Play ball!

No matter how many times I start an elective, I always goof the first patient. It's like not swinging for the first pitch. And then the first pitch beans you in the head. Except the not-swinging-beaning process repeats itself everytime you start a new game.

Starting clerkship was no different. Clerkship started in some small town in some rural area with some nervous little clerk in the emergency department. The first patient I saw was sweaty, short of breath and could only speak Italian. The first clerk he saw was also sweaty, short of breath and could only speak gibberish. The hundreds of lectures and hundreds of hours of clinical experience I've had since starting school might as well not have happened. It's as if I was starting all over again at the beginning of my education, and in many ways I suppose I was.

I didn't ask many pertinent questions, and did a limited but accurate physical assessment. I managed to put a couple of decent diagnoses on my differential and went to report back. As soon as I started to give my report to my attending physician, I realized I'd forgotten to write anything I'd learned in my history or physical on the chart.

Ahh crap.

We've been taught that people who suffer from mania may display a speech pattern known as a "word salad" (http://en.wikipedia.org/wiki/Word_salad_(mental_health). I think I could have managed to produce a pretty awesome word salad of a report but instead a sliced boiled word egg from the word salad caught in my throat and the only sound I could make was sort of like that sound you hear when you get static on your tv late at night.

khkhkkhkhkhkhhkhhkakaaaaaaaaaaaaaaaaaaaakhkhkhakaa.

It didn't go over well.

However, when the next few patients come along everything usually falls back into place. And today everything came rushing back as soon as I'd had time to think a little bit about what my job in the department was. I resolved to improve for the rest of the night, and improve I did.

For the remainder of the evening I was the future of medicine. Like baby Jesus, except without the miraculous healing powers. My medical knowledge base returned quicker than if someone had slapped me in the face with Harrison's. Everything clicked somehow after I got that first one out of the way. I think after I allowed myself some mistakes with patient number one, the pressure was off for the rest of the night. I managed to convince my preceptor that I wasn't an idiot, and everything was great. We had pizza. And breadsticks.

So next time I step up to the plate, make sure you head for the bleachers. Cause even though the first pitch is gonna get me right in the face, my big thick skull is gonna hit it so hard it'll clear the park.