Bleary-eyed Rounds

“Is he out of bed today?”

The nurse practitioner – NP for short – shook her head with a something like resigned disappointment.

“He needs to get out of bed,” the attending murmured into his computer as he started it up. The portable PCs had been plugged in the night before and were ready for moving around the patient floor. Two years ago, before electronic medical notes had fully been instituted, blue binders filled with patient charts were pushed in a cart. I’d been a clinical research assistant for a while now, and had been on my fair share of rounds in the main hospital. Rounding wasn’t necessarily in the job description, but I was happy to take the shadowing opportunity.

We were just setting up for rounds. It was early on a weekend, and we were all bleary eyed and coffee infused. I was nursing a Venti Blonde Roast, and scanning my handoff – the list of patients on our floor that morning – for anyone I’d worked with previously. For my research, I worked in the clinical trials department, and we usually enrolled a small cohort of patients on our investigational studies.

“Do you want to go over his case while I set up?” the attending asked, smiling apologetically at his slow computer.

“Absolutely!” The NP read off the patient’s history as well as his overnight symptoms. “The family is asking about the next steps,” she finished, looking up.

I followed along on the handoff, deciphering the mass of acronyms with a flicker of pride. I recalled the first time I’d stared quizzically at “SOB,” in a patient summary, and grinned to myself. It meant shortness of breath. The next acronym, GOC, meant Goals of Care. I read that one now as we reviewed the patient’s history. These days, I could read “…on adm, vss & pt a&o x3,” as “…on admission, vital signs stable and patient was alert and oriented to person, place and time.”

The lights were off when we got to the room and the attending paused before going in.

“Mr. A, we’re going to turn on the lights, okay,” he said before flicking the switch upward. The fluorescent tubes crackled to life and cast a white glow over the room. I always feel a sense of solemnity whenever I walk into a patient room, and the grave air of the two occupants heightened that.

The patient had pulled the white sheets over his head, perhaps even before we’d come in. His brother, a robust looking man nodded a greeting to our chorus of good mornings. His eyes were as bleary as mine.

“How is he feeling this morning?”

“A little better, no more fever, so better, yes,” the man replied with a nod.

“That’s good, but we’d like to have him getting out of bed a bit.”

“Yes, yes, we’ll try today, again,” the brother, agreed, somewhat half-heartedly.

“Mr. A?” The attending addressed the covered figure. “Is he awake?”

Then the sheets came down, revealing wisps of white hair, and a gaunt face, marked with exhaustion. They were brothers? Illness could really make itself seen. The brother’s eyes met mine and I tried to convey some sense of support. I’m not sure how well I managed that.

Somehow, even though I’d learned the acronyms, little things still seemed to elude me. I watched now, as the attending held the brother’s hand. Would I learn that in medical school? Would I know how to show my future patients that I really did care what happened to them, to their loved ones?

I examined our attending closely, noting the calm tone in his words and his actions. There was confidence there, too. Did I have that? Would I learn that? I remembered something our Service Chief had said to me while I was studying for the MCAT and feeling overwhelmed by nervousness. “Competence breeds confidence.” I had some ways to go, but perhaps it wasn’t hopeless.
Perhaps I only felt awkward now because I was only too aware that I knew absolutely nothing. And that should the brother or patient turn to me with a question, I would be tongue-tied beyond belief. There is a certain degree of fear, as a pre-med, in going into a patient room. You want to blend in, because blending in is safe. But in blending in, you feel responsibility to communicate some kind of knowledge. What did I know? Well, I did know some things. I’d proved that to myself earlier while decoding the acronyms that seemed like hieroglyphics only weeks prior. In medicine, even in the future when I wear a long white coat, one thing is for sure: I will always be learning. I’m looking forward to it.