her left side is aggravating. Oh and position and movement. And a hot - no, warm! - water bottle. Because that's what she used to self-treat, but it ended up hurting..."

Yeah, that look on your face right now? That what the heck is she talking about face?

Mirrored on my preceptor's.

It was pretty terrible. I seriously don't know what happened. I even wrote things out in an orderly manner. I particularly like how I mentioned there were four TIAs, but only gave dates for three. Oh, and you know how I said that they were part of her pertinent past medical history? They weren't pertinent at all.

Anyways, you'd think it couldn't get any worse, but it did. At the end of my convoluted mess, my preceptor asked me what I thought it was.

"Um...."

And there was silence. For a good thirty seconds. Uncomfortable, squirm in my seat, awkward silence.

"Um...well...um..."

Here, my preceptor tried to help me out and point me in the right direction: "She had abdominal tenderness. And what did her CT show?"

"Inflammation." Right on cue.

"Right, so now what's on your differential diagnosis?"

"...um....um....malabsorption syndrome?"

"..."

I said malabsorption syndrome! Which, to my credit, does present with inflammation. But if I were just to ask a random person, what causes extreme pain on your right abdominal side that could cause you to wake up in the middle of night and needs to be taken care of right away? you'd probably get the answer my preceptor was looking for.

Because that would be appendicitis.

Or even, just something simple like 'what causes stomach pain and vomiting?' would yield a better answer than malabsorption syndrome.

Cause that would be food poisoning.

But okay, so I'm a little slow when it comes to medical diagnoses. I know I'm not going to be the next Dr. House. That's fine. The thing that broke my heart was the way my preceptor looked at me. Like she suddenly realized that I was not the mentee she was hoping for. I didn't have the smarts or natural mental acuity to be the next her. I was suddenly, just another medical student, and she was disappointed in me. She snapped out of it quickly, stepped back into her teaching role, and took me down to see the patient. And elicited all the information she needed and performed a better physical exam in less than ten minutes, whereas I was with the patient for a little over two hours. And then, I was dismissed to go home. But instead of the "good job today" that I've come to expect, I merely got a cursory "see you in two weeks."

So since then, I've been a little crushed and a lot disappointed at myself today. Because I should have done better. I know I definitely could have done better.

She didn't buy me coffee today.