Interview Anxiety

Mitch having called in sick, Dr. Berg is the only psychiatrist in the C&L office today. Dr. Berg is really too busy to deal with the students, but reserves some time for us in the morning. He recommends that Sam follow up on Herman, and instructs me to talk to a patient in the Surgical Intensive Care Unit (SICU).

Problem - I have no idea where the SICU is.
Mikey: Dr. Berg, where's the SICU?
Dr. Berg starts then stops. Then starts to stop. Then starts again.
Dr. Berg: Uh, never mind. Meet me back here at 10 o'clock.
Dr. Berg exits, stage right. Exits? More like sprints awaaaay.

Sam and I wander over to the hospital to check on Herman. Aw, Herman's sleeping. Should we wake him? Herman had reported trouble sleeping yesterday. And now he's sleeping like a baby. We let Herman sleep.

So now what? Two hours before our meeting with Dr. Berg. Sam suggests looking for the SICU ourselves. Wow - imagine that. Two Noobs taking the initiative. We ask around, a nurse kindly points us out to the SICU. The signs in front of the SICU are bright red 'AUTHORIZED PERSONNEL ONLY' notices, making us whither away from the entrance. Boldly, Sam walks up to the ID scanner and waves his ID in front of it and the SICU doors swing open.

Sweeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeet.

Even more surprisingly, Sam and I are walking freely around the SICU. No one gives us a second look. Hello, people. You've got two med students with the word 'NOOB' tattooed on their foreheads, and you're not stopping them?!?! No, of course not. Because we're Authorized Personnel, Baby!!!

We look around for my patient, Mr. Franks. Mr. Franks is a jolly soul who had undergone a coronary artery bypass graft (CABG) almost a week ago. Dr. Berg hadn't told me much, so I'm going to walk in there and figure things out. I assess his mental status (affect, orientation, memory, etc.), check on his family support, and discuss his plans for the future. Mr. Franks is 'okay.' OKAY?!?! What does that even mean? I conclude the interview. Sam cuts in to ask a few questions. Apparently, I forgot to ask about possible substance abuse. Crap.

Our meeting with Dr. Berg goes fairly well. We admit to hesitating to wake Herman up for an assessment:

Noobs: He was sleeping like a baby. We didn't want to wake him.
Dr. Berg: I'll make a note of that...Look. You have to realize how valuable your time is. Even though I know you don't think so right now.

We go in to check on Herman, who's awake now. His delirium has improved a little, although he's still slightly disoriented. It's easier to detect a little sadness now, and he mentions that he hasn't seen his son in almost a week.

We then visit Mr. Franks. Mr. Franks is on the potty, but Dr. Berg conducts the interview anyway. I think Dr. Berg could interview a patient during a hurricane with a flurry of bullets flying around him. Dr. Berg asks me if I want to update the chart and write the psychiatry consult note. I decline. I'm such a wimp.

I run into my friend John (who is in the middle of his surgery clerkship) in the SICU. We give each other 'the look.' That 'look' that two people share when they've been through something together. We got through graduate school, and now we're back in the thick of medical school. We're doing this, and we're wearing the respective "uniforms" (me in my tie, John in his scrubs). This feels awesome.

*******

Self-assessment: My interview skills are rusty. I find getting social history quite natural, but obtaining medical history from the patient takes a bit more concentration, and I've never been comfortable getting alcohol or illicit drug usage information from the patient.

And I need to be more aggressive. I missed an opportunity today in not writing the note. I'm going to set a goal with the service. By the end of the week, I know how to update the patient chart independently.